Imaging modalities in Cerebral Glioma

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Imaging modalities in Cerebral Glioma

  1. 1. PROF.DR.K.H.NOORUL AMEEN’S UNIT By Dr.S.Dhileepan 1 st year pg
  2. 2. <ul><li>44 year old female Mrs.Rani, florist by occupation </li></ul><ul><li>c/o Weakness of Rt. UL & LL since 1 month </li></ul><ul><ul><li>Deviation of angle of mouth to the Rt.side </li></ul></ul><ul><li>No H/o trauma, LOC, seizures </li></ul><ul><li>No H/o fever vomiting, Headache, blurring of vision </li></ul><ul><li>Not a hypertensive or diabetic </li></ul><ul><li>H/o treatment for pelvic tuberculosis 10 years back </li></ul>
  3. 3. <ul><li>CVA with right hemiparesis and UMN type of facial palsy. </li></ul>
  4. 14. <ul><li>Hetero intense in T1 & T2 and uniformly enhancing SOL in the left thalamus involving midbrain and left superior cerebral peduncle </li></ul><ul><li>MR Spectroscopy shows choline peak suggestive of high grade glioma </li></ul>
  5. 15. <ul><li>Brain tumour </li></ul><ul><ul><li>Glioma </li></ul></ul><ul><ul><li>Lymphoma </li></ul></ul><ul><ul><li>Medulloblastoma </li></ul></ul><ul><ul><li>Ependymoma </li></ul></ul><ul><ul><li>Meningioma </li></ul></ul><ul><ul><li>Schwanomma </li></ul></ul><ul><li>Tuberculoma </li></ul><ul><li>Brain Abscess – Pyogenic </li></ul><ul><li>Toxplasma </li></ul><ul><li>Cystercercosis </li></ul>
  6. 16. <ul><li>History </li></ul><ul><ul><li>Felix Block – 1946 </li></ul></ul><ul><li>Principle </li></ul><ul><ul><li>Nuclear magnetic resonance using FOURIER Principle </li></ul></ul><ul><ul><li>Uses proton of the methyl groups </li></ul></ul><ul><ul><li>Water and fat are suppressed </li></ul></ul>
  7. 17. Hunter’s Angle
  8. 18. PPM Content Role Significance 0.9 – 1.4 Lipid Brain destruction Necrosis 1.3 Lactate Anaerobic Glycolysis Acute stroke Mito. Cytopathy 2.0 NAA Neuronal marker Mass lesion Dementia 2.2 – 2.4 Glutamate Glutamine Neurotransmitter Bacterial Abscess 3.0 Creatine Energy metabolism Decreased in Stroke 3.2 Choline Membrane marker Cell turnover 3.5 Myo-inoisitol Glial cell, Hormonal receptor Increased in Downs White matter disease
  9. 19. <ul><li>Tumour </li></ul><ul><ul><li>Tumour or not </li></ul></ul><ul><ul><li>Type of tumour </li></ul></ul><ul><ul><ul><li>Glial or non-glial </li></ul></ul></ul><ul><ul><li>Grade of tumour </li></ul></ul><ul><ul><ul><li>High grade or low grade </li></ul></ul></ul><ul><ul><li>Spread of tumour </li></ul></ul><ul><ul><li>Guiding stereotactic biopsy and radiation </li></ul></ul><ul><ul><li>Response to treatment </li></ul></ul><ul><ul><li>Rercurrence of the tumour </li></ul></ul><ul><ul><li>Radiation necrosis </li></ul></ul>
  10. 20. <ul><li>Infection </li></ul><ul><ul><li>Tubereculoma </li></ul></ul><ul><ul><ul><li>Increased lipid </li></ul></ul></ul><ul><ul><ul><li>Decreased choline </li></ul></ul></ul><ul><ul><li>Pyogenic abscess </li></ul></ul><ul><ul><ul><li>Increased lipid & amino acids </li></ul></ul></ul><ul><ul><ul><li>No choline </li></ul></ul></ul><ul><ul><li>Toxoplasma, Cysticercosis & Cryptococcosis </li></ul></ul><ul><ul><ul><li>Increased lactate & lipid </li></ul></ul></ul><ul><li>Alzeimers Disease </li></ul><ul><ul><li>Decreased NAA </li></ul></ul><ul><ul><li>Increased Myo-inositol </li></ul></ul>
  11. 21. <ul><li>Radiation necrosis </li></ul><ul><ul><li>Increased lipid </li></ul></ul><ul><ul><li>No choline </li></ul></ul><ul><li>Ischaemia </li></ul><ul><ul><li>Increased lactate / lipid </li></ul></ul><ul><li>Infarction </li></ul><ul><ul><li>Increased lipid / lactate </li></ul></ul><ul><li>Hepatic encephalopathy </li></ul><ul><ul><li>Increased Glutamate a& Myo-inositol </li></ul></ul><ul><li>Mitochondrial cytopathy </li></ul><ul><ul><li>Increased lactate </li></ul></ul><ul><li>White matter disease </li></ul>
  12. 22. <ul><li>Cannot differentiate primary tumour from secondary </li></ul>
  13. 23. <ul><li>MRS is useful in doubtful mass lesion brain </li></ul><ul><li>Let us utilise this facility which is available in our hospital judicially </li></ul>

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