Fig. 7

a, b, c & d. Figures a-d depict treatment planning in a recurrent glioblastoma patient presenting with an area of increased perfusion on sequential imaging. Figure a shows lack of enhancement on the axial T1 postcontrast sequence. Figure b shows axial treatment planning performed on the corresponding slice in the FLAIR sequence, where diffuse signal abnormality is present. Measurements are obtained from a reference frame drawn at the level of the scalp. Tumor coordinates are determined in a standard manner correlating the region of FLAIR signal abnormality with the area of increased perfusion observed on MR perfusion (figure d). Figure c shows the corresponding area of hypodensity on the coronal T1 with contrast sequence which is used for treatment planning in the absence of a coronal FLAIR sequence. All measurements are obtained from a reference frame drawn at the level of scalp, extending inferiorly to the lowest margin of frontal lobe. In anterior coronal sections, the reference frame should encompass all of the cerebrum at this level. Tumor location measurements are obtained in a standard fashion extending from the right frame to the edges of the T1 hypo intensity. Figure d shows an area of increased perfusion (white arrow) in the left frontal lobe on MR perfusion indicative of tumor recurrence