Imaging

Tuberous Sclerosis

Preliminary Diagnosis: Tuberous sclerosis

I. What imaging technique is first-line for this diagnosis

  • MRI with contrast

  • MR spectroscopy can be performed for accurately diagnosing associated cortical tubers and subependymal nodules

II. Describe the advantages and disadvantages of this technique for diagnosis of tuberous sclerosis.

Advantages

  • Often diagnostic in the appropriate clinical setting.

  • Useful as a surveillance imaging technique in young children and adolescents in monitoring for development of subependymal giant cell astrocytoma (SEGA)

  • Able to localize anatomically and define the extent of disease better than any other imaging modality

  • Does not utilize ionizing radiation

Disadvantages

  • Expensive

  • Time-consuming

  • Prone to motion artifact

  • Unable to differentiate quiescent tubers from active tubers that are associated with a seizure focus

  • MR with contrast can be used only in patients with adequate renal function (i.e., GFR >30)

III. What are the contraindications for the first-line imaging technique?

  • Patients with non-MR compatible metallic hardware and certain foreign bodies

IV. What alternative imaging techniques are available?

  • Contrast enhanced and non-contrast enhanced CT

  • PET/SPECT nuclear medicine imaging

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tuberous sclerosis.

Contrast enhanced and non-contrast CT

Advantages

  • Able to detect enhancing subependymal nodules (SEN) characteristic in tuberous sclerosis

  • Can be used to follow enlarging SEN worrisome for developing SEGA

  • Can be used to detect calcified SEN and cortical/subcortical tubers to better effect than MRI

  • Faster than MRI and less susceptible to motion artifact

Disadvantages

  • Lacks anatomic resolution of MRI

  • Not as sensitive or specific as MRI in the detection of cranial lesions associated with tuberous sclerosis

  • Exposes the patient to ionizing radiation

PET/SPECT nuclear medicine imaging

Advantages

  • Able to differentiate active from non-active cortical/subcortical tubers, which in turn helps surgical planning if necessary

  • Able to differentiate epileptogenic foci in tuberous sclerosis

  • Able to differentiate SEGA from SEN

Disadvantages

  • Lacks anatomic resolution compared with both CT and MR

  • Easily misses lesions under 1.5 cm in size

  • Exposes the patient to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

Contrast enhanced and non-contrast CT

  • Contraindicated in pregnant patients, especially during the first two trimesters.

  • CT with contrast is contraindicated in patients with end-stage renal disease who are not on dialysis.

PET/SPECT nuclear medicine imaging

  • Contraindicated in pregnant patients

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs

Sign Up for Free e-newsletters