Novel Biomarkers for Differentiating Between Recurrent Brain Tumor and Radiation Necrosis

Abstract Background: Differentiating between recurrent brain tumors and radiation necrosis (RN) remains a significant challenge in neuro-oncology due to overlapping clinical and imaging features. Accurate diagnosis is crucial for guiding treatment strategies and improving patient outcomes. Main Body: Recent advances in imaging techniques have shown promise in enhancing diagnostic accuracy for distinguishing between recurrent tumors and RN. Perfusion-weighted imaging (PWI), diffusion-weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) are among the modalities being studied. Magnetic resonance spectroscopy, for example, has demonstrated a sensitivity of approximately 80% and a specificity of 78% in differentiating these conditions. Additionally, positron emission tomography (PET) with new tracers, such as fluorine-18 labeled DOPA (18F-FDOPA) and fluorine-18 labeled fluciclovine (18F-Fluciclovine), offers diagnostic accuracies ranging from 75% to 95%. Beyond imaging, molecular biomarkers, such as circulating tumor DNA (ctDNA) and microRNAs, are being explored for their potential to improve non-invasive diagnostic methods. Conclusion: This review synthesizes recent advancements in imaging technologies and molecular biomarkers, highlighting their potential role in refining clinical decision-making and enhancing patient outcomes in the management of brain tumors and radiation necrosis. Keywords: Brain Tumor, Radiation Necrosis, Biomarkers, Neuroimaging, PET, MRI, MR Spectroscopy