The document summarizes the history and evolution of brain tumor imaging from X-rays to modern techniques like MRI, PET, and genetic analysis. It describes how early techniques like pneumoencephalography and myelography helped visualize parts of the brain and identify tumors. Later, MRI emerged and advanced with techniques like DWI, DTI, perfusion imaging, and MR spectroscopy that provided greater diagnostic ability. Modern imaging now combines genetic data with high-field MRI to better characterize tumors and guide treatment.
This document describes a rare case of a 72-year-old man with papillary thyroid cancer that has metastasized to his lungs. Papillary thyroid cancer typically grows slowly and rarely spreads, but this patient presented with an enlarged thyroid gland and numerous lung nodules. A biopsy confirmed the diagnosis of papillary thyroid cancer. He underwent surgery to remove his thyroid gland and neck lymph nodes. While the long-term prognosis is generally favorable for differentiated thyroid cancer that has metastasized, this case represented an advanced stage of the disease.
This document discusses diagnostic imaging techniques for evaluating lymph nodes in patients with head and neck cancer. It describes the use of ultrasound, CT, MRI, diffusion-weighted MRI, and PET imaging to analyze lymph node characteristics like size, shape, margins, echogenicity, necrosis and vascularity which can help differentiate between metastatic, inflammatory and normal lymph nodes. Quantitative measurements like ADC from diffusion MRI and SUV from PET can also provide diagnostic information and predict cancer spread and treatment response.
Imaging HNF(head neck and face) -canceramol lahoti
1. Imaging plays an important role in head and neck cancer for tumor detection, characterization, staging, treatment planning, and monitoring treatment response and recurrence. MRI is often the preferred initial imaging modality, while CT and PET are also used.
2. Ultrasound is useful for imaging neck lymph nodes and salivary glands. CT is better for evaluating bone involvement. PET is used for detecting distant metastases.
3. Imaging also guides biopsies and interventions such as embolization prior to surgery. Advances include functional MRI, PET/CT, and intra-arterial chemotherapy.
This document discusses the use of computerized tomography (CT) and positron emission tomography (PET) in evaluating the central nervous system. CT is useful for imaging many neurological conditions such as trauma, tumors, strokes, and infections. It provides anatomical details quickly and is widely available, but MRI generally provides better soft tissue contrast. PET combined with CT or MRI provides functional imaging of brain metabolism and is useful for conditions like Alzheimer's disease, Parkinson's disease, seizures, and cancers. Both CT and PET have advantages and limitations and are generally used together with other clinical information for diagnosis and management of neurological diseases.
Literature Review Of Management Of Pineal Region TumourLiew Boon Seng
- Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults and 3.0-8.0% of brain tumors in children, with most children presenting between ages 10-20 years old.
- MRI with gadolinium is used to evaluate pineal region lesions and assess characteristics like size, vascularity and borders, though tumor type cannot be determined reliably from imaging alone.
- Histopathological examination is needed for diagnosis, as germ cell tumors are the most common in children and include germinomas and other tumors derived from totipotential germ cells.
Meningeal hemangiopericytoma is an aggressive brain tumor that originates from meningeal cells. While sometimes misdiagnosed as meningioma, it is distinct in that it can metastasize outside the brain. The document discusses the clinical, radiographic, and pathological features of meningeal hemangiopericytoma. Treatment involves surgical resection along with radiation and chemotherapy, but recurrence and metastasis remain high. Prognosis is generally poor with 5-year survival rates around 60%.
This document provides information about lymphoma, including Hodgkin lymphoma and non-Hodgkin lymphoma. It discusses the workup, tests, staging, prognostic factors like the International Prognostic Index, treatments, and management of lymphoma in both inpatient and outpatient settings. Key points covered include diagnostic testing like biopsies, immunophenotyping, common genetic translocations, associations with infections, and treatment approaches depending on factors like tumor stage and grade.
1) Molecular approaches are increasingly being used to predict oral cancer behavior, prognosis, guide treatment and surveillance through analysis of alterations in genes like p53 and CDKN2A.
2) Molecular analysis of surgical margins can identify occult tumor cells not seen on histology, as margins may contain genetic alterations increasing risk of recurrence.
3) The concept of "field cancerization" recognizes that oral cancers arise from areas of the mouth with multiple precancerous cells due to carcinogen exposure, increasing risk of additional primary cancers.
This document describes a rare case of a 72-year-old man with papillary thyroid cancer that has metastasized to his lungs. Papillary thyroid cancer typically grows slowly and rarely spreads, but this patient presented with an enlarged thyroid gland and numerous lung nodules. A biopsy confirmed the diagnosis of papillary thyroid cancer. He underwent surgery to remove his thyroid gland and neck lymph nodes. While the long-term prognosis is generally favorable for differentiated thyroid cancer that has metastasized, this case represented an advanced stage of the disease.
This document discusses diagnostic imaging techniques for evaluating lymph nodes in patients with head and neck cancer. It describes the use of ultrasound, CT, MRI, diffusion-weighted MRI, and PET imaging to analyze lymph node characteristics like size, shape, margins, echogenicity, necrosis and vascularity which can help differentiate between metastatic, inflammatory and normal lymph nodes. Quantitative measurements like ADC from diffusion MRI and SUV from PET can also provide diagnostic information and predict cancer spread and treatment response.
