A comparison is made to the previous MRI.
FLAIR hyperintensity and expansion of the left middle temporal gyrus have increased, associated with the development of vivid contrast enhancement in this region. The contrast-enhancing mass measures 31 x 21 x 27 mm (AP x LR x SI). The mass is peripherally based, involving cortex and abutting dura which is smoothly thickened. There is further diffuse bilateral supratentorial pachymeningeal enhancement more prominent on the left, a new finding. Mild diffusion restriction has developed at the medial margin of the mass. The mass demonstrates elevated cerebral blood volume. On spectroscopy, a voxel anterior to the contrast enhancement demonstrates elevated choline to creatine and increased lactate.
Conclusion: Left temporal tumour progression. The development of contrast enhancement and elevated cerebral blood volume indicate dedifferentiation into a glioblastoma.