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Figure 4: MR images in a 53-year-old man with pathologically proved low-grade mixed oligoastrocytoma and high baseline relative CBV of 4.29. A, Transverse FLAIR image (9000/110/2500) shows area of increased signal intensity within right mesial frontal lobe (arrow). B, Transverse T2-weighted image (3400/119) shows area of increased signal intensity within right mesial frontal lobe (arrow), with some mass effect on adjacent genu of corpus callosum. C, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates no appreciable enhancement, a finding compatible with imaging and pathologic diagnosis of low-grade glioma. D, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map shows lesion with high initial perfusion and relative CBV of 4.23, more in keeping with high-grade glioma than with low-grade glioma. E, Transverse FLAIR image (9000/110/2500) obtained at 127 days (18 weeks) of follow-up. F, Transverse T2-weighted image (3400/119) shows substantial increase in tumor volume and in volume of T2 signal abnormality to 220.97 cm3. Obvious evidence of tumor crossing corpus callosum to the contralateral left frontal lobe is seen. G, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates increase in enhancing tumor volume to 58.23 cm3. More mass effect, with almost complete effacement of frontal horns, is seen. H, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map demonstrates progressively increasing relative CBV from 4.23 to 13.37.
