Preliminary Diagnosis: Primary Brain Tumors

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

MR imaging of the brain with IV contrast

II. Describe the advantages and disadvantages of this technique for diagnosing primary brain tumors.

Advantages

  • Diagnostic with positive pertinent findings in the correct clinical situation.

  • Able to localize the area of abnormality better than any other modality.

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  • Evaluates for secondary complications such as hemorrhage, mass effect, midline shift, etc.

  • Does not utilize ionizing radiation.

Disadvantages

  • Exposure to radiation.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • MR with contrast is contraindicated in patients with renal disease (i.e. GFR < 30).

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

Contraindicated in patients with non-MR compatible metallic hardware or foreign bodies.

IV. What alternative imaging techniques are available?

  • FDG – PET

  • CT with contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing primary brain tumors.

FDG-PET
Advantages

  • Able to distinguish benign and malignant lesions based on degree of radiopharmaceutical uptake (i.e., a low grade glioma will demonstrate significantly less uptake than a high grade glioma).

  • Able to detect distant metastatic disease.

Disadvantages

  • Exposes the patient to a high degree of radiation.

  • Lacks the anatomic detailing of MRI and is unable to detect many secondary neurological complications.

  • Unable to fully characterize properties of neoplasm to the degree that MRI can.

CT with contrast
Advantages

  • Less expensive, quicker, and requires less patient cooperation than MRI.

  • Can determine many secondary complications, such as hemorrhage, mass effect, midline shift, etc.

  • Better than MRI at detecting calcified neoplasms.

Disadvantages

  • Lacks specificity and anatomic detailing of MRI.

  • Exposes patient to ionizing radiation.

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

FDG-PET

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

CT with contrast

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

  • Relative contraindication in patients with renal failure.

  • Relative contraindication in patients with allergy to contrast.

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