Figure 4

Serial MR imaging in case 4. T1-weighted image after application of contrast agent. a) November 2005, before surgery. GBM located in the right frontal region. b) May 2006, a small, extra-axial enhancing lesion. c) September 2011, no change of the enhancing lesion. d) FLAIR and MR spectroscopy images, September 2011. The small volume of increased signal intensity on FLAIR images did not show a tumor-like pattern on MR spectroscopy. FLAIR, Fluid Attenuated Inversion Recovery; GBM, glioblastoma multiforme; MR, magnetic resonance.