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Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a\u00a0neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neuro-oncologist. A\u00a0multistep approach as an opportunity to review as many characteristics as possible to improve diagnostic confidence is recommended. Additional information about radiotherapy (RT) techniques is crucial for the diagnosis of RN. Misdiagnosis of untreated and progressive RN can lead to severe neurological deficits. In this practice guideline, we propose a\u00a0detailed nomenclature of treatment-related changes and a\u00a0multistep approach for their diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-022-01994-3","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T16:03:56Z","timestamp":1661789036000},"page":"873-883","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["DEGRO practical guideline for central nervous system radiation necrosis part\u00a01: classification and a\u00a0multistep approach for diagnosis"],"prefix":"10.1007","volume":"198","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-9097","authenticated-orcid":false,"given":"Denise","family":"Bernhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Grosu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Wiestler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rieken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Wick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Gempt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Schmidt-Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Sahm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd J.","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Fietkau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wittig-Sauerwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghazaleh","family":"Tabatabai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Steinbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Expert Panel of the German Society of Radiation Oncology (DEGRO)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,8,29]]},"reference":[{"key":"1994_CR1","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1016\/S1470-2045(17)30414-X","volume":"18","author":"A Mahajan","year":"2017","unstructured":"Mahajan\u00a0A et al (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: A\u00a0single-centre, randomised, controlled, phase 3 trial. 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L.\u00a0K\u00f6nig reports grants from Ruprecht-Karls Universit\u00e4t Heidelberg, personal fees from Accuray Inc., and Novocure GmbH outside the submitted work. D.\u00a0Bernhardt reports personal fees and honoraria from Accuray Inc., AstraZeneca, and Novocure GmbH outside the submitted work. D.\u00a0Bernhardt\u2019s spouse is employed at Gilead Science. M.\u00a0Thomas reports personal fees, honoraria for advisory boards, and research funding from AstraZeneca, Beigene, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Daiichi Sankyo, GlaxoSmithKline, Janssen Oncology, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda. F.\u00a0Giordano reports research grants, honoraria, and travel expenses from Carl Zeiss Meditec AG and NOXXON Pharma AG, personal fees from MVZ Venusberg GmbH, and consulting\/speaker honoraria from Bristol Myers Squibb, Medac GmbH, Merck Sharp & Dohme, Elsevier, AstraZeneca, and Guerbet SA. S.M.\u00a0Krieg is consultant for Brainlab AG (Munich, Germany) and Ulrich Medical (Ulm, Germany). S.M.\u00a0Krieg received honoraria from Nexstim Plc (Helsinki, Finland), Spineart Deutschland GmbH (Frankfurt, Germany), Medtronic (Meerbusch, Germany), and Carl Zeiss Meditec (Oberkochen, Germany). J.\u00a0Debus: institution received research grants from Merck Serono, institution received consultation honoraria from Merck serono, J.\u00a0Debus received travel reimbursement from Merck Serono, institution received research grants from Siemens Healthineers and Accuray.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics approval was not necessary for the comprehensive review article. All coauthors have agreed to participate. <i>Consent for publication:<\/i> All coauthors have approved the final manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}