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Purpose <p>To compare the diagnostic performance of relative cerebral blood volume (rCBV) and percentage of signal recovery (PSR), both derived from dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI), in distinguishing tumor progression from radiation necrosis in brain metastases that have been treated with stereotactic radiosurgery (SRS).</p> Methods <p>This retrospective, single-centre study analysed 96 brain metastases with post-radiotherapy increase in contrast enhancement. The lesions were classified as tumor progression (<i>n</i> = 46) or radiation necrosis (<i>n</i> = 50) based on histopathology and clinical evolution determined by consensus in the multidisciplinary committee. All patients underwent dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with leakage correction and contrast preload, and rCBV was normalised to contralateral white matter. PSR was calculated from the T2* signal-time curve as (S<sub>1</sub>–S<sub>min</sub>)/(S<sub>0</sub>–S<sub>min</sub>). Diagnostic performance was assessed using ROC analysis and the Youden index.</p> Results <p>The median rCBV was significantly higher in tumor progression than in radiation necrosis (4.21 vs. 1.6; <i>p</i> &lt; 0.001), whereas the PSR was significantly lower (59.58% vs. 88.61%, <i>p</i> &lt; 0.001). AUC was 0.86 for rCBV and 0.99 for PSR. PSR outperformed rCBV (<i>p</i> = 0.0028, DeLong test). An optimal cut-off value for rCBV of 2.42 yielded 91.7% sensitivity and 72.2% specificity and for PSR of 68.8% yielded 95.8% sensitivity and 98.1% specificity.</p> Conclusion <p>PSR is more accurate than rCBV in distinguishing tumor progression versus radiation necrosis after SRS in brain metastases. PSR is a reliable, non-invasive biomarker that can improve clinical decision-making.</p>

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Percentage of signal recovery (PSR): a more accurate marker than rCBV for differentiating radiation necrosis from tumor progression in brain metastases treated with stereotactic radiosurgery

  • 期刊论文

  • 发表日期：

    2025年10月29日

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  • Zhao Hui Chen Zhou,
  • Amaya Hilario,
  • Elena Salvador Álvarez,
  • Agustín Cárdenas del Carre,
  • Juan Romero,
  • Carmen Lechuga,
  • Ana Martínez de Aragón,
  • Rafael D´Ambrosi,
  • Ana Ramos

摘要

Purpose

To compare the diagnostic performance of relative cerebral blood volume (rCBV) and percentage of signal recovery (PSR), both derived from dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI), in distinguishing tumor progression from radiation necrosis in brain metastases that have been treated with stereotactic radiosurgery (SRS).

Methods

This retrospective, single-centre study analysed 96 brain metastases with post-radiotherapy increase in contrast enhancement. The lesions were classified as tumor progression (n = 46) or radiation necrosis (n = 50) based on histopathology and clinical evolution determined by consensus in the multidisciplinary committee. All patients underwent dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with leakage correction and contrast preload, and rCBV was normalised to contralateral white matter. PSR was calculated from the T2* signal-time curve as (S1–Smin)/(S0–Smin). Diagnostic performance was assessed using ROC analysis and the Youden index.

Results

The median rCBV was significantly higher in tumor progression than in radiation necrosis (4.21 vs. 1.6; p < 0.001), whereas the PSR was significantly lower (59.58% vs. 88.61%, p < 0.001). AUC was 0.86 for rCBV and 0.99 for PSR. PSR outperformed rCBV (p = 0.0028, DeLong test). An optimal cut-off value for rCBV of 2.42 yielded 91.7% sensitivity and 72.2% specificity and for PSR of 68.8% yielded 95.8% sensitivity and 98.1% specificity.

Conclusion

PSR is more accurate than rCBV in distinguishing tumor progression versus radiation necrosis after SRS in brain metastases. PSR is a reliable, non-invasive biomarker that can improve clinical decision-making.