Advanced MRI Techniques for Differentiating Glioma Progression from Treatment-Related Changes: A Systematic Review

Background: Distinguishing between glioma progression and treatment-related changes remains a critical clinical challenge in neuro-oncology. Conventional MRI often fails to adequately differentiate these entities, leading to potential treatment delays or unnecessary interventions. Objective: To systematically review the utility of advanced MRI techniques including diffusion-weighted imaging (DWI), perfusion imaging, and magnetic resonance spectroscopy (MRS) in differentiating glioma progression from treatment-related changes. Methods: A comprehensive search of PubMed, Embase, and Cochrane databases was conducted from 2002 to 2025. Studies evaluating advanced MRI techniques for distinguishing tumor progression from treatment effects in glioma patients were included. Data extraction focused on diagnostic accuracy metrics, technical parameters, and clinical outcomes. Results: Sixty-three studies met inclusion criteria, encompassing 4,287 patients. Diffusion-weighted imaging demonstrated pooled sensitivity and specificity of 84.2% and 79.6% respectively. Perfusion imaging showed superior performance with sensitivity of 91.3% and specificity of 85.7%. MRS achieved sensitivity of 87.4% and specificity of 82.1%. Combined multiparametric approaches yielded the highest diagnostic accuracy with sensitivity of 93.8% and specificity of 89.2%. Conclusions: Advanced MRI techniques substantially enhance the ability to differentiate glioma progression from treatment-related changes compared with conventional imaging. A multiparametric approach combining two or more advanced modalities offers the highest diagnostic accuracy and should be considered in clinical practice to guide timely management.