Clinical question: glioblastoma compare to last MRI and measure with bidimensional measurements mass in left operculum. Signs and Symptoms: post 2 cycles of therapy. Pre and post enhanced brain MRI:Examination demonstrates interval progression of disease since prior study.A left frontal peritoneum enhancing/necrotic GBM demonstrate interval increased size and measuring at 37 x 44 mm in transaxial dimensions compared to prior study measurements of 27 x 33 mm. There is also interval increase in surrounding vasogenic edema and regional mass effect.Previously seen post operative changes of left parietal region is again identified. There is interval better visualization of the surgical cavity and with extensive residual post operative blood products. There is also interval increased size of finding at this site since prior exam with increased surrounding edema. There is change in the pattern of enhancement at this site which now is more conspicuous in the surgical cavity wall and appears thick, irregular and nodular. Constellation of changes at this site is highly suspected of residual or recurrence of tumor. Closer follow-up is recommended.
1.Interval increased size and edema with region mass effect of a left frontal operculum tumor as detailed/measured above.2.Postoperative changes in the left posterior parietal demonstrate interval change concerning for recurrence and or residual tumor in the surgical bed as detailed above.3.Constellation of above changes results in regional mass effect in the left hemisphere without mass effect on the ventricular system or deviation of midline.