Emergency Imaging of Brain Tumors: Introduction/Role of Imaging
Hi everyone! In this video, we’re going to talk about the emergent imaging of brain tumors, particularly as it applies to a general approach when you might see patients like this coming through the emergency department. We’ll have a special emphasis on computed tomography throughout this lecture. This is the ideal lecture for someone who practices neuroradiology and sees some patients with brain tumors, but isn’t exactly a brain tumor expert.
Role of imaging brain tumors in emergencies. There are 2 main tools for imaging brain tumors, CT and MRI. CT is the screening tool for initial identification of a potential mass and then evaluating complications such as hemorrhage, edema, mass effect, hydrocephalus, and herniation. However, MRI is the mainstay of tumor evaluation used for evaluation of tumor type, tumor worsening, and tumor details.
MRI. MRI is used to make a more specific initial diagnosis, for pre-treatment planning, and for follow-up after surgery and treatment. It will almost always have FLAIR, diffusion weighted imaging (DWI), and pre- and post-contrast T1 imaging. A few other tools are used for troubleshooting, such as perfusion and functional MRI (fMRI).
FLAIR. This is a key sequence for evaluating a mix of edema and infiltrative tumor. It is the best comparison for CT
Pre- and post-contrast T1. Areas of post-contrast enhancement show areas of breakdown of the blood brain barrier. This can happen when the tumor itself has disrupted it or when there has been tissue damage from radiation therapy. More aggressive tumors have more enhancement
Role of emergent imaging. When a patient comes to the ER, if a patient doesn’t have a known tumor, you might use it to identify a potential tumor, give a practical differential, and recommend next steps. In patients with tumors, you might use it to identify urgent complications. The role of emergent imaging is not to give an exact diagnosis or assess tumor progression.
Summary. In this video, we have covered some of the basics of imaging patients with brain tumors in emergent situations, including when CT and MRI are most appropriate.
This is the first lecture in this series about imaging brain tumors in the emergent setting. Hopefully you learned a little bit about the role of different imaging types. The next lectures are going to discuss some additional topics in detail, including how to classify these tumors, how to interpret common imaging studies, and how to avoid red flags.
Thanks for tuning in. Be sure to check out the other videos on the brain tumor topic page if you want to learn more about brain tumors.