BRAINSTORMBRAINSTORM

UnderstandingDiagnostic Scans:MRI, CT, PET AND MORE

Stanley Lu, MDDirector, Neuroradiology

Monmouth Medical Center

March 5, 2012

NeuroradiologyNeuroradiology

What is a Neuroradiologist?

Design imaging protocols

Interpret scans - make diagnosis

Provide reports

Consult with the Brain Tumor Team

Suggest follow-up plan

NeuroradiologyNeuroradiology

Imaging of the brainTumorsStrokeInfection

Imaging of the spine

NeuroradiologyNeuroradiology

Imaging modalitiesComputed tomography (CT)Magnetic resonance imaging (MRI)

Advanced techniques

Positron emission tomography (PET)

Diagnosis - Different appearances for different tumors

NeuroradiologyNeuroradiology

Post-operative assessment

Tumor monitoringChallenges

CT TechniqueCT Technique

CT TechniqueCT Technique

CT TechniqueCT Technique

CT TechniqueCT Technique

CT TechniqueCT Technique

MRI TechniqueMRI Technique

MRI TechniqueMRI Technique

What is MRI?

How does it work?

MRI TechniqueMRI Technique

MRI TechniqueMRI Technique

Z-axis

MRI TechniqueMRI Technique

Z-axis

MRI TechniqueMRI Technique

MRI TechniqueMRI Technique

MRI AdvantagesMRI Advantages

Superior contrast resolutionespecially for soft tissue

MultiplanarNo ionizing radiation

MRI DisadvantagesMRI Disadvantages

Higher costLower availabilityLonger study

increased chance of patient motion

ClaustrophobiaMetallic implants contraindicated

pacemakers, aneurysm clips, etc.

Brain TumorsBrain Tumors

Brain TumorsBrain Tumors

Metastatic diseaseMeningiomaPrimary brain tumors

AstrocytomaOligodendrogliomaLymphoma

Brain TumorsBrain Tumors

Metastatic diseaseMeningiomaPrimary brain tumors

AstrocytomaOligodendrogliomaLymphoma

Metastatic DiseaseMetastatic Disease

Pt with melanoma

Brain TumorsBrain Tumors

Metastatic diseaseMeningiomaPrimary brain tumors

AstrocytomaOligodendrogliomaLymphoma

MeningiomaMeningioma

Brain TumorsBrain Tumors

Metastatic diseaseMeningiomaPrimary brain tumors

AstrocytomaOligodendrogliomaLymphoma

Brain TumorsBrain Tumors

Astrocytoma WHO GradingGrade I: small subsetGrade II: Low-grade astrocytomaGrade III: Anaplastic astrocytomaGrade IV: Glioblastoma multiforme (GBM)

Low-grade AstrocytomaLow-grade Astrocytoma

Anaplastic AstrocytomaAnaplastic Astrocytoma

GBMGBM

Gliomatosis CerebriGliomatosis Cerebri

Management of GBMManagement of GBM

Pre-operativeFull brain MRI with STEALTHMR tractography

Post-op day #1Follow-up at 2-3 months, and furtherAs needed, with new symptoms

Management of GBMManagement of GBM

Pre-operativeFull brain MRI with STEALTHMR tractography

Post-op day #1Follow-up at 2-3 months, and furtherAs needed, with new symptoms

Management of GBMManagement of GBM

Pre-operativeFull brain MRI with STEALTHMR tractography

Post-op day #1Follow-up at 2-3 months, and furtherAs needed, with new symptoms

MR TractographyMR Tractography

MR TractographyMR Tractography

Disorganized water Water organizedalong neurons

MR TractographyMR Tractography

MR TractographyMR Tractography

MR TractographyMR Tractography

Management of GBMManagement of GBM

Pre-operativePost-op day #1Follow-up at 2-3 months, and furtherAs needed, with new symptoms

Management of GBMManagement of GBM

Pre-operativePost-op day #1Follow-up at 2-3 months, and furtherAs needed, with new symptoms

18 mo.

Pt #2: Two follow-up scansPt #2: Two follow-up scans

Dec 2007 Jan 2008

Pt #3: Multiple follow-up scans Pt #3: Multiple follow-up scans

1 mo.Post-opPre-op

Pt #3: Multiple follow-up scans Pt #3: Multiple follow-up scans

1 mo. 8 mo.4 mo.Post-opPre-op

Pt #4: Follow-up scanPt #4: Follow-up scan

Pt #4: Follow-up scanPt #4: Follow-up scan

?

Pt #4: Follow-up scanPt #4: Follow-up scan

Challenge of Pseudo-progressionChallenge of Pseudo-progression

We have great difficulty distinguishing real from pseudo

Modalities that we utilizePETMR spectroscopyMR perfusion

Positron Emission Tomography (PET)Positron Emission Tomography (PET)

Positron Emission Tomography (PET)Positron Emission Tomography (PET)

Positron Emission Tomography (PET)Positron Emission Tomography (PET)

Positron Emission Tomography (PET)Positron Emission Tomography (PET)

MR SpectroscopyMR Spectroscopy

MR SpectroscopyMR Spectroscopy

MR SpectroscopyMR Spectroscopy

MR SpectroscopyMR Spectroscopy

MR PerfusionMR Perfusion

MR PerfusionMR Perfusion

MR PerfusionMR Perfusion

SummarySummary

What is a Neuroradiologist?Neuroradiology modalities

CTMRIPET

AstrocytomasGrades and appearancesRadiologic follow-upChallenges and advanced techniques

SuggestionsSuggestions

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 YouThank You

Any questions, medical or personal?Email me at slu@barnabashealth.org