Imaging HNF(head neck and face) -canceramol lahoti
1. Imaging plays an important role in head and neck cancer for tumor detection, characterization, staging, treatment planning, and monitoring treatment response and recurrence. MRI is often the preferred initial imaging modality, while CT and PET are also used.
2. Ultrasound is useful for imaging neck lymph nodes and salivary glands. CT is better for evaluating bone involvement. PET is used for detecting distant metastases.
3. Imaging also guides biopsies and interventions such as embolization prior to surgery. Advances include functional MRI, PET/CT, and intra-arterial chemotherapy.
This document discusses the use of computerized tomography (CT) and positron emission tomography (PET) in evaluating the central nervous system. CT is useful for imaging many neurological conditions such as trauma, tumors, strokes, and infections. It provides anatomical details quickly and is widely available, but MRI generally provides better soft tissue contrast. PET combined with CT or MRI provides functional imaging of brain metabolism and is useful for conditions like Alzheimer's disease, Parkinson's disease, seizures, and cancers. Both CT and PET have advantages and limitations and are generally used together with other clinical information for diagnosis and management of neurological diseases.
Literature Review Of Management Of Pineal Region TumourLiew Boon Seng
- Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults and 3.0-8.0% of brain tumors in children, with most children presenting between ages 10-20 years old.
- MRI with gadolinium is used to evaluate pineal region lesions and assess characteristics like size, vascularity and borders, though tumor type cannot be determined reliably from imaging alone.
- Histopathological examination is needed for diagnosis, as germ cell tumors are the most common in children and include germinomas and other tumors derived from totipotential germ cells.
Meningeal hemangiopericytoma is an aggressive brain tumor that originates from meningeal cells. While sometimes misdiagnosed as meningioma, it is distinct in that it can metastasize outside the brain. The document discusses the clinical, radiographic, and pathological features of meningeal hemangiopericytoma. Treatment involves surgical resection along with radiation and chemotherapy, but recurrence and metastasis remain high. Prognosis is generally poor with 5-year survival rates around 60%.
This document provides information about lymphoma, including Hodgkin lymphoma and non-Hodgkin lymphoma. It discusses the workup, tests, staging, prognostic factors like the International Prognostic Index, treatments, and management of lymphoma in both inpatient and outpatient settings. Key points covered include diagnostic testing like biopsies, immunophenotyping, common genetic translocations, associations with infections, and treatment approaches depending on factors like tumor stage and grade.
1) Molecular approaches are increasingly being used to predict oral cancer behavior, prognosis, guide treatment and surveillance through analysis of alterations in genes like p53 and CDKN2A.
2) Molecular analysis of surgical margins can identify occult tumor cells not seen on histology, as margins may contain genetic alterations increasing risk of recurrence.
3) The concept of "field cancerization" recognizes that oral cancers arise from areas of the mouth with multiple precancerous cells due to carcinogen exposure, increasing risk of additional primary cancers.
The document provides information on brain tumors including definition, types, incidence, clinical presentation, diagnosis, and treatment. It notes that brain tumors are abnormal cell growth within the brain and discusses primary and secondary tumors. Diagnosis involves medical history, exams, imaging like CT/MRI, and biopsy. Treatment may include surgery, chemotherapy, radiation therapy, and stereotactic radiosurgery. Rehabilitation is also important for regaining abilities affected by the tumor.
1) Wilhelm Roentgen discovered X-rays in 1895 and Arthur Schiiller studied skull X-rays systematically, establishing neuroradiology. 2) Advances like ventriculography and cerebral angiography in the early 20th century allowed visualization of the brain. 3) Magnetic resonance imaging was developed in the 1940s-1980s and became the preferred method for evaluating brain tumors due to its superior soft tissue contrast compared to CT.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
This document summarizes key MRI features of common pediatric posterior fossa and suprasellar tumors. It discusses pilocytic astrocytoma, medulloblastoma, atypical teratoid-rhabdoid tumor, ependymoma, brainstem glioma, hemangioblastoma, craniopharyngioma, and hypothalamic hamartoma. For each tumor type, it describes typical location, imaging appearance on various MRI sequences, distinguishing imaging characteristics, and differential diagnosis considerations.
Intracranial chordomas are rare, slow-growing tumors that arise from remnants of the embryonic notochord in the skull base. They typically present as soft tissue masses originating in the clivus with associated bone destruction. MR imaging and CT are effective in diagnosing and monitoring these tumors. Treatment involves surgical resection followed by radiation therapy, which provides the best outcomes for patients with intracranial chordomas.
This document provides a summary of imaging features of lesions in the anterior skull base region, including sinonasal neoplasms such as squamous cell carcinoma, adenocarcinoma, esthesioneuroblastoma, malignant melanoma, and lymphoma. Key imaging findings discussed include tumor appearance on CT and MRI, characteristics of bone and soft tissue involvement, and distinguishing features between lesion types. Imaging plays an important role in diagnosis and surgical planning for anterior skull base pathology.
