Preliminary Diagnosis: Glioma
I. What imaging technique is first-line for this diagnosis
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MR imaging of the brain with intravenous (IV) contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of glioma.
Advantages
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Diagnostic in the appropriate clinical setting
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Can localize the area of abnormality
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Can assess for any secondary complications
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Does not use ionizing radiation
Disadvantages
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Time-consuming and expensive
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Prone to motion artifact and requires a significant degree of patient cooperation
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IV contrast is limited to patients with adequate renal function (i.e., GFR >30)
III. What are the contraindications for the first-line imaging technique?
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Contraindicated in patients with non-MR compatible hardware or foreign bodies
IV. What alternative imaging techniques are available?
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CT with IV contrast
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18-Fluoro-deoxyglucose positron emission tomography (FDG-PET)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of glioma.
CT with IV contrast
Advantages
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Can be performed quickly and is not nearly as expensive as MRI
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Associated with less motion artifact than MRI
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Can assess for secondary complications, though not to the same extent as MRI
Disadvantages
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Does not provide the same anatomic detail as MRI
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Lacks the specificity of MRI
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Exposes the patient to ionizing radiation
FDG-PET
Advantages
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Can differentiate high-grade from low-grade gliomas based on degree of radiopharmaceutical uptake
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Can detect distant metastatic disease
Disadvantages
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Exposes the patient to high radiation dose
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Lacks specificity and anatomic detail of MRI
VI. What are the contraindications for the alternative imaging techniques?
CT with IV contrast
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Generally contraindicated in pregnant patients, especially during the first two trimesters
FDG-PET
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PET imaging is also contraindicated during pregnancy.
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