Legend Axial FLAIR images centered at the third ventricle and thalamus (left) and lateral ventricles (right) reveal a large area of encephalomalacia in the right frontal lobe likely from prior resection, with some hyperintensity in the adjacent brain parenchyma. Additionally, note the abnormal high signal in the medial right thalamus.

Legend Additional FLAIR sequences (left and middle) reveal abnormal high signal in the right external capsule, right thalamus and posterior right midbrain. A post-gadolinium sequence (right) reveals no abnormal enhancement.

Legend Single voxel spectroscopy (TE 30 msec) reveals mildly elevated choline in the right thalamus.

Legend Multivoxel spectroscopy on the right reveals elevated choline peaks in all but the most posterior voxels.

Legend Multivoxel spectroscopy reveals abnormal choline elevation on the left as well in all but the most lateral and posterior voxels. Key words: mri mrs tumor neoplasia postoperative

Brain Diagnosis: Recurrent anaplastic astrocytoma with conversion to a higher grade