This document presents a case report of a rare occurrence of basal cell adenoma in the palate of a 25-year-old male patient. It describes the clinical findings and diagnostic workup including imaging, biopsy, histopathological examination, and immunohistochemical analysis of the excised tumor. The pathological features were consistent with basal cell adenoma. The tumor was successfully removed surgically and the patient recovered well, with the tumor representing an unusual site for this rare minor salivary gland tumor.
This document discusses various imaging modalities and protocols for evaluating different neurological, head and neck conditions. It recommends MRI with diffusion weighted imaging and T2* sequences for evaluating acute cerebral infarction. For hypertensive intracranial hemorrhage, it recommends non-contrast CT for initial screening in older patients with hypertension and high suspicion, and MRI if acute ischemic stroke is suspected. For subdural hematomas, non-contrast CT is recommended for initial screening.
This document discusses the use of color Doppler sonography and sonohysterography to evaluate abnormal vaginal bleeding. It finds that:
1. Color Doppler sonography (CDS) can detect vessels in both benign and malignant endometrial lesions, but the number of vessels seen correlates with malignancy risk. More vessels were seen in lesions with higher microvessel density.
2. A study of 25 women found CDS could distinguish between endometrial polyps and submucosal fibroids based on vascularity patterns. Polyps typically had a single feeding vessel while fibroids had multiple vessels from the myometrium. Lesions with more vessels >0.5mm on CDS also had higher microvessel
A 58-year-old man presented with a seizure and loss of consciousness. Neuroimaging revealed a highly vascularized 5.7 x 5 cm solid mass in his right temporo-parietal region. Biopsy determined the mass was a solid supratentorial hemangioblastoma, a rare tumor. Further tests ruled out Von Hippel-Lindau disease. The patient underwent partial resection of the mass, improving his symptoms. Solid supratentorial hemangioblastomas occurring as single lesions unrelated to Von Hippel-Lindau disease are infrequent and atypical clinical presentations like this case are rarely reported.
Validity of sentinel node biopsy in early oral and oropharyngeal carcinomaDibya Falgoon Sarkar
This study evaluated the validity of sentinel node biopsy in early oral and oropharyngeal carcinoma to determine if it can help avoid unnecessary elective neck dissections. The study found that sentinel node biopsy identified occult metastases in 12 of 36 patients (33.3%), suggesting that neck dissection may be overtreatment for many patients. Sentinel nodes correctly identified metastases in 14 of 15 cases. While the study was limited by its small size and retrospective design, the results suggest sentinel node biopsy could help reduce overtreatment through more precise staging of early-stage cancers. Larger prospective studies are still needed to establish sentinel node biopsy as a reliable alternative to elective neck dissection.
MR spectroscopy by Dr. Nida Kanwal, Neurosurgery, Liaquat National Hospitalnoorulainiqbal
MR spectroscopy provides a non-invasive way to measure brain chemistry by detecting metabolic biomarkers. It can help characterize tumors, infections, strokes and neurodegenerative diseases. Placement of the voxel for spectroscopy is important to include the area of interest while avoiding areas like necrosis. Various metabolites are measured including NAA, creatine and choline to determine the nature of the lesion. MR spectroscopy is an advanced technique that is added on to conventional MRI scans.
This document provides tips for using a PowerPoint presentation on lymphangioma and cystic hygroma. It recommends freely editing and modifying the slides. It suggests showing blank slides first to elicit student responses before presenting content. Repeating this process of blank slide then content slide three times promotes active learning. The presentation can also be used for self-study. The final slides provide links to access the full presentation on mobile devices or download the collection.
This case report describes an 84-year old female patient with a neuroendocrine carcinoma of the breast diagnosed by fine needle aspiration cytology. The smears showed discohesive polygonal cells with abundant cytoplasm and eosinophilic granules. Histology confirmed a solid type neuroendocrine carcinoma with metastasis to lymph nodes. Immunohistochemistry was positive for markers like chromogranin and synaptophysin. Neuroendocrine carcinomas are rare breast tumors that can be diagnosed on cytology by observing characteristic cytoplasmic granules, though they may otherwise appear as invasive ductal carcinoma. Recognition of this rare tumor is important for prognosis and management.
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
The document discusses low grade glioma and provides details about a case. It begins with definitions of diffuse infiltrating gliomas and some key facts. It then provides details of a 39-year-old male patient who presented with frontal headache and personality changes. MRI showed a left temporal lesion measuring 6cm without enhancement. The document discusses the imaging protocol and findings in detail. It provides neuropathology findings of diffuse glioma, IDH mutant, and 1p/19q codeletion, consistent with oligodendroglioma grade II. The document discusses surgery details, post-op imaging, and recommendations for adjuvant treatment including radiation, chemotherapy options and dose.
