Female, 58 years old, with secondary GBM on Avastin. Assess for growth, compare to past two MRIs. Sequelae of extensive prior left-sided craniotomy is seen with a large left frontal resection cavity.A masslike T2 hyperintense lesion remains evident involving portions of the left frontal lobe, the insula and basal ganglia, and the anterior left temporal lobe. When compared to the immediate prior examination, this large lesion has not significantly changed in size. When compared to the examination of 4/30/2015, however, there has been a slight increase in size. For reference, the lesion measures 63 x 43 mm in the coronal plane (image 14 series 801), whereas previously it measured 60 x 40 mm.Most of the above-mentioned lesion is nonenhancing. However, at the level of the left inferior frontal resection cavity, projecting into the cavity, there is a persistent enhancing nodule which measures 18 x 15 mm. This lesion shows no significant or convincing change in size from the prior examinations.The above lesion contains several small foci of susceptibility perhaps related to chronic blood product. Some of these may be new relative to the prior examination. Elsewhere, no significant intracranial hemorrhage is suspected.Patchy white matter T2 hyperintensity within the right cerebral hemisphere has not significantly changed, possibly representing a combination of chronic microvascular ischemic disease and treatment related white matter injury. The size and configuration of the ventricles is approximately stable relative to the prior examination, but there is slightly more effacement of the left frontal horn relative to older exams due to lesion growth as above.
A large tumor-like process is redemonstrated involving portions of the left frontal lobe, left insula/basal ganglia, and left anterior temporal lobe. When compared to the immediate prior examination, this lesion has not significantly changed in size. When compared to older exams, however, there has been a mild generalized increase in bulkiness.Most of the above-mentioned lesion is nonenhancing. However, at the level of the inferior left frontal lobe, projecting into the resection cavity, there remains a nodule of enhancing tissue which shows no significant interval change in size over several prior exams.