Abstract #3709

Differentiation of Radiation Necrosis from Tumor Progression in Brain Metastasis Treated with Stereotactic Radiosurgery using CEST at 3T

Rachel W Chan¹, Hatef Mehrabian¹, Hany Soliman², Hanbo Chen², Aimee Theriault², Sten Myrehaug², Chia-Lin Tseng², Jay Detsky², Wilfred W Lam¹, Angus Z Lau^1,3, Gregory J Czarnota^1,2,3, Arjun Sahgal², and Greg J Stanisz^1,3,4

¹Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada, ²Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ³Medical Biophysics, Sunnybrook Research Institute, Toronto, ON, Canada, ⁴Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland

Stereotactic radiosurgery (SRS) is the standard of care treatment for patients with limited brain metastases; however radiation necrosis can develop. Standard clinical approaches have limited ability in differentiating radiation-induced changes from tumor progression. This work examines the performance of CEST metrics (MTR_Amide and MTR_rNOE) at 3T for differentiating radiation necrosis from tumor progression, extending a previous study to include higher saturation power (using B₁=2.0μT) with added multivariable logistic regression. Results in 24 lesions showed that both saturation powers (0.52μT and 2.0μT) could distinguish tumor progression from radiation necrosis, with the MTR_Amide(0.52μT) parameter selected from multivariable modelling with AUC=0.91.

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