CANCER PAPILAR DE TIROIDES CON VACIAMIENTO CENTRALPedro Proaño T
This document discusses the controversy around performing prophylactic central compartment neck dissection (pCCND) for clinically node-negative papillary thyroid cancer (PTC). While pCCND may provide more accurate staging, there is no evidence from randomized controlled trials that it reduces recurrence rates or improves survival. Studies have found recurrence rates are similar whether pCCND is performed or not. Additionally, pCCND is associated with higher risks of temporary hypoparathyroidism and recurrent laryngeal nerve injury. Therefore, the balance of risks and benefits favors total thyroidectomy alone for clinically node-negative PTC, as pCCND provides no proven oncologic benefit.
This document provides an overview of approaches to musculoskeletal neoplasms (tumors). It discusses the classification and staging of bone tumors, the evaluation and workup of patients, and treatment approaches including biopsy, surgery, radiation therapy, and chemotherapy. Specifically, it summarizes a case of a 51-year-old woman who presented with knee pain and was found to have a low-grade chondrosarcoma in her fibula that was successfully treated with wide excision without preoperative biopsy.
Leadership Ambassador club Adventist modulekakomaeric00
Aims to equip people who aspire to become leaders with good qualities,and with Christian values and morals as per Biblical teachings.The you who aspire to be leaders should first read and understand what the ambassador module for leadership says about leadership and marry that to what the bible says.Christians sh
A Guide to a Winning Interview June 2024Bruce Bennett
This webinar is an in-depth review of the interview process. Preparation is a key element to acing an interview. Learn the best approaches from the initial phone screen to the face-to-face meeting with the hiring manager. You will hear great answers to several standard questions, including the dreaded “Tell Me About Yourself”.
The document provides information on brain tumors including definition, types, incidence, clinical presentation, diagnosis, and treatment. It notes that brain tumors are abnormal cell growth within the brain and discusses primary and secondary tumors. Diagnosis involves medical history, exams, imaging like CT/MRI, and biopsy. Treatment may include surgery, chemotherapy, radiation therapy, and stereotactic radiosurgery. Rehabilitation is also important for regaining abilities affected by the tumor.
1) Wilhelm Roentgen discovered X-rays in 1895 and Arthur Schiiller studied skull X-rays systematically, establishing neuroradiology. 2) Advances like ventriculography and cerebral angiography in the early 20th century allowed visualization of the brain. 3) Magnetic resonance imaging was developed in the 1940s-1980s and became the preferred method for evaluating brain tumors due to its superior soft tissue contrast compared to CT.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
This document summarizes key MRI features of common pediatric posterior fossa and suprasellar tumors. It discusses pilocytic astrocytoma, medulloblastoma, atypical teratoid-rhabdoid tumor, ependymoma, brainstem glioma, hemangioblastoma, craniopharyngioma, and hypothalamic hamartoma. For each tumor type, it describes typical location, imaging appearance on various MRI sequences, distinguishing imaging characteristics, and differential diagnosis considerations.
Intracranial chordomas are rare, slow-growing tumors that arise from remnants of the embryonic notochord in the skull base. They typically present as soft tissue masses originating in the clivus with associated bone destruction. MR imaging and CT are effective in diagnosing and monitoring these tumors. Treatment involves surgical resection followed by radiation therapy, which provides the best outcomes for patients with intracranial chordomas.
This document provides a summary of imaging features of lesions in the anterior skull base region, including sinonasal neoplasms such as squamous cell carcinoma, adenocarcinoma, esthesioneuroblastoma, malignant melanoma, and lymphoma. Key imaging findings discussed include tumor appearance on CT and MRI, characteristics of bone and soft tissue involvement, and distinguishing features between lesion types. Imaging plays an important role in diagnosis and surgical planning for anterior skull base pathology.
This document presents a case report of a rare occurrence of basal cell adenoma in the palate of a 25-year-old male patient. It describes the clinical findings and diagnostic workup including imaging, biopsy, histopathological examination, and immunohistochemical analysis of the excised tumor. The pathological features were consistent with basal cell adenoma. The tumor was successfully removed surgically and the patient recovered well, with the tumor representing an unusual site for this rare minor salivary gland tumor.
This document discusses various imaging modalities and protocols for evaluating different neurological, head and neck conditions. It recommends MRI with diffusion weighted imaging and T2* sequences for evaluating acute cerebral infarction. For hypertensive intracranial hemorrhage, it recommends non-contrast CT for initial screening in older patients with hypertension and high suspicion, and MRI if acute ischemic stroke is suspected. For subdural hematomas, non-contrast CT is recommended for initial screening.
This document discusses the use of color Doppler sonography and sonohysterography to evaluate abnormal vaginal bleeding. It finds that:
1. Color Doppler sonography (CDS) can detect vessels in both benign and malignant endometrial lesions, but the number of vessels seen correlates with malignancy risk. More vessels were seen in lesions with higher microvessel density.
