Stereotactic radiosurgery for brain metastases delivers a focal dose of radiation and has excellent local tumour control but leads to radiation necrosis (RN) in up to 22% of patients. This study used saturation transfer MRI for distinguishing between RN and tumour progression (TP), extending our previous work to a larger cohort of 70 patients (75 lesions). Eleven out of 14 metrics (including quantitative MT and CEST) showed statistically significant differences between the RN and TP cohorts, including magnetization transfer ratio (MTR) metrics showing the best separation. Univariable logistic regression resulted in the high-power MTR having the highest AUC=0.88 (with AIC=67.3).
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