Neuro-oncology workstation
Post-Treatment Brain Lesion
Radiation necrosis versus tumor recurrence — multiparametric evidence weighting, structured findings and impression. RadioGraphics 2012 (Shah et al.) · DEGRO 2022.
RT planMorphologySerialDiffusionPerfusionMRSPET11% complete
Decision support only. No single imaging feature or study-derived threshold establishes the diagnosis; multidisciplinary correlation with the radiation treatment plan and clinical course is required.
Clinical scenario
Primary tumor
Interval since radiation
Radiation technique
Relationship to radiation field
Isodose relationship
Prior radiation
Treatment plan available
Corticosteroids
Location
At the treated site
Current size
Prior size
Interval change
Enhancement patternmulti-select
Enhancement locationmulti-select
Central necrosis
T2/FLAIR abnormality
Vasogenic edema
Serial evolution
Enhancement trend
T2/FLAIR trend
Edema trend
Prior spontaneous regression
Steroid response
Diffusion
DWI
ADC
Lesion ADC×10⁻³ mm²/s
Reference ADC×10⁻³ mm²/s
ADC ratio
—
Perfusion
Engine suggestion (non-binding)
Indeterminate
Overall assessmentyou decide
Treatment-related classification
Diagnostic confidence
Next stepsmulti-select
Report mode
Impression style
Generated report
FINDINGS At the site of the previously treated metastasis in the treated site, there is enhancement. IMPRESSION • Interval increased enhancement at the previously treated lesion with the appearance is nonspecific on conventional MRI and may reflect treatment-related change/radiation necrosis or recurrent tumor. • Advanced perfusion/diffusion imaging and correlation with the radiation treatment plan may improve diagnostic confidence.