BRAINSTORM Understanding Diagnostic Scans: MRI, CT, PET AND MORE Stanley Lu, MD Director, Neuroradiology Monmouth Medical Center March 5, 2012.

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Presentation transcript:

BRAINSTORM Understanding Diagnostic Scans: MRI, CT, PET AND MORE Stanley Lu, MD Director, Neuroradiology Monmouth Medical Center March 5, 2012

Neuroradiology What is a Neuroradiologist? Design imaging protocols Interpret scans - make diagnosis Provide reports Consult with the Brain Tumor Team Suggest follow-up plan

Neuroradiology Imaging of the brain Tumors Stroke Infection Imaging of the spine

Neuroradiology Imaging modalities Computed tomography (CT) Magnetic resonance imaging (MRI) Advanced techniques Positron emission tomography (PET) Diagnosis - Different appearances for different tumors

Neuroradiology Post-operative assessment Tumor monitoring Challenges

CT Technique

MRI Technique

What is MRI? How does it work?

MRI Technique

Z-axis

MRI Technique Z-axis

MRI Technique

MRI Advantages Superior contrast resolution especially for soft tissue Multiplanar No ionizing radiation

MRI Disadvantages Higher cost Lower availability Longer study increased chance of patient motion Claustrophobia Metallic implants contraindicated pacemakers, aneurysm clips, etc.

Brain Tumors

Metastatic disease Meningioma Primary brain tumors Astrocytoma Oligodendroglioma Lymphoma

Brain Tumors Metastatic disease Meningioma Primary brain tumors Astrocytoma Oligodendroglioma Lymphoma

Metastatic Disease Pt with melanoma

Brain Tumors Metastatic disease Meningioma Primary brain tumors Astrocytoma Oligodendroglioma Lymphoma

Meningioma

Brain Tumors Metastatic disease Meningioma Primary brain tumors Astrocytoma Oligodendroglioma Lymphoma

Brain Tumors Astrocytoma WHO Grading Grade I: small subset Grade II: Low-grade astrocytoma Grade III: Anaplastic astrocytoma Grade IV: Glioblastoma multiforme (GBM)

Low-grade Astrocytoma

Anaplastic Astrocytoma

GBM

Gliomatosis Cerebri

Management of GBM Pre-operative Full brain MRI with STEALTH MR tractography Post-op day #1 Follow-up at 2-3 months, and further As needed, with new symptoms

Management of GBM Pre-operative Full brain MRI with STEALTH MR tractography Post-op day #1 Follow-up at 2-3 months, and further As needed, with new symptoms

Management of GBM Pre-operative Full brain MRI with STEALTH MR tractography Post-op day #1 Follow-up at 2-3 months, and further As needed, with new symptoms

MR Tractography

Disorganized water Water organized along neurons

MR Tractography

Management of GBM Pre-operative Post-op day #1 Follow-up at 2-3 months, and further As needed, with new symptoms

Management of GBM Pre-operative Post-op day #1 Follow-up at 2-3 months, and further As needed, with new symptoms 18 mo.

Pt #2: Two follow-up scans Dec 2007Jan 2008

Pt #3: Multiple follow-up scans 1 mo.Post-opPre-op

Pt #3: Multiple follow-up scans 1 mo.8 mo.4 mo.Post-opPre-op

Pt #4: Follow-up scan

?

Challenge of Pseudo-progression We have great difficulty distinguishing real from pseudo Modalities that we utilize PET MR spectroscopy MR perfusion

Positron Emission Tomography (PET)

MR Spectroscopy

MR Perfusion

Summary What is a Neuroradiologist? Neuroradiology modalities CT MRI PET Astrocytomas Grades and appearances Radiologic follow-up Challenges and advanced techniques

Suggestions Know if a Neuroradiologist is involved with your care Know if your hospital has a Brain Tumor Board Know if the imaging facility can perform advanced techniques Get your scans at one place!

Thank You Any questions, medical or personal? me at