2. A study of 25 women found CDS could distinguish between endometrial polyps and submucosal fibroids based on vascularity patterns. Polyps typically had a single feeding vessel while fibroids had multiple vessels from the myometrium. Lesions with more vessels >0.5mm on CDS also had higher microvessel
A 58-year-old man presented with a seizure and loss of consciousness. Neuroimaging revealed a highly vascularized 5.7 x 5 cm solid mass in his right temporo-parietal region. Biopsy determined the mass was a solid supratentorial hemangioblastoma, a rare tumor. Further tests ruled out Von Hippel-Lindau disease. The patient underwent partial resection of the mass, improving his symptoms. Solid supratentorial hemangioblastomas occurring as single lesions unrelated to Von Hippel-Lindau disease are infrequent and atypical clinical presentations like this case are rarely reported.
Validity of sentinel node biopsy in early oral and oropharyngeal carcinomaDibya Falgoon Sarkar
This study evaluated the validity of sentinel node biopsy in early oral and oropharyngeal carcinoma to determine if it can help avoid unnecessary elective neck dissections. The study found that sentinel node biopsy identified occult metastases in 12 of 36 patients (33.3%), suggesting that neck dissection may be overtreatment for many patients. Sentinel nodes correctly identified metastases in 14 of 15 cases. While the study was limited by its small size and retrospective design, the results suggest sentinel node biopsy could help reduce overtreatment through more precise staging of early-stage cancers. Larger prospective studies are still needed to establish sentinel node biopsy as a reliable alternative to elective neck dissection.
MR spectroscopy by Dr. Nida Kanwal, Neurosurgery, Liaquat National Hospitalnoorulainiqbal
MR spectroscopy provides a non-invasive way to measure brain chemistry by detecting metabolic biomarkers. It can help characterize tumors, infections, strokes and neurodegenerative diseases. Placement of the voxel for spectroscopy is important to include the area of interest while avoiding areas like necrosis. Various metabolites are measured including NAA, creatine and choline to determine the nature of the lesion. MR spectroscopy is an advanced technique that is added on to conventional MRI scans.
This document provides tips for using a PowerPoint presentation on lymphangioma and cystic hygroma. It recommends freely editing and modifying the slides. It suggests showing blank slides first to elicit student responses before presenting content. Repeating this process of blank slide then content slide three times promotes active learning. The presentation can also be used for self-study. The final slides provide links to access the full presentation on mobile devices or download the collection.
This case report describes an 84-year old female patient with a neuroendocrine carcinoma of the breast diagnosed by fine needle aspiration cytology. The smears showed discohesive polygonal cells with abundant cytoplasm and eosinophilic granules. Histology confirmed a solid type neuroendocrine carcinoma with metastasis to lymph nodes. Immunohistochemistry was positive for markers like chromogranin and synaptophysin. Neuroendocrine carcinomas are rare breast tumors that can be diagnosed on cytology by observing characteristic cytoplasmic granules, though they may otherwise appear as invasive ductal carcinoma. Recognition of this rare tumor is important for prognosis and management.
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
The document discusses low grade glioma and provides details about a case. It begins with definitions of diffuse infiltrating gliomas and some key facts. It then provides details of a 39-year-old male patient who presented with frontal headache and personality changes. MRI showed a left temporal lesion measuring 6cm without enhancement. The document discusses the imaging protocol and findings in detail. It provides neuropathology findings of diffuse glioma, IDH mutant, and 1p/19q codeletion, consistent with oligodendroglioma grade II. The document discusses surgery details, post-op imaging, and recommendations for adjuvant treatment including radiation, chemotherapy options and dose.
CANCER PAPILAR DE TIROIDES CON VACIAMIENTO CENTRALPedro Proaño T
This document discusses the controversy around performing prophylactic central compartment neck dissection (pCCND) for clinically node-negative papillary thyroid cancer (PTC). While pCCND may provide more accurate staging, there is no evidence from randomized controlled trials that it reduces recurrence rates or improves survival. Studies have found recurrence rates are similar whether pCCND is performed or not. Additionally, pCCND is associated with higher risks of temporary hypoparathyroidism and recurrent laryngeal nerve injury. Therefore, the balance of risks and benefits favors total thyroidectomy alone for clinically node-negative PTC, as pCCND provides no proven oncologic benefit.
This document provides an overview of approaches to musculoskeletal neoplasms (tumors). It discusses the classification and staging of bone tumors, the evaluation and workup of patients, and treatment approaches including biopsy, surgery, radiation therapy, and chemotherapy. Specifically, it summarizes a case of a 51-year-old woman who presented with knee pain and was found to have a low-grade chondrosarcoma in her fibula that was successfully treated with wide excision without preoperative biopsy.
Leadership Ambassador club Adventist modulekakomaeric00
Aims to equip people who aspire to become leaders with good qualities,and with Christian values and morals as per Biblical teachings.The you who aspire to be leaders should first read and understand what the ambassador module for leadership says about leadership and marry that to what the bible says.Christians sh
A Guide to a Winning Interview June 2024Bruce Bennett
This webinar is an in-depth review of the interview process. Preparation is a key element to acing an interview. Learn the best approaches from the initial phone screen to the face-to-face meeting with the hiring manager. You will hear great answers to several standard questions, including the dreaded “Tell Me About Yourself”.
Jill Pizzola's Tenure as Senior Talent Acquisition Partner at THOMSON REUTERS...dsnow9802
Jill Pizzola's tenure as Senior Talent Acquisition Partner at THOMSON REUTERS in Marlton, New Jersey, from 2018 to 2023, was marked by innovation and excellence.
