Imaging
Primary Brain Tumors
- Preliminary Diagnosis: Primary Brain Tumors
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing primary brain tumors.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing primary brain tumors.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Primary Brain Tumors
I. What imaging technique is first-line for this diagnosis?
MR imaging of the brain with IV contrast
II. Describe the advantages and disadvantages of this technique for diagnosing primary brain tumors.
Advantages
Diagnostic with positive pertinent findings in the correct clinical situation.
Able to localize the area of abnormality better than any other modality.
Evaluates for secondary complications such as hemorrhage, mass effect, midline shift, etc.
Does not utilize ionizing radiation.
Disadvantages
Exposure to radiation.
Time consuming.
Requires significant patient cooperation to minimize motion artifact.
MR with contrast is contraindicated in patients with renal disease (i.e. GFR < 30).
III. What are the contraindications for the first-line imaging technique?
Contraindicated in patients with non-MR compatible metallic hardware or foreign bodies.
IV. What alternative imaging techniques are available?
FDG - PET
CT with contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing primary brain tumors.
FDG-PET
Advantages
Able to distinguish benign and malignant lesions based on degree of radiopharmaceutical uptake (i.e., a low grade glioma will demonstrate significantly less uptake than a high grade glioma).
Able to detect distant metastatic disease.
Disadvantages
Exposes the patient to a high degree of radiation.
Lacks the anatomic detailing of MRI and is unable to detect many secondary neurological complications.
Unable to fully characterize properties of neoplasm to the degree that MRI can.
CT with contrast
Advantages
Less expensive, quicker, and requires less patient cooperation than MRI.
Can determine many secondary complications, such as hemorrhage, mass effect, midline shift, etc.
Better than MRI at detecting calcified neoplasms.
Disadvantages
Lacks specificity and anatomic detailing of MRI.
Exposes patient to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
FDG-PET
Contraindicated in pregnant patients, especially during the first two trimesters.
CT with contrast
Contraindicated in pregnant patients, especially during the first two trimesters.
Relative contraindication in patients with renal failure.
Relative contraindication in patients with allergy to contrast.
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