Fig. 9.

Glioblastoma—true progression. a Immediate post-operative contrast-enhanced T1-weighted scan following resection of a right fronto-parietal glioblastoma. b Conventional post-contrast T1-weighted image one month after chemoradiotherapy treatment demonstrates increase in the enhancing lesion size with associated oedema. Multiparametric MRI at this timepoint demonstrates: c, d areas of low ADC (903 × 10⁻⁶ mm² s⁻¹, arrow), (e) a high rCBV ratio (3.0, arrow) on PWI, (f, g) a high Cho/Cr ratio (2.3, arrow), high Cho/NAA ratio and presence of lipid/lactate on MRS. All parameters suggest a poor response and disease progression. h Six-month follow-up conventional post-contrast T1W sequence confirms an increase in enhancing disease, indicating true progression