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Radiation necrosis or tumor progression? A review of the radiographic modalities used in the diagnosis of cerebral radiation necrosis

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Abstract

Purpose

Cerebral radiation necrosis is a complication of radiation therapy that can be seen months to years following radiation treatment. Differentiating radiation necrosis from tumor progression on standard magnetic resonance imaging (MRI) is often difficult and advanced imaging techniques may be needed to make an accurate diagnosis. The purpose of this article is to review the imaging modalities used in differentiating radiation necrosis from tumor progression following radiation therapy for brain metastases.

Methods

We performed a review of the literature addressing the radiographic modalities used in the diagnosis of radiation necrosis.

Results

Differentiating radiation necrosis from tumor progression remains a diagnostic challenge and advanced imaging modalities are often required to make a definitive diagnosis. If diagnostic uncertainty remains following conventional imaging, a multi-modality diagnostic approach with perfusion MRI, magnetic resonance spectroscopy (MRS), positron emission tomography (PET), single photon emission spectroscopy (SPECT), and radiomics may be used to improve diagnosis.

Conclusion

Several imaging modalities exist to aid in the diagnosis of radiation necrosis. Future studies developing advanced imaging techniques are needed.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA

    Zachary S. Mayo, Ahmed Halima, James R. Broughman, Timothy D. Smile, Erin S. Murphy, John H. Suh & Samuel T. Chao

  2. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Martin C. Tom

  3. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Simon S. Lo

  4. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Erin S. Murphy, John H. Suh, Gene H. Barnett & Samuel T. Chao

  5. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Gene H. Barnett

  6. Department of Radiology, Cleveland Clinic, Cleveland, OH, USA

    Guiyun Wu & Scott Johnson

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  1. Zachary S. Mayo
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  2. Ahmed Halima
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  3. James R. Broughman
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Contributions

The first draft of the manuscript was written by ZSM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Samuel T. Chao.

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Conflict of interest

Samuel Tay Chao (Research support from Blue Earth Diagnostics and Honorarium from Varian Medical Systems). John H. Suh (Scientific advisory board of Philips, NovoCure, and Neutron Therapeutics). Gene H. Barnett (Speaker for Elekta AB, Consultant for Monteris Medical, Inc.).

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Mayo, Z.S., Halima, A., Broughman, J.R. et al. Radiation necrosis or tumor progression? A review of the radiographic modalities used in the diagnosis of cerebral radiation necrosis. J Neurooncol 161, 23–31 (2023). https://doi.org/10.1007/s11060-022-04225-y

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