MRI obtained 11 months post op (3.5 months after last scan).
Previous right parietal craniotomy and frontoparietal resection cavity again noted. The degree of FLAIR signal abnormality has reduced superiorly within the frontal and parietal lobes. Signal abnormality more inferiorly extending into the temporal lobe, insular and the right cerebral peduncle is similar to previous. The peripherally enhancing lobulated lesion is similar in extent to previous. The margins are less distinct, however no discrete new nodular enhancement is identified.
There is persisting persisting reduced ADC values at the margins of the enhancement, progressed since previous with increased CBV within this region.
New FLAIR signal abnormality involving the ipsilateral medial cerebral hemispheric cortex (precuneus and posterior cingulate) and contralateral (left) caudate head, anterior limb of internal capsule and the anterior putamen. This region does not demonstrate abnormal diffusion restriction or definite elevated CBV.
Spectroscopy demonstrates elevated choline and reduced NAA within the FLAIR signal abnormality consistent with residual tumour.
There is stable mass effect on the right cerebral hemisphere with stable ventricular size.
While the extent of FLAIR signal abnormality within the superior frontal and parietal lobes has reduced, as has contrast enhancement, there is evidence of disease progression at the posteromedial margin of the resection cavity within the periventricular white matter as well as parietal and cingulate cortex.
New mass like FLAIR abnormality involving left caudate head is also concerning for new tumor.