MRI obtained 7 months post resection, 3-4 months following the end of radiotherapy, demonstrates significant increase in enhancement. There are a number of features that suggest that this, despite the timing and presence of MGMT methylation, represents tumour progression:
- ADC values are low, particularly anteriorly where they are much lower than normal brain, suggesting high cellularity
- CBV is elevated, compared to normal white matter
- MRS demonstrates a high choline and preserved NAA peak
Interestingly much of the change seen posteriorly may actually represent treatment effect.