Point/counterpoint: The use of perfusion-weighted MRI and amino acid PET for the identification of treatment-related changes

Neuro-Oncology, vol. 28, pp. 1625–1633

Abstract

Lay Summary Accurately differentiating actual tumor progression from treatment-related changes, such as pseudoprogression or radiation-induced injury, remains one of the most critical diagnostic challenges in neuro-oncology for both primary and secondary brain tumors. Conventional MRI often lacks specificity because it primarily reflects blood-brain barrier disruption rather than viable tumor tissue. Consequently, advanced techniques like perfusion-weighted MRI and amino acid PET have gained significant attention. While perfusion-weighted MRI provides essential insights into blood flow and is widely available, accumulating evidence suggests that amino acid PET can be more reliable in identifying treatment-related changes. Since both modalities offer complementary information, there is an ongoing debate regarding their relative roles and the optimal way to integrate them into clinical practice. Combining these tools aims to provide more reliable diagnoses, ultimately preventing unnecessary interventions and ensuring that true tumor growth is detected as early as possible.

Authors 6

1. Norbert Galldiks corresponding

   Forschungszentrum Jülich · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) ,

   Department of Neurology, Faculty of Medicine and University Hospital Cologne , Cologne,

   Institute of Neuroscience and Medicine (INM-3), Research Center Juelich , Juelich,

2. Philipp Lohmann Aachen Department of Nuclear Medicine

   RWTH Aachen University · Universitätsklinikum Aachen · Forschungszentrum Jülich

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital RWTH Aachen , Aachen,

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich , Juelich,

3. Jan‐Michael Werner

   University Hospital Cologne

   Affiliation as printed

   Department of Neurology, Faculty of Medicine and University Hospital Cologne , Cologne,

4. Jörg Felder Aachen Faculty of Medicine

   RWTH Aachen University · Forschungszentrum Jülich

   Affiliation as printed

   Faculty of Medicine, RWTH Aachen , Aachen,

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich , Juelich,

5. Leland Hu

   Mayo Clinic · Mayo Clinic Hospital

   Affiliation as printed

   Department of Radiology, Mayo Clinic , Phoenix, Arizona,

6. Timothy J. Kaufmann

   Mayo Clinic

   Affiliation as printed

   Department of Radiology, Mayo Clinic , Rochester, Minnesota,