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Table 1 Diagnostic value of several imaging techniques in differentiating tumor recurrence from radiation necrosis after SRS for brain metastases

From: Differentiation of local tumor recurrence from radiation-induced changes after stereotactic radiosurgery for treatment of brain metastasis: case report and review of the literature

Study Imaging modality Number of patients (metastasis) Treatment (n) Interval SRS – Imaging (mo) Number of recurrent metastasis / radiation-induced changes Confirmation of diagnosis (n) Sensitivity Specificity
Histo FU
Serizawa et al., 2005 [16] 201Thallium SPECT 70 (72) SRS 7 30/42 10 62 90% 91%
Tsuyuguchi et al., 2003 [12] MET PET 21 (21) SRS 12 9/12 11 10 78% 100%
Terakawa et al., 2008 [13] MET PET 51 (56) SRS (47), EBI (4) 17 24/32 56 0 79% 75%
Galldiks et al., 2012 [17] FET PET 31 (40) SRS (16), SRS+WBRT (15) 12 19/21 11 29 95% 91%
Horky et al., 2010 [18] Dual phase FDG PET 25 (27) SRS/EBI (22), CTx (3) 18,15 n.r. 16 11 95% 100%
Chao et al., 2001 [19] FDG PET 32 (36) SRS 6 18/18 n.r. n.r. 65% 80%
FDG PET + MRI 32 (36) SRS 6 18/18 n.r. n.r. 86% 80%
Belohlavek et al., 2003 [20] FDG PET 25 (57) SRS 8 8/49 3 54 75% 94%
Chernov et al., 2005 [21] FDG PET 9 (9) SRS 11 4/5 5 4 50% 80%
Single voxel MRS 9 (9) SRS 11 4/5 5 4 50% 100%
Multi voxel MRS 9 (9) SRS 11 4/5 5 4 100% 100%
Kimura et al., 2003 [22] Single voxel MRS 36 (43) SRS 6-12 0/6 5 1 100%*
Barajas et al., 2009 [23] PWI 27 (30) SRS 10 20/10 22 8 96% 100%
Hoefnagels et al., 2009 [4] PWI 31 (34) SRS 8/9 20/14 11 23 70% 100%
Mitsuya et al., 2010 [24] PWI 27 (28) SRS 12 7/21 2 26 100% 95%
Truong et al., 2006 [25] PWI 12** SRS 9 10/2 12 0 PPV 80%
Multi voxel MRS 9*** SRS 9 7/2 9 0 PPV 83%
  1. *Radiation necrosis was correctly diagnosed in all cases; **3 patients were excluded due to susceptibility artifacts; ***2 patients were excluded.
  2. CTx = chemotherapy; PWI = perfusion weighted imaging; EBI = external beam irradiation; FDG = 2-deoxy-[18F]fluoro-D-glucose; FET = O-(2-18F-Fluoroethyl)-L-tyrosine; FLAIR = fluid attenuated inversion recovery; FU = confirmation of diagnosis by (serial) follow-up MRI; Histo = diagnosis proven by histological confirmation; MET = 11C-methyl-L-methionine; MRS = magnetic resonance spectroscopy; n.r. = not reported; PPV = positive predictive value for tumor recurrence; SPECT = single photon emission computed tomography; SRS = stereotactic radiosurgery; WBRT = whole brain radiation therapy.