Preliminary Diagnosis: Cerebellar hemangioblastoma
I. What imaging technique is first-line for this diagnosis
MRI with and without contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of cerebellar hemangioblastoma.
Advantages
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Provides highest anatomic resolution while also allowing evaluation of sequelae such as mass effect
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Has the highest sensitivity for detecting small lesions
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MRI of the spine can also be obtained, as concurrent spinal hemangioblastomas are common
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Used as a screening tool in patients over 10 years of age with diagnosis of von Hippel-Lindau disease
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No ionizing radiation is used
Disadvantages
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MRI requires patient cooperation to minimize motion artifact as the examination time is lengthy.
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MRI is expensive.
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Adequate renal function with GFR >60 is needed for IV contrast administration. Patients with GFR between 30 and 60 can be evaluated for contrast administration on a case-by-case basis.
III. What are the contraindications for the first-line imaging technique?
MRI is contraindicated in patients with non-MR-compatible metallic hardware or foreign bodies.
IV. What alternative imaging techniques are available?
CT of the brain with and without IV contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cerebellar hemangioblastoma.
CT of the brain with and without IV contrast
Advantages
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Examination can be obtained quickly, which reduces the chances of significant motion artifact in an uncooperative patient.
Disadvantages
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Decreased sensitivity and anatomic detail compared with MRI
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Adequate renal function required for IV contrast administration, generally creatinine <1.7
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Uses ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
CT of the brain with and without IV contrast
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CT is contraindicated in pregnant patients.
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