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. 2020 Jan;41(1):10–20. doi: 10.3174/ajnr.A6358

Fig 11.

Fig 11.

Typical features of pseudoprogression and progressive disease on diffusion-weighted imaging. A, Axial contrast-enhanced T1-weighted image from a previously presented case of a patient with pseudoprogression (Fig 5) after treatment of a GBM in the left parietal lobe shows an enhancing lesion with irregular margins in the surgical bed (arrows). Despite an axial DWI (B) and ADC map (C) showing a punctate focus of restricted diffusion in the lesion (arrowhead), with ADC = 0.9 × 10−6 mm2/s, most of the enhancing lesion has no corresponding restricted diffusion, exhibiting ADC levels around 1.5–1.7 × 10−6 mm2/s, which is consistent with radiation injury. D, Axial contrast enhanced T1-weighted image shows a heterogeneously enhancing lesion in the right temporal lobe (arrowhead) in a patient with a resected GBM. Axial DWI (E) and an ADC map (F) show moderately restricted diffusion, with ADC values ranging from 1.0–1.1 × 10−6 mm2/s, consistent with predominance of malignant cells within the lesion (progressive disease). The ADC measurements were obtained by drawing a circular ROI in the visually lowest ADC areas on the ADC map.