There has been marked disease progression since the previous scan (which demonstrated minor enhancement in the surgical bed) with a large peripherally enhancing mass with multiple regions of nodular enhancement having developed at the site of the previous resection, now almost the same size as the lesion was prior to the initial surgery. There has been a commensurate increase in T2 signal hyperintensity and mass-effect, although the 4th ventricle remains open and there is no evidence of hydrocephalus. Cerebral blood volume (CBV) is elevated in parts of the enhancing tumour and MR spectroscopy demonstrates elevation of choline and a small lactate peak with a mostly preserved NAA peak. The supratentorial brain is unremarkable.