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BRAINSTORM

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62 diapositives · 853 Views · Sep 07, 2014

BRAINSTORM. Understanding Diagnostic Scans: MRI, CT, PET AND MORE. Stanley Lu, MD Director, Neuroradiology Monmouth Medical Center March 5, 2012. Neuroradiology. What is a Neuroradiologist? Design imaging protocols Interpret scans - make diagnosis Provide reports

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  1. BRAINSTORM Understanding Diagnostic Scans: MRI, CT, PET AND MORE Stanley Lu, MD Director, Neuroradiology Monmouth Medical Center March 5, 2012

  2. Neuroradiology • What is a Neuroradiologist? • Design imaging protocols • Interpret scans - make diagnosis • Provide reports • Consult with the Brain Tumor Team • Suggest follow-up plan

  3. Neuroradiology • Imaging of the brain • Tumors • Stroke • Infection • Imaging of the spine

  4. Neuroradiology • Imaging modalities • Computed tomography (CT) • Magnetic resonance imaging (MRI) • Advanced techniques • Positron emission tomography (PET) • Diagnosis - Different appearances for different tumors

  5. Neuroradiology • Post-operative assessment • Tumor monitoring • Challenges

  6. CT Technique

  7. CT Technique

  8. CT Technique

  9. CT Technique

  10. CT Technique

  11. MRI Technique

  12. MRI Technique • What is MRI? • How does it work?

  13. MRI Technique

  14. MRI Technique Z-axis

  15. MRI Technique Z-axis

  16. MRI Technique

  17. MRI Technique

  18. MRI Advantages • Superior contrast resolution • especially for soft tissue • Multiplanar • No ionizing radiation

  19. MRI Disadvantages • Higher cost • Lower availability • Longer study • increased chance of patient motion • Claustrophobia • Metallic implants contraindicated • pacemakers, aneurysm clips, etc.

  20. Brain Tumors

  21. Brain Tumors • Metastatic disease • Meningioma • Primary brain tumors • Astrocytoma • Oligodendroglioma • Lymphoma

  22. Brain Tumors • Metastatic disease • Meningioma • Primary brain tumors • Astrocytoma • Oligodendroglioma • Lymphoma

  23. Metastatic Disease • Pt with melanoma

  24. Brain Tumors • Metastatic disease • Meningioma • Primary brain tumors • Astrocytoma • Oligodendroglioma • Lymphoma

  25. Meningioma

  26. Brain Tumors • Metastatic disease • Meningioma • Primary brain tumors • Astrocytoma • Oligodendroglioma • Lymphoma

  27. Brain Tumors • Astrocytoma WHO Grading • Grade I: small subset • Grade II: Low-grade astrocytoma • Grade III: Anaplastic astrocytoma • Grade IV: Glioblastoma multiforme (GBM)

  28. Low-grade Astrocytoma

  29. Anaplastic Astrocytoma

  30. GBM

  31. Gliomatosis Cerebri

  32. Management of GBM • Pre-operative • Full brain MRI with STEALTH • MR tractography • Post-op day #1 • Follow-up at 2-3 months, and further • As needed, with new symptoms

  33. Management of GBM • Pre-operative • Full brain MRI with STEALTH • MR tractography • Post-op day #1 • Follow-up at 2-3 months, and further • As needed, with new symptoms

  34. Management of GBM • Pre-operative • Full brain MRI with STEALTH • MR tractography • Post-op day #1 • Follow-up at 2-3 months, and further • As needed, with new symptoms

  35. MR Tractography

  36. MR Tractography Disorganized water Water organized along neurons

  37. MR Tractography

  38. MR Tractography

  39. MR Tractography

  40. Management of GBM • Pre-operative • Post-op day #1 • Follow-up at 2-3 months, and further • As needed, with new symptoms

  41. Management of GBM • Pre-operative • Post-op day #1 • Follow-up at 2-3 months, and further • As needed, with new symptoms 18 mo.

  42. Pt #2: Two follow-up scans Dec 2007 Jan 2008

  43. Pt #3: Multiple follow-up scans Pre-op Post-op 1 mo.

  44. Pt #3: Multiple follow-up scans Pre-op Post-op 1 mo. 4 mo. 8 mo.

  45. Pt #4: Follow-up scan

  46. Pt #4: Follow-up scan ?

  47. Pt #4: Follow-up scan

  48. Challenge of Pseudo-progression • We have great difficulty distinguishing real from pseudo • Modalities that we utilize • PET • MR spectroscopy • MR perfusion

  49. Positron Emission Tomography (PET)

  50. Positron Emission Tomography (PET)