Figure 8.

A 55-year-old male patient. Tumor resection (glioblastoma multiforme) in the left temporal lobe six months ago, undergoing treatment with radiotherapy and temodal. MRI scan with advanced techniques was requested for differential diagnosis between recurrence and radionecrosis in post-gadolinium enhancement areas in the surgical site. On A, one observes contrast-enhanced T1-weighted image demonstrating enhancement of the surgical site (arrow). On B, one observes increased perfusion (arrow) on the rBV map (the ROI in this area, compared with a contralateral area of healthy white matter, presenting a ratio >2.6, a value which has been proposed for tumor recurrence. On C and D, the spectroscopy study demonstrates decreased peak of the metabolite Nacetyl aspartate (NAA) and increased choline peak (Cho), corroborating the diagnosis. Courtesy of Dr. Leonardo Vedolin - Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.