Job Finding Apps Everything You Need to Know in 2024SnapJob
SnapJob is revolutionizing the way people connect with work opportunities and find talented professionals for their projects. Find your dream job with ease using the best job finding apps. Discover top-rated apps that connect you with employers, provide personalized job recommendations, and streamline the application process. Explore features, ratings, and reviews to find the app that suits your needs and helps you land your next opportunity.
Resumes, Cover Letters, and Applying OnlineBruce Bennett
This webinar showcases resume styles and the elements that go into building your resume. Every job application requires unique skills, and this session will show you how to improve your resume to match the jobs to which you are applying. Additionally, we will discuss cover letters and learn about ideas to include. Every job application requires unique skills so learn ways to give you the best chance of success when applying for a new position. Learn how to take advantage of all the features when uploading a job application to a company’s applicant tracking system.
1. History and Evolution of Brain
Tumor Imaging
PRESENTOR: DR. ABHINAYA
MODERATOR: DR. BHAGYALAKSHMI
2. X-rays and the Brain
• Limited utility in the diagnosis of brain tumor
but that they had value in the diagnosis of
tumors near the sella turcica
• Intracranial calcifications, which can indicate
tumors such as oligodendroglioma,
astrocytoma, meningioma, choroid plexus
neoplasia, and pituitary tumor, are easily seen
in images
3. • cranial nerve tumors were suggested by expansion of
their corresponding outlet foramina
• cranial nerve VIII schwannomas were diagnosed by
demonstrating expanded internal auditory canals on
oblique skull radiographs, optic nerve gliomas inferred
by enlargement of the optic canals
• Measurements, stereo views, proportional and graphic
methods of localizing the pineal calcification
in patients with brain tumors all
documented gland displacements that
were abnormal in 30%–50% of cases
4.
5. The Living Brain and Spinal Cord Are
Visualized
• pneumoencephalography - Written in 1923, the
authors,neurosurgeons from the MayoClinic
(Rochester, Minn), reported on 532 patients and
concluded that air ventriculograms were very helpful
for diagnosing supratentorial masses but were not
helpful for the diagnosis of small and/or cerebellar
tumors
• Eg:- lateral and midline displacement of the ventricles
in the presence of gliomas
Trapped air inside a mass signified cystic degeneration
and/or necrosis and a high-grade malignancy
6.
7. Myelography and angiography
• injected lipiodol into the subarachnoid space,
and myelography was born.
• Later sodium iodide was directly injected into
veins first and years later into the carotid
arteries via a surgical exposure; thus, cerebral
angiography was created
8.
9. • technique of threading a guidewire onto a
needle and over it into a catheter thereafter,
cerebral angiography via femoral approach
became risk free
12. later that year, an article put
an end to radiographs, angiography,
and nuclear scans as means of diagnosing
intracranial tumors
13. Later MRI was developed
• In the first report T1 measurements of brain masses
were performed, and the authors found that
astrocytomas had the longest T1 and lipomas had the
shortest.
• The second article (49) was a comparison between the
then well-established CT and MR imaging. The authors
pointed out that very small tumors and calcifications
were missed at MR imaging (the studies were
performed with 7-mm-thick sections and a 0.35-T unit)
and that differentiation of tumors from surrounding
edema was difficult
14.
15. • Later on gadolinium chelates to help improve
tumor identification, as well as identify target
areas for biopsies
16. • One of the better known MR imaging signs for diagnosing
meningioma is the presence of “dural tails.”
• Thickening and contrast enhancement of meninges adjacent to
the mass localize it to the extraaxial compartment and provide
clues about its nature.
• However, the authors of one article showed that dural tails were
not due to tumor infiltration but rather to reactive changes
caused by the neighboring tumor. Thus, the authors concluded
that resection of all of enhancing dura at the time of surgery was
not needed. It is to be noted that this opinion was controversial.
• Later another article concluded that dural tails were due to
nodular tumor seeding and that the surrounding dura must be
resected (currently, this issue is still controversial).
17. • Rubin and Dohrmann pointed out the utility
of intraopeative US in depicting small (,1-cm)
lesions and in helping identify cysts and
determine the site for biopsy.
• Three years later, results of another
investigation confirmed that when sampled
with biopsy, echogenic areas seen during
intraoperative US provided the best sites for
tumor grading.
18.
19. • Coupled with echo-planar imaging, DWI became the first
technique to offer fast, practical, reliable, reproducible, and
easy to interpret physiologic imaging
• Soon DWI became, and remains, the imaging method of
choice for patients suspected of having cerebral infarction
or abscess and is also very helpful in grading brain tumors.
It is now well known that hypercellular tumors such as
glioblastoma and lymphoma have a lower apparent
diffusion coefficient (ADC) than do benign masses and that
lymphomas show a lower ADC than do gliomas
• Guoet al also showed that tumor cellularity is the main
determinant of ADC
20. DTI
• diffusion-tensor imaging (DTI) could produce maps that
show white matter fiber direction
• DTI is useful in displaying the normal anatomy of white
matter tracts for surgical planning and in evaluating
traumatic injuries, tumors, white matter disorders, and
some dementias and provides physiologic information
regarding the integrity of brain tissues.
