Fig. 1

Brain-MRIs. Legend: postoperative findings after Astrocytoma tumor (WHO grade II) resection in the right frontal lobe (not shown). A, axial FLAIR (A1) and contrast-enhances T1 (A2) images 12-months FU after first surgery demonstrate small residual tumor posterior to surgical cavity without any enhancing portions. B, axial FLAIR (B1) and contrast-enhances T1 (B2) obtained after 14 months shows minimal residual tumor enlarge without enhancement. C, axial FLAIR (C1), contrast-enhances T1(C2), corresponding DSC perfusion CBV map (C3) and Single-Voxel Spettroscopy (5 months after second-surgery): progression-disease with right-frontal heterogeneously enhancing mass (C2) with surrounding FLAIR signal hyperintensity (C1), elevated cerebral blood flow (C3) and abnormally elevated Cho/NAA ratio (C4), found to be a Glioblastoma (WHO grade IV). D, axial FLAIR (D1), contrast-enhances T1(D2), perfusion CBV map (D3) and Single-Voxel Spettroscopy (D4) 6 months after third surgery: gross total resection of enhancing tumor (D2) with minimal surrounding nonenhancing white matter signal abnormality (D1) and focal dubious rCBV elevation (D3). E, axial FLAIR (E1), contrast-enhances T1(E2), perfusion CBV map (E3) and Single-Voxel Spettroscopy (E4) 12 months after third-surgery: substantial stability of the gross total resection of enhancing tumor (E2) with persistence of both minimal surrounding nonenhancing white matter signal abnormality (E1) without focal rCBV elevation (E3)