Imaging

Glioma

Preliminary Diagnosis: Glioma

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

  • MR imaging of the brain with intravenous (IV) contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of glioma.

Advantages

  • Diagnostic in the appropriate clinical setting

  • Can localize the area of abnormality

  • Can assess for any secondary complications

  • Does not use ionizing radiation

Disadvantages

  • Time-consuming and expensive

  • Prone to motion artifact and requires a significant degree of patient cooperation

  • 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?

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

IV. What alternative imaging techniques are available?

  • CT with IV contrast

  • 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

  • Can be performed quickly and is not nearly as expensive as MRI

  • Associated with less motion artifact than MRI

  • Can assess for secondary complications, though not to the same extent as MRI

Disadvantages

  • Does not provide the same anatomic detail as MRI

  • Lacks the specificity of MRI

  • Exposes the patient to ionizing radiation

FDG-PET

Advantages

  • Can differentiate high-grade from low-grade gliomas based on degree of radiopharmaceutical uptake

  • Can detect distant metastatic disease

Disadvantages

  • Exposes the patient to high radiation dose

  • Lacks specificity and anatomic detail of MRI

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

CT with IV contrast

  • Generally contraindicated in pregnant patients, especially during the first two trimesters

FDG-PET

  • PET imaging is also contraindicated during pregnancy.

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