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Transcript of BRAINSTORM Understanding Diagnostic Scans: MRI, CT, PET AND MORE Stanley Lu, MD Director,...
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 [email protected]