imaging modalities in cerebral glioma
TRANSCRIPT
PROF.DR.K.H.NOORUL AMEEN’S UNIT
By Dr.S.Dhileepan 1st year pg
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
CVA with right hemiparesis and UMN type of facial
palsy.
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
Brain tumourGliomaLymphomaMedulloblastomaEpendymomaMeningiomaSchwanomma
Tuberculoma Brain Abscess – Pyogenic Toxplasma Cystercercosis
HistoryFelix Block – 1946
PrincipleNuclear magnetic resonance using FOURIER
PrincipleUses proton of the methyl groupsWater and fat are suppressed
Hunter’s Angle
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
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
InfectionTubereculoma
Increased lipidDecreased choline
Pyogenic abscess Increased lipid & amino acidsNo choline
Toxoplasma, Cysticercosis & Cryptococcosis Increased lactate & lipid
Alzeimers DiseaseDecreased NAAIncreased Myo-inositol
Radiation necrosisIncreased lipidNo choline
Ischaemia Increased lactate / lipid
InfarctionIncreased lipid / lactate
Hepatic encephalopathyIncreased Glutamate a& Myo-inositol
Mitochondrial cytopathyIncreased lactate
White matter disease
Cannot differentiate primary tumour from secondary
MRS is useful in doubtful mass lesion brain
Let us utilise this facility which is available in our hospital judicially