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In the presence of increased permeability, lesion-related cerebral blood volume within limits of normal brain suggests radiation necrosis of a locally irradiated glioma. Perfusion computed tomography allows the distinction between a treatment effect following targeted high dose radiotherapy (e.g. [90Y]-DOTAGAsubstance P) and an upgrading of low- to high-grade glioma. For further details, please see Kneifel et al. on page 3843.