The Diagnostic Ability of Follow-Up Imaging Biomarkers after Treatment of Glioblastoma in the Temozolomide Era: Implications from Proton MR Spectroscopy and Apparent Diffusion Coefficient Mapping

Figure 1

Representative MRI examples of glioblastoma relapse ((a)–(e)) and pseudoprogression ((f)–(j)): (a) + (f) show T1WI with gadolinium after surgical resection before radiotherapy, (b) + (g) show follow-up T1WI with gadolinium after 3 months from radiotherapy, (c) + (h) show ADC maps with marked VOI (ADCmean values for VOI: 848 × 10⁻⁶mm²/s in GBM relapse and 1355 × 10⁻⁶mm²/s in PsP), (d) + (i) show proton MR spectroscopy maps focused on tCho/tNAA ratio with marked VOI (peak values: 2.98 in GBM relapse and 1.33 in PsP), and (e) + (j) show proton MR spectroscopy maps focused on Lip + Lac/tCr ratio with marked VOI (peak values: 2.93 in GBM relapse and 0.83 in PsP).