Imaging
Brain metastases
- Preliminary Diagnosis: Brain Metastases
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of brain metastases.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of brain abscesses.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Brain Metastases
I. What imaging technique is first-line for this diagnosis?
MRI imaging of the brain with intravenous contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of brain metastases.
Advantages
Highly suggestive of etiology in appropriate clinical situation
Able to localize exact anatomic area of disease and as a result predict any current or potential neurologic compromise
Can assess for secondary complications such as mass effect, midline shift, hemorrhage, etc
Does not utilize ionizing radiation
Disadvantages
Expensive
Time consuming and requires significant patient cooperation
Very susceptible to motion artifact
MRI with IV contrast requires a renal function of at least GFR >30
III. What are the contraindications for the first-line imaging technique?
MRI is contraindicated in patients with non-MR-compatible metallic hardware or foreign body.
IV. What alternative imaging techniques are available?
Enhanced and nonenhanced CT
PET/CT
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of brain abscesses.
Enhanced (intravenous contrast) and nonenhanced CT
Advantages
May be performed much quicker than MRI
Can be performed on unstable patients
Associated with less motion artifact
Disadvantages
Often misses lesions unless hemorrhagic, calcified, or associated with significant vasogenic edema
Demonstrates less anatomic detail and contrast resolution compared with MRI
Exposes the patient to ionizing radiation
PET/CT
Advantages
High sensitivity and specificity for detecting tumors
Often used to distinguish between neoplasm and radiation necorsis, a common mimicker
Can often differentiate benign versus malignant lesions based on hypermetabolism
Ability to detect distant disease affecting staging and therapy
Disadvantages
High degree of radiation exposure to patient
Cannot detect small lesions (i.e. less than 1.5 cm)
Limited anatomic detail
VI. What are the contraindications for the alternative imaging techniques?
Enhanced and nonenhanced CT imaging
Contraindicated in pregnant patients. especially within the first two trimesters
IV contrast is relatively contraindicated in patients with contrast or iodine allergy. If IV contrast is necessary, the patient must be prepped with antihistamines and corticosteroids.
Relative contraindication in patients with renal dysfunction
PET/CT
Contraindicated in pregnant patients especially within the first two trimesters
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