Brain tumors are a serious medical concern that can significantly impact a patient’s health and quality of life. They are categorized into primary brain tumors (originating in the brain) and secondary (metastatic) brain tumors (spreading from other parts of the body).
Primary tumors can arise from brain parenchyma, such as gliomas, or surrounding structures like the meninges, leading to meningiomas. On the other hand, metastatic brain tumors most commonly originate from cancers of the lung, breast, kidney, or melanoma.
Medical imaging plays a crucial role in diagnosing, characterizing, and planning the treatment of brain tumors. Early and accurate imaging can determine the tumor type, location, and impact on surrounding structures, guiding clinical decisions.
I am Dr. Vahid Alizadeh. In this article from the ‘When, Why, Who’ series, I will explain the role of medical imaging in brain tumor diagnosis and management.
Why Is Medical Imaging Needed for Brain Tumors?
Medical imaging is essential for diagnosing and assessing brain tumors due to the following reasons:
- Early detection and accurate diagnosis: Brain tumors can present with non-specific symptoms such as headaches, seizures, or cognitive changes. Imaging helps differentiate tumors from other neurological conditions, such as inflammatory processes like MS or infections.
- Tumor localization and characterization: Imaging techniques like MRI and CT scans help determine the tumor’s size, shape, location, and whether it is benign or malignant
- Surgical planning: High-resolution imaging assists neurosurgeons in planning the safest approach to tumor removal while preserving critical brain functions(in my experience, most malignant primary brain tumors cannot be eradicated by surgery and need additional radio and chemotherapy ).
- Treatment monitoring: After surgery, radiation, or chemotherapy, imaging helps track tumor response and detect recurrence.
- Differentiation between primary and metastatic tumors: Identifying whether a cancer originates from the brain or another organ impacts treatment strategies and prognosis.
Why Are Different Imaging Modalities Used?
- MRI with and without contrast: The gold standard for brain tumor imaging, providing detailed views of soft tissues and tumor vascularity. 
- Diffusion-Weighted Imaging (DWI) helps assess tumor cellularity and distinguish abscesses from tumors, while Susceptibility-Weighted Imaging (SWI) can detect hemorrhagic components and calcifications, aiding in tumor characterization.
- Magnetic Resonance Spectroscopy (MRS) can assess the tumor’s metabolic profile, helping differentiate between benign and malignant lesions.
- CT scan: Useful for detecting calcifications, hemorrhage and in emergency settings.
- Functional MRI (fMRI) and Diffusion Tensor Imaging (DTI): Helps map critical brain pathways before surgery.
- PET scan: Assesses metabolic activity, distinguishing high-grade from low-grade tumors.
Without proper imaging, misdiagnosis or delayed treatment can lead to significant complications, including neurological deficits and poor prognosis.
When Should Medical Imaging Be Used for Brain Tumor Diagnosis?
When Symptoms Suggest a Brain Tumor
Brain tumors can manifest with various neurological symptoms, including:
– Persistent or worsening headaches, especially in the morning
– Seizures, particularly new-onset in adults
– Vision problems, such as blurriness, double vision, or vision loss
– Weakness or numbness in limbs
– Cognitive and personality changes, including memory loss and confusion
– Difficulty with balance or coordination
Immediate imaging is warranted if any of these symptoms are progressive or unexplained.
When a Brain Tumor Is Suspected Clinically?
Patients with a history of cancer elsewhere in the body (e.g., lung or breast cancer) and new neurological symptoms should undergo urgent imaging to rule out metastatic disease.
When Monitoring Tumor Progression or Treatment Response?
Before treatment: Imaging determines the tumor’s exact location and characteristics.
Post-treatment follow-up: To assess tumor shrinkage or recurrence.
After surgery: Ensures complete resection and detects complications like bleeding or swelling.
When Planning for Neurosurgical Intervention
For tumors located near critical brain structures, advanced imaging like fMRI and tractography helps preserve essential functions during surgery.
Delaying imaging in symptomatic patients can lead to tumor progression, worsening prognosis, and reduced treatment options.
Who Needs Imaging and an Expert Consultation?
High-Risk Individuals Who Should Get Imaging
- Patients with persistent neurological symptoms: Unexplained seizures, headaches, or vision disturbances require prompt imaging.
- Individuals with a history of cancer: Metastatic brain tumors are common in patients with lung, breast, or melanoma cancers.
- People with a family history of brain tumors: Some genetic syndromes increase the risk of gliomas and meningiomas.
- Patients with known brain tumors: Regular imaging is essential for monitoring growth or response to therapy.
Specialists Involved in the Imaging Process
- Neurologists: Evaluate symptoms and order initial imaging.
- Neurosurgeons: Plan surgical interventions based on imaging findings.
- Oncologists: Use imaging to guide chemotherapy or radiation therapy.
- Radiologists: Interpret scans and differentiate tumor types.
When to Seek a Second Opinion?
- Unclear or inconclusive imaging results
- Unique new sequences like MRS and FMRI … need an expert second opinion**
- Deciding between surgery, radiation, or chemotherapy
- Assessing treatment response or new symptoms post-treatment
A second opinion from an experienced radiologist can help avoid misdiagnosis and optimize treatment plans.
Conclusion
Brain tumors require timely and accurate diagnosis to improve treatment outcomes. Medical imaging is pivotal in early detection, surgical planning, and post-treatment monitoring.
For expert interpretation of your medical imaging, use the radiology specialists from our team at AI-PACS for online reporting.
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