Glioblastoma. Status post resection in December 2015 and radiation treatment. On chemotherapy (TMZ and TTF). The right frontal surgical cavity is unchanged in size. However, the fluid within the surgical cavity is more T2-FLAIR hyperintense, which may reflect increased protein or debris content. The right frontal surgical cavity shows persistent contrast enhancement along the margin with evidence of hemosiderin staining. A relatively nodular area of contrast enhancement at the anterior aspect of the surgical cavity has slightly increased in size: on sagittal imaging, this component measures 15 mm x 11 mm compared to 14 mm x 9 mm previously. No clear elevated rCBV is seen in association with this nodule.The associated surrounding right frontal white-matter T2-hyperintensity is slightly increased as well as the mass-effect resulting in smaller overlying sulci. Otherwise, there is diffuse slight increase in the size of the ventricles and the other sulci, reflecting parenchymal volume loss. There is no new or separate contrast-enhancing brain lesion. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved.There are findings of prior right frontal craniotomy with mild, contrast-enhancing dural thickening and minimal fluid. The orbits are grossly unremarkable.
1.The nodular contrast enhancement along the anterior resection margin has slightly increased since the prior examination. There is no significant change in the appearance of enhancing tissue along the remainder of the surgical cavity. Given the mild nature of the change and the short time interval since the most recent examination, it is difficult to determine the significance of the findings, which may still represent pseudoprogression versus true progression. 2.Increased T2 signal surrounding the surgical cavity is nonspecific, and may reflect evolving posttreatment change. Similarly, increased FLAIR signal of the fluid in the surgical cavity is nonspecific.