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The authors retrospectively reviewed patients treated between 2007–2010 and identified 14 patients with cerebral metastasis who had clinical or radiographic progression following stereotactic radiosurgery and were imaged with arterial spin-labeling (ASL), FDG-PET, and thallium SPECT before stereotactic biopsy. FDG-PET and ASL were equally sensitive in detecting tumor progression (83%). The specificity of ASL was superior to that of the other modalities (100%, 75%, and 50%, respectively). A combination of modalities did not augment the sensitivity, specificity, positive predictive value, or negative predictive value of ASL.