Imaging
Neurofibromatosis
- Preliminary Diagnosis: Neurofibromatosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of neurofibromatosis.
-
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 neurofibromatosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Neurofibromatosis
I. What imaging technique is first-line for this diagnosis?
MRI imaging of the brain and spine with contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of neurofibromatosis.
Advantages
Diagnostic in the appropriate clinical setting
Able to determine both the extent and type of intracranial anomaly associated with NF1/NF2
Does not utilize ionizing radiation
Disadvantages
Expensive
Time consuming
Requires significant patient cooperation to minimize motion artifact
Requires the patient have adequate renal function (ie, GFR > 30 )
III. What are the contraindications for the first-line imaging technique?
Contraindicated in patients with poor renal function (ie, GFR < 30)
Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies
IV. What alternative imaging techniques are available?
Contrast-enhanced CT
Catheter-based angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of neurofibromatosis.
Contrast-enhanced CT
Advantages
Quicker and less expensive than MR imaging
Less prone to motion artifact
More adept than MR at detecting associated osseous abnormalities such as sphenoid and occipital bone dysplasias, spinal scoliosis, etc
Disadvantages
Has both a lower sensitivity and specificity in detecting associated intracranial abnormalities
Not able to depict early parenchymal brain changes associated with neurofibromatosis and has less anatomic detail than MRI
Exposes the patient to ionizing radiation
Catheter Angiography
Advantages
Gold standard in detecting associated vascular lesions of NF such as aneurysms/AVMs, stenoses, etc
Can be used as both diagnostic and therapeutic modality
Disadvantages
Invasive procedure
Limited to only vascular findings associated with NF
Time consuming
Exposes the patient to a high degree of ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
Contrast-enhanced CT
Contraindicated in pregnant patients, especially during the first two trimesters
Contraindicated in patients with poor renal function
Catheter Angiography
Contraindicated in patients in a hypocoagulable state (ie, platelets < 50,000 and INR > 2)
Contraindicated in pregnant patients
Contraindicated in patients with poor renal function
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