• DTI enables one to distinguish tumorinfiltrated edema
from simply vasogenic edema and thus allowed
differentiation of gliomas from metastases
21. • Fractional anisotropy (a measurement foundin
DTI studies) aided in detection of tumoral
infiltration of surrounding tissues that is not
visible on conventional MR images
• Peritumoral DTI differences were found in
low-and high-grade gliomas
22. DIFFUSION KURTOSIS IMAGING
• A recent refinement of DWI is diffusion
kurtosis imaging, which provides information
on the nonlinear, Gaussian, and non-Gaussian
components of three-dimensional water
motion in the brain. When diffusion kurtosis
imaging was applied to tumors, it was found
to be better than DWI for helping separate
glioma grades
23. DYNAMIC CT / MRI
• By using dynamic sequential imaging, both MR imaging
and CT can be used to measure the amount of contrast
agent traveling through blood vessels contained in
predetermined voxels. This technique is capable of
producing parametric maps that include relative
measurements of cerebral blood flow and volume and
mean transit time, as well as time to peak
enhancement
• low-grade gliomas had lower perfusion than did
glioblastomas, while the benign but hypervascular
hemangioblastomas had the highest perfusion.
24. • It known that about 5%–10% of glioblastomas
arise from malignant transformation of lower-
grade gliomas, and in this respect perfusion
imaging was reported to be helpful
• high cerebral blood volume in tumors
correlated with mitotic activity and vascularity
but not with cellular atypia, endothelial
proliferation, cellularity, or necrosis
25.
26. arterial spin labeling perfusion imaging
• In this technique, an inversion pulse is used to
label cephalad flowing blood spins which then
provides a quantitative map of cerebral blood
flow.
• Suitable for measurement of microvascular
perfusion which helps to differentiate low and
high grade gliomas
27. MR SPECTROSCOPY
• clearly showed spectral differences between
astrocytoma, meningioma (absence of N-
acetylaspartate, a neuronal marker in
meningioma), metastases, and cysts.
• treatment-induced necrosis shows a lower
choline level than do viable tumors, that lactate is
more common in high-grade tumors, and that a
progressive decrease in choline during treatment
correlates with clinical improvement. Similarly,
posttreatment reductions of choline and lactate
were also observed in brain lymphomas
28. • In addition, when dealing with peripherally
enhancing and centrally necrotic cerebral masses,
MR spectroscopy was shown to enable
differentiation of abscesses from tumors by
virtue of demonstrating the presence of amino
acids that are byproducts of bacterial metabolism
• taurine, the presence of which, particularly in
pediatric brain tumors, is indicative of primitive
neuroectodermal tumors
29. • myo-inositol which is a glial marker, and its
presence offers a glimpse into the difficulty of
treating glioblastoma.
• myo-inositol and glutamine levels were
elevated in the normal appearing cerebral
hemisphere contralateral to a glioblastoma,
which is consistent with astrocytosis and
implies diffuse tumoral infiltration at the time
of diagnosis
30.
31.
32.
33. origin of a solitary mass.
• MR spectrosocopy together with perfusion
measurements of the peritumoral regions
(outside the areas of contrast enhancement)
together enabled differentiation of primary
tumor from solitary metastasis
• Metastases, which are well defined and often
encapsulated, showed no elevation of choline
or perfusion in their peritumoral regions.
34. PET
• fluorodeoxyglucose utilization was found to be as reliable as
histologic findings for predicting type, behavior, and recurrence of
intracranial meningiomas. FlDG has low specificity and low contrast
in brain tumors due to the already high uptake by the normal brain
hence the use of the novel tracer carbon 11 tyrosine permitted
visualization of protein synthesis rates in brain tumors, and its
sensitivity and specificity were very high. Also for assessing the
effect of therapy on brain tumors.
• methionine PET was proved to be a better radiotracer for
determining the extent, rather than the grade
• As MR spectroscopy demonstrates elevated choline metabolism
hence it can be labeled with 18F, and one study showed that the
use of this PET technique could help differentiate among high-
grade gliomas, metastases, and benign lesions.
35. • important role in the evaluation of tumor resectability
• Demonstrates changes in blood oxygenation induced by
increased activityin the cerebral cortex, functional MR imaging is
capable of mappingsome motor and sensory activities. In
• patients whose tumors are closely associated with eloquent
brain regions (ie, motor cortex, language areas), functional MR
imaging may help establish their locations and, thus, resection
potential.
• lesions around the central sulcus, and functional maps showed
expected or deformed activations that were thought to be
helpful in surgical planning with aggressive surgical treatments
in patients with brain tumors by identifying language and motor
areas
36.
37. Neuroradiology Goes to the Operating
Room
• Postoperative MR imaging studies had
traditionally been obtained within the first 24
hours after surgery to assess for the presence
of residual tumor after resection
• the exact site of biopsy and the extent of
resection could be determined immediately
and changed as needed
38. Genetics and High-Field-Strength MR
Imaging of Brain Tumors
• incompletely and completely enhancing
glioblastomas showed differences in gene
expressions and thatpatients with incompletely
enhancing tumors had longer survival
• contrast-enhancing regions in glioblastomas were
found to overexpress genes that were involved
with up-regulation of mitosis, angiogenesis, and
apoptosis, all of which contribute to aggressive
behavior of tumor
39. • the proneural-expressive type showed lower
enhancement,
• whereas the mesenchymal-expressive type
showed more enhancement;
• in addition larger glioblastomas harbored
epidermal growth factor receptor mutations,
• whereas smaller ones showed TP53
mutations.
Radiographic aid in the diagnosis intracranial lesions.
Radiograph (fig 10 from reference 6) shows a calcified tumor of choroid
plexus (arrows) in a 27-year-old woman
Figure 2: Pneumoencephalograms (figs 5 [left] and 6 [right] from reference 12) show signs of frontal lobe
tumor.
general anesthesia and the
common carotid artery was surgically
exposed and a canula inserted. The angiogram
was obtained by using Diodrast
(iodopyracet), a contrast agent previously
used for studies of the kidneys
and heart and used at a lower concentration
for the brain study
Figure 3: Differential diagnosis of intracranial neoplasms by using cerebral angiography.
Arteriogram (fig 11A from reference 23) shows temporoparietal glioblastoma with aneurysmal
dilatations of small vessels
Figure 5: CT scan obtained with the EMI scanner
(fig 4 from reference 34). Low-attenuation region
involving almost the entire left temporal lobe and
extending into parietal and frontal lobes represents
astrocytoma
Figure 6: An approach to contrast enhancement for CT of the brain.
Transverse scans obtained, A, before and, B, after contrast agent infusion
show right thalamic glioblastoma (fig 1 from reference
Figure 7: MR imaging versus CT in a 10-year-old boy with anaplastic astrocytoma (fig 1 from reference 49). Transverse (a) CT and (b, c) MR images show
compression of left ventricle and displacement of midline due to compression by a mass. No focal lesion is visible on a, but b (repetition time msec/echo time msec,
2000/28) and c (2000/56) clearly show mass extending into frontal and parietal white matter (arrows
Figure 8: MR imaging demonstration of glioblastoma multiforme in a 70-year-old man (fig 2a [a] and 2c
[b] from reference 64). (a) Transverse gadolinium-enhanced T1-weighted MR image (500/11) shows ringenhancing
mass in left temporal lobe (arrow). (b) Apparent diffusion coefficient map from DWI (b = 1000
sec/mm2) at same level as a shows high signal intensity in solid posterior portion of tumor (arrow). 1 =
region of interest for apparent diffusion coefficient calculation
Figure 9: Perfusion MR imaging (fig 6 from reference 73). On
proton density–weighted (top left [2000/30]) and T2-weighted (top right
[2000/80]) MR images, tumor in right thalamus appears homogeneous
and enhances only slightly on contrast-enhanced MR image (bottom left).
Cerebral blood volume map (bottom right) shows varying areas of elevated
blood volume in tumor, however, consistent with high-grade glioma.
A challenge with
human spectroscopy is the need for
high uniformity of the magnetic field
in relatively large MR units for imaging
humans.
Imaging and spectroscopy in 56-year-old
woman suspected of having low-grade glioma (fig 2
from reference 81). (a) Transverse T1-weighted (left)
and gadolinium-enhanced (right) MR images (600/16)
show hypointense nonenhancing mass in right
temporal lobe and insula.
(b) Mass is hyperintense on
gradient-recalled-echo MR image (600/30, 10° flip
angle).
(c) Fluorine 18 fluorodeoxyglucose positron
emission tomographic (PET) image shows decreased
glucose metabolism in right insula.
(c) Fluorine 18 fluorodeoxyglucose positron
emission tomographic (PET) image shows decreased
glucose metabolism in right insula. (d) Proton MR
spectroscopic imaging maps for choline, creatine, and
N-acetylaspartate (NAA). Gray-blue = low metabolite
signal, yellow-red-white = high metabolite signal.
Figure 11: Preoperative functional MR imaging localization of language and motor areas in a 37-year-old
woman with recurrent left parietal anaplastic astrocytoma (fig 2 from reference 95). T2-weighted echo-planar
MR images (2000/40) displayed as threshold activation maps (red and yellow) overlaid on T2-weighted fast
spin-echo images (3000/84). Green arrows = dominant receptive speech areas, yellow arrows = dominant
expressive speech areas.
Figure 12: Relationship between contrast enhancement and genetic expression pattern of glioblastoma multiforme (fig 2 from reference 99).
Left: Genetic expression map of biopsy samples (Bx) with hierarchical clustering of the 500 most-variant genes. Blue = gliosis (G) samples,
green = enhancing samples, purple = nonenhancing samples. Right: Spoiled gradient-recalled acquisition in the steady state MR image. Green
circle = enhancing region for biopsy, purple circle = nonenhancing region for biopsy