The purpose of this study was to evaluate the diagnostic potential of decision-tree model of diffusion kurtosis imaging (DKI) and 11C-methionine (11C-MET) PET imaging, for the differentiation of radiotherapy injury from glioblastoma recurrence using integrated PET/MR. Eighty-six glioblastoma cases with suspected lesions after radiotherapy were retrospectively enrolled. Compared to models of DKI-alone (AUC=0.85) and PET-alone (AUC=0.89), the combined model demonstrated the best diagnostic accuracy (AUC=0.95). The decision-tree model has the potential to further increase diagnostic accuracy for discrimination between radiotherapy injury and glioblastoma recurrence. 11C-MET PET/MR may thus contribute to the management of glioblastoma patients with suspected lesions after radiotherapy.
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