Fig. 8.
Glioblastoma—pseudoprogression. a Pre-operative T1-weighted image shows a right deep parietal region glioblastoma. b Conventional post-contrast T1-weighted image approximately 4 weeks after chemoradiotherapy treatment demonstrates a significant increase in the contrast-enhancing area (arrow). Multiparametric MRI at this timepoint demonstrates: c, d areas of high ADC (1186 × 10−6 mm2 s−1), (e) a low rCBV ratio (1.4, arrow) on PWI, (f, g) a low Cho/Cr ratio (1.4), a low Cho/NAA ratio and presence of lipid and lactate on MRS. Combination of parameters suggest pseudoprogression. h Clinical follow-up and conventional post-contrast T1W sequence at six months confirms a decrease in the amount of enhancing disease, indicating pseudoprogression