Neuro Oncology: The Role of Neuroradiology Mary Gawne-Cain Department of Neuroradiology Southampton University Hospitals Trust

How does neuroradiology assist the neuro oncology team?

The Basic Kit

CT Computed tomography Uses x-rays Contrast – iodine based

MRI Magnetic Resonance Imaging Strong magnetic field Metal – artefact, movement Pacemakers!! Size of bore

Neuroradiology Roles Diagnosis Staging Localisation Surveillance Complications

Diagnosis Diagnosis Staging Localisation Surveillance Complications

Acoustic Neuroma A: CT soft tissue B: CT bone C: MRI with Gad

Brainstem Glioma Axial T2 Sagittal T1 Coronal FLAIR

Abscess vs Tumour A B

Abscess vs Tumour A B

DWI ADC B A Tumour Abscess

Staging Local Spread incl meningeal Metastatic Meningeal Spread Brain Spine Diagnosis Staging Localisation Surveillance Complications

Tumours with Meningeal Spread Germinoma PNET and medulloblastoma Ependymoma (Glioma / Astrocytoma) (Metastasis from body)

All Children with Posterior Fossa Tumours Should have Spinal Imaging Before Surgery

12yr boy SB

Spine Screening Clear SB

Another Case

Surgical Workup Localisation is the commonest Define anatomy (e.g. trans petrous) Vascular Supply Vascular Occlusion Functional WADA fMRI Diagnosis Staging Localisation Surveillance Complications

Stereotactic Localisation SB – biopsy: germinoma

Another Biopsy Stereo MRI Post biopsy check CT

? Sagittal Sinus Patent

fMRI - language R L

Surveillance Diagnosis Staging Localisation Surveillance Complications

Serial Studies SB Diagnosis 8 Weeks 8 Months

Complications Diagnosis Staging Localisation Surveillance

Hydrocephalus Obstructive hydrocephalus due to posterior fossa tumour

Hydrocephalus Communicating hydrocephalus due to meningeal deposits

Optic Nerve / Chiasm Compression Pituitary adenoma

Summary Neuroradiology is used for Tumour diagnosis Staging Surgical workup Post surgical check Radiotherapy planning Surveillance

But don’t forget…. Not all lumps are tumours Arachnoid Cyst