Work

Bevacizumab withdrawal–associated cortical hyperperfusion in recurrent high-grade astrocytoma: An underrecognized MRI pitfall

Year: 2026

Type: article

Abstract: Bevacizumab is widely used in recurrent high-grade gliomas due to its anti-angiogenic effects mediated through vascular endothelial growth factor (VEGF) inhibition. While radiological pseudo response during treatment is well recognized, cerebral hemodynamic alterations following treatment discontinuation are poorly characterized. We report a 50-year-old male with recurrent IDH-mutant WHO grade 4 astrocytoma who developed focal cortical hyperperfusion on perfusion MRI after cessation of long-term Bevacizumab therapy. The finding occurred in the absence of diffusion restriction, seizure activity, systemic hypertension, stroke episode or imaging evidence of tumor recurrence. The imaging pattern is most consistent with a transient vascular autoregulatory rebound phenomenon related to vascular endothelial growth factor pathway re-equilibration after anti-angiogenic withdrawal.

Source: Radiology Case Reports

DOI: 10.1016/j.radcr.2026.03.027

Authors: Alice Coelho, Zhijian Chen, Charif Sidani, Kevin J Abrams, Leonardo Furtado Freitas

Institutions: American University of Antigua, Florida International University, Baptist Health South Florida

Language: English

Topic: Glioma Diagnosis and Treatment

Subfield: Genetics

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $600