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CT scan shows defect in parietal bone. Areas of hemorrhage, necrosis with foci of calcification. Meaning?

ct scan - clinical history: post op case of intracranial SOL
The study shows large defect in the right parietal bome with an ill defined area of mixed attenuation in the right parietal lobe measuring approx.53 x 48 mm in size.the lesion shows small areas of necrosis an homorrhage with few small foci of calcification- post operartive changes/residual lesion.the lesion of causing mass effect in the form of compression of occipital horn of lateral ventricle.
normal attenuation is seen in rest of the cerebral parenchyma ,basal ganglia,thalami,braintem and cerebellum.
rest of the ventricular system and basal cisterns are normal. no midline shift is seen.
Asked On : Sat, 20 Apr 2013
Answers:  3 Views:  71
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Radiologist 's  Response

Three important details required while interpreting the scan would be the interval between the scan and surgery, the pre-operative diagnosis on the baseline scan and the appearance on contrast injection.

In the immediate post op period (first few days), hemorrhage and other post operative changes can mimic a residual tumor.

If the scan has been done within a week or two of surgery, then these features could represent a residual tumor (incompletely excised).

Even later, these features probably represent a recurrent tumor.

A comparison with the pre-operative scan would be vital.

It would be important to get a neurosurgeon's opinion, preferably the same doctor who has operated you earlier.

Also, a contrast enhanced MRI scan would be very important to decide further management as this would demonstrate the extent of involvement and definitely diagnose a residual / recurrent tumor.

Answered: Tue, 23 Apr 2013
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Internal Medicine Specialist Dr. Omer's  Response
by the description of your ct findings they are suggestive of
Glioma (GBM???)
Gliomas are very common in adults with more on outer surface of brain with areas of necrosis and calcification ......its the best thing you did excision of that mass...but post op is more important as fits are common so take care more in post op period....residual mass will be left or can be hemorrhage after the excision .....never the less the biopsy of mass will prove glioma then proceed for chemo x6 months with stereotactic radiotherapy ..
.take care
Answered: Sun, 21 Apr 2013
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Pathologist and Microbiologist Dr. Shailja Puri 's  Response
Hello and welcome to HCM,

The CT scan reveals a mass which is hemorrhagic and has necrotic foci.
This appearance is commonly seen in malignncy/ tumor.
Since, this is a post-operative CT scan, this mass could be residual mass (mass which could not be excised with the main mass) or a recurrence.
If the scan is taken shortly taken after the surgery then it is unlikey to be a recurrence.
Residual mass is more likely.

Rest of the brain and ventricles are within normal limits.
You need to consult your neurosugeon for furter work up.
This mass may require chemo or/ and radiotherapy depending on the tumor type.

Thanks and take care.
Dr Shailja P Wahal
Answered: Sun, 21 Apr 2013
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