Performance of Conventional Approaches Compared to Novel Blood Volume-, Angiogenesis-, and Tumor Hypoxia-Based Approaches to Diagnosing Tumor Recurrence on MRI After Radiation Therapy of Brain Metastases

Background/Objectives: Differentiating tumor recurrence (TR) from radiation necrosis (RN) remains a significant challenge in the post-radiation management of brain metastases due to their overlapping clinical and radiographic features. Existing imaging techniques often lack the sensitivity and specificity necessary for accurate differentiation. This study evaluates the performance of a novel suite of imaging biomarkers characterizing microvasculature, blood flow dynamics, and tumor oxygen utilization in distinguishing TR from RN, compared with established cerebral blood volume (CBV) measures.