Glioblastoma multiforme. Status post resection in November 2014 and redo resection in December 2014 followed by concomitant chemoradiation therapy. Now on maintenance chemotherapy with Temozolomide. The surgical cavity in the left parietal lobe has not changed in size. Contrast enhancement along the medial surgical margin has not significantly changed except in the superficial part of the surgical tract where a new contrast enhancing focus measuring 12 mm x 5 mm in the axial plane (image #18 of series #1101) has developed and is associated with slightly increased surrounding FLAIR signal. The small focus of enhancement is also associated with mild diffusion restriction and relatively low T2 signal. The contrast enhancement along the medial surgical margin otherwise extends toward the trigone as it did before. The FLAIR signal associated with the treatment is largely unchanged except for slight increase superficially and relation to the progressive nodular enhancement.Additionally, the contrast enhancing nodule overlying the left temporal lobe has remarkably progressed and now measures 11 mm in the axial plane compared to 4 mm previously. It is based on the dura though does not involve the skull.The contrast enhancing dura overlying the right frontal and parietal lobes underneath and anterior to the craniotomy has not changed.The perfusion scan showed slightly increased CBV and MTT on the left parietal lobe surgical resection cavity enhancing lesion suggest possibility of recurrence of malignant mass. The left temporal area extra axial enhancing lesion shows subtle increased CBF and CBV, this MR perfusion characteristics cannot differentiate the diagnosis of meningioma from possible metastatic nodule.
1.Since the previous examination, a new focus of contrast enhancement has the lobe along the medial surgical margin superficially and has signal characteristics that are in favor of disease progression.2.The small dural based contrast enhancing extra axial lesion overlying the left temporal lobe has also progressed significantly since the previous examination. The rate of progression makes a meningioma less likely and would favor metastatic disease from the known glioblastoma.3.MR perfusion study indicate possibility of recurrent malignant mass on the surgical resection cavity. The MR perfusion finding of the left temporal extra axial lesion is non-specific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.