{Reference Type}: Journal Article
{Title}: Differentiating radiation necrosis from tumor recurrence: a systematic review and diagnostic meta-analysis comparing imaging modalities.
{Author}: Smith EJ;Naik A;Shaffer A;Goel M;Krist DT;Liang E;Furey CG;Miller WK;Lawton MT;Barnett DH;Weis B;Rizk A;Smith RS;Hassaneen W;
{Journal}: J Neurooncol
{Volume}: 162
{Issue}: 1
{Year}: Mar 2023
{Factor}: 4.506
{DOI}: 10.1007/s11060-023-04262-1
{Abstract}: <B>UNASSIGNED: </B>Cerebral radiation necrosis (RN) is often a delayed phenomenon occurring several months to years after the completion of radiation treatment. Differentiating RN from tumor recurrence presents a diagnostic challenge on standard MRI. To date, no evidence-based guidelines exist regarding imaging modalities best suited for this purpose. We aim to review the current literature and perform a diagnostic meta-analysis comparing various imaging modalities that have been studied to differentiate tumor recurrence and RN.<BR><B>METHODS: </B>A systematic search adherent to PRISMA guidelines was performed using Scopus, PubMed/MEDLINE, and Embase. Pooled sensitivities and specificities were determined using a random-effects or fixed-effects proportional meta-analysis based on heterogeneity. Using diagnostic odds ratios, a diagnostic frequentist random-effects network meta-analysis was performed, and studies were ranked using P-score hierarchical ranking.<BR><B>RESULTS: </B>The analysis included 127 studies with a total of 220 imaging datasets, including the following imaging modalities: MRI (n = 10), MR Spectroscopy (MRS) (n = 28), dynamic contrast-enhanced MRI (n = 7), dynamic susceptibility contrast MRI (n = 36), MR arterial spin labeling (n = 5), diffusion-weighted imaging (n = 13), diffusion tensor imaging (DTI) (n = 2), PET (n = 89), and single photon emission computed tomography (SPECT) (n = 30). MRS had the highest pooled sensitivity (90.7%). DTI had the highest pooled specificity (90.5%). Our hierarchical ranking ranked SPECT and MRS as most preferable, and MRI was ranked as least preferable.<BR><B>CONCLUSIONS: </B>These findings suggest SPECT and MRS carry greater utility than standard MRI in distinguishing RN from tumor recurrence.