Diagnosis: Chemotherapy follow-up examination. Malignant neoplasm of brain, unspecified siteClinical question: Glioblastoma compare to last MRI and provide bidimensional measurementsSigns and Symptoms: post 2 cycles of PDL1 antibody The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy.Since the prior exam the contrast enhancing portion of the patient's neoplasm centered in the left parietal lobe has changed. The enhancing portion of this neoplasm primarily involves the left parietal lobe but extends towards the posterior aspect of the left temporal lobe and inferiorly extends into the fusiform gyrus. This neoplasm appears to have enlarged along its more anterior aspect in the white matter adjacent to the trigone of the left lateral ventricle . Overall dimensions on the prior exam were 42 x 41 mm axial dimensions on the prior and 44 x 44 mm axial dimensions on the current. There is heterogeneous T2 signal within the tumor bed and multiple serpiginous flow-voids on the susceptibility weighted imaging within the tumor bed. This appearance was also present on the prior exam from 6/18/2015. There is T2 signal hyperintensity surrounding the enhancing component of the mass and heterogeneous component of the mass which has a vasogenic pattern. The extent of this surrounding T2 signal hyperintensity appears similar to the prior exam. There is associated midline shift with the 14 mm shift of the septum pellucidum towards the right. This is stable and compared to the prior exam. There is associated uncal herniation and associated subfalcine herniation. The temporal horn of the right lateral ventricle remains dilated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the previous exam from June there is been some interval progression of the enhancing portion of the patient's known left parietal neoplasm. This is known to represent a glioblastoma. There is associated midline shift as well as uncal and subfalcine herniation which is stable when compared to the prior exam from 6/18/15.