Download - Imaging modalities in Cerebral Glioma
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PROF.DR.K.H.NOORUL AMEEN’S UNIT
By Dr.S.Dhileepan 1st year pg
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44 year old female Mrs.Rani, florist by occupation
c/o Weakness of Rt. UL & LL since 1 month
Deviation of angle of mouth to the Rt.side
No H/o trauma, LOC, seizures No H/o fever vomiting, Headache,
blurring of vision Not a hypertensive or diabetic H/o treatment for pelvic tuberculosis 10
years back
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CVA with right hemiparesis and UMN type of facial
palsy.
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Hetero intense in T1 & T2 and uniformly enhancing SOL in the left thalamus involving midbrain and left superior cerebral peduncle
MR Spectroscopy shows choline peak suggestive of high grade glioma
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Brain tumourGliomaLymphomaMedulloblastomaEpendymomaMeningiomaSchwanomma
Tuberculoma Brain Abscess – Pyogenic Toxplasma Cystercercosis
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HistoryFelix Block – 1946
PrincipleNuclear magnetic resonance using FOURIER
PrincipleUses proton of the methyl groupsWater and fat are suppressed
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Hunter’s Angle
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PPM Content Role Significance
0.9 – 1.4 Lipid Brain destruction Necrosis
1.3 Lactate Anaerobic Glycolysis
Acute strokeMito. 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 DownsWhite matter disease
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TumourTumour or notType of tumour
Glial or non-glialGrade of tumour
High grade or low gradeSpread of tumourGuiding stereotactic biopsy and radiationResponse to treatmentRercurrence of the tumourRadiation necrosis
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InfectionTubereculoma
Increased lipidDecreased choline
Pyogenic abscess Increased lipid & amino acidsNo choline
Toxoplasma, Cysticercosis & Cryptococcosis Increased lactate & lipid
Alzeimers DiseaseDecreased NAAIncreased Myo-inositol
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Radiation necrosisIncreased lipidNo choline
Ischaemia Increased lactate / lipid
InfarctionIncreased lipid / lactate
Hepatic encephalopathyIncreased Glutamate a& Myo-inositol
Mitochondrial cytopathyIncreased lactate
White matter disease
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Cannot differentiate primary tumour from secondary
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MRS is useful in doubtful mass lesion brain
Let us utilise this facility which is available in our hospital judicially
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