Clinical question: Patient with history of grade 3/4 tumor. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Examination redemonstrate large irregular hemorrhagic, necrotic and enhancing right hemispheric tumor extensively involving the left mid to posterior temporal and with superior extension into the right parietal lobe and medially into the right thalamus and right basal ganglia. The very large and irregular shape of the tumor makes precise comparison difficult, however within this limitation there is interval increased size of tumor is more apparent in the right basal ganglia and thalamus. Also compared to prior exam the enhancement of the tumor appears to be more solid in appearance. Mild ex vacuo dilatation of right lateral ventricle remains similar to prior exam and there is no evidence of midline shift.There is no detectable new foci of parenchymal signal abnormality or enhancement since prior study. The CSF spaces remain patent. The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.
1.Interval progression of patient's known right hemispheric GBM as detailed above.2.Stable size of ventricular system and with maintained midline.3.No detectable new foci of signal abnormality or abnormal enhancement beyond the above detailed tumor.