Male, 63 years old, with GBM, no longer on PDL1 antibody trial, now receiving Avastin plus CCNU. No significant change is seen in the size or morphology of the resection cavity which incorporates the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. Likewise, the degree of surrounding T2 signal abnormality has not substantially changed.Thin nonspecific enhancement seen along the medial margin of the right frontal lobe resection cavity appears similar to prior exams. Contiguous with this is a rim of ependymal enhancement along the right frontal horn which has become slightly thinner. Nodular enhancement along the left frontal horn ependyma has also diminished, as have several additional small patches of ependymal enhancement along the body and atrium of the right lateral ventricle. Many of these areas of decreasing ependymal enhancement show a corresponding interval increase in restricted diffusion.No new enhancing lesions are seen. No new parenchymal signal abnormality is detected. A mild degree of periventricular FLAIR hyperintensity along the left lateral ventricle is not significantly changed and may be treatment related. The size and morphology of the ventricular system are unchanged including ex vacuo dilatation of the right lateral ventricle.
1.Stable appearance of the resection cavity involving the right anterior temporal lobe, insula and inferior frontal lobe. No concerning new enhancement is seen along the margins of the cavity.2.Since the prior examination, scattered areas of ependymal enhancement along both lateral ventricles show decreased intensity of enhancement and progressive diffusion restriction. Findings may reflect a true response to therapy or pseudoresponse related to antiangiogenic therapy.