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Ryken TC, Aygun N, Morris J, Schweizer M, Nair R, Spracklen C, Kalkanis SN, Olson JJ, AANS/CNS Joint Guidelines Committee. The role of imaging in the management of progressive glioblastoma : a systematic review and evidence-based clinical practice guideline. Journal of Neuro-Oncology. 2014 Jul 1; 118(3):435-60.
QUESTION: Which imaging techniques most accurately differentiate true tumor progression from pseudo-progression or treatment related changes in patients with previously diagnosed glioblastoma? TARGET POPULATION: These recommendations apply to adults with previously diagnosed glioblastoma who are suspected of experiencing progression of the neoplastic process. RECOMMENDATIONS LEVEL II: Magnetic resonance imaging with and without gadolinium enhancement is recommended as the imaging surveillance method to detect the progression of previously diagnosed glioblastoma. LEVEL II: Magnetic resonance spectroscopy is recommended as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma. LEVEL III: The routine use of positron emission tomography to identify progression of glioblastoma is not recommended. LEVEL III: Single-photon emission computed tomography imaging is recommended as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma.