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Intra‐Axial Primary Brain Tumors

Annette O. Nusbaum¹, Scott W. Atlas²

¹New York Presbyterian Hospital, New York, New York
²Stanford University Medical Center, Stanford, California

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A3.3

DOI:

10.1002/0471142719.mia0303s00

Online Posting Date:

May, 2001

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Abstract

The majority of primary brain tumors in adults are found in the supratentorial compartment, while tumors in pediatric patients are usually infratentorial in location. This unit presents basic protocols for imaging all types of primary intra-axial brain tumors, whether infiltrative (i.e., astrocytoma, oligodendroglioma, lymphoma) or circumscribed (i.e., ganglioglioma, cystic astrocytoma). Specific modifications are discussed where necessary. The sequences described in this unit are based on a 1.5 T scanner (Echospeed GE Medical Systems), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

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Unit Introduction
Basic Protocol 1: Rule Out (R/O) Primary Cerebral Tumor
Alternate Protocol: Optional Sequences
Basic Protocol 2: R/O Primary Cerebellar and Brainstem Tumor
Commentary
Literature Cited
Figures
Tables

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Materials

Basic Protocol 1: Rule Out (R/O) Primary Cerebral Tumor

Materials

Intravenous contrast agent (e.g., Magnevist, Omniscan, or Prohance)
Normal saline (0.9% NaCl), sterile

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Figures

Figure A3.3.1

(A) T₂-weighted fast spin echo image (T_R = 2000 msec, T_E = 105 msec, N_acq = 2) through a large mass in the right thalamus and basal ganglia of a 35 year old female with headaches. Water suppressed protocon spectroscopy was performed using PRESS sequence (point resolved spectroscopy) in an 8-cm³ voxel with a T_E = 144 msec positioned (B) over the tumor mass and (C) on the contralateral side at the equivalent location. Resonances are labeled as: Lac = lactate; NAA = N-acetyl aspartate; Cre = creatine; Cho = choline; MyoI = myoinositol. The horizontal axis is given in parts per million (ppm). Automated software used creatine as reference signal intensity quantified the NAA as significantly decreased in the tumor and NAA/Cre ratio of 1.47 in the normal tissue. The presence of lactate, markedly reduced NAA and elevated choline, is characteristic of neoplasm.

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Literature Cited

Literature Cited
	Alsop, D.C. and Detre, J.A. 1998. Multisection cerebral blood flow MR imaging with continuous arterial spin labeling. Radiology 208:410-416.
	Atlas, S.W., Mark, A.S., Grossman, R.I., Gomori, J.M. 1988. Intracranial hemorrhage: Gradient-echo MR imaging at 1.5 T. Radiology 168:803-807.
	Atlas, S.W. and Lavi, E. 1996. Intra-axial brain tumors. In Magnetic Resonance Imaging of the Brain and Spine, 2nd Edition. (S.W. Atlas, ed.). pp. 315-422. Lippincott-Raven, Philadelphia.
	Legler, J.M., Gloeckler Ries, L.A., Smith, M.A., Warren, M.A., Warren, J.L., Heineman, E.F., Kaplan, R.S., and Linet, M.S. 1991. Brain and other central nervous system cancers: Recent trends in incidence and mortality. J. Natl. Cancer Inst. 91:1382-1390.
	Meyer, M.E., Pipas, J.M., Mamourian, A., Tosteson, T.D., and Dunn, J.F. 1999. Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy. Am. J. Neuroradiol. 20:117-123.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Sijens, P.E., van den Bent, M.J., Nowak, P.J., van Dijk, P., and Ouderk, M. 1997. ¹H chemical shift imaging reveals loss of brain tumor choline signal after administration of Gd-contrast. Magn. Reson. Med. 37:222-225.
	Singer, M.B., Atlas, S.W., and Drayer, B.P. 1998. Subarachnoid space disease: Diagnosis with fluid-attenuated inversion-recovery MR imaging and comparison with gadolinium-enhanced spin echo MR imaging-blinded reader study. Radiology 208:417-422.
	Stejskal, E.O. and Tanner, J.E. 1965. Spin diffusion measurements: spin echoes in the presence of time-dependent field gradient. J. Chem. Phys. 42:288-292.
	Tien, R.D., Flesberg, G.J., Friedman, H., Brown, H., and MacFall, J. 1994. MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. Am. J. Roentgenol. 162:671-677.