Medical Monday: Do You Know Your Brain?


“This month is Brain Tumor Awareness Month, a time to honor the advanced, cutting-edge tumor research that is happening worldwide. Brain Tumor Awareness Month also recognizes the teams of researchers and scientists, who work tirelessly to discovering novel and alternate methods to detect and manage brain tumors.

As part of Brain Tumor Awareness Month, Ajit Shankaranarayanan PhD, Global MR Neuro Applications Manager, Applications & Workflow at GE Healthcare, took some time out to answer questions about his research into brain tumors and what he thinks the future holds in the areas of detection and diagnosis. A MR physicist by training, Ajit has worked in non-contrast perfusion and motion insensitive imaging areas. His current role involves managing a global team engaged in development of advanced neuro MR applications.

Firstly how are brain tumors diagnosed and why is early detection and diagnosis so crucial in its management and treatment? How do the types of brain imaging technologies help researchers increase understanding of the causes and progression of brain tumors?

The clinical presentation of various brain tumors is best appreciated by considering the relationship of signs and symptoms to anatomy. General signs and symptoms include headaches, seizures, visual changes etc. Whether primary, metastatic, malignant, or benign, brain tumors must be differentiated from other space-occupying lesions such as abscesses, arteriovenous malformations, and infarction, which can have a similar clinical presentation. Brain imaging technologies help enable the physician to non-invasively detect and differentiate (to certain extent) the tumors. They also help facilitate effective treatment planning for the neurosurgeons.

CT/MRI scanning can help in early diagnosis, uncovering valuable information on tumor location, size and metabolic activity.  How have these technologies and others contributed to the more personalized cancer treatment and management decisions?

Computed tomography (CT) and magnetic resonance imaging (MRI) have complementary roles in the diagnosis of small tumors in the brain and/or spinal cord. CT is typically faster than MRI and is therefore desirable for evaluating clinically unstable patients and is superior for detecting skull lesions, and hyperacute hemorrhage (bleeding less than 24-hours old). On the other hand, MRI has superior soft-tissue resolution and can better detect tumor enhancement, and associated findings such as edema. High-quality MRI is also the modality of choice in the evaluation of spinal cord lesions due to its high sensitivity.

For patients who have completed therapy, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) may be useful in determining tumor recurrence. Biopsy confirmation to corroborate the suspected diagnosis of a primary brain tumor is critical, whether before surgery by needle biopsy or at the time of surgical resection, except in cases where it is clear that it’s a benign tumor.

Radiologic patterns may be misleading, and it is necessary to do a biopsy to rule out other causes of space-occupying lesions, such as metastatic cancer or infection. CT and MRI can be used to guide the needle to complete a biopsy in many locations in the brain.”..

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