In every stage of brain tumor management, neuroimaging proves to be an indispensable tool. Daratumumab molecular weight By leveraging technological advancements, the clinical diagnostic capacity of neuroimaging has been enhanced, supporting the vital role it plays alongside patient history, physical exams, and pathology assessments. Differential diagnoses and surgical planning are improved in presurgical evaluations, thanks to the integration of advanced imaging techniques such as functional MRI (fMRI) and diffusion tensor imaging. The clinical challenge of differentiating treatment-related inflammatory change from tumor progression is enhanced by novel applications of perfusion imaging, susceptibility-weighted imaging (SWI), spectroscopy, and new positron emission tomography (PET) tracers.
Brain tumor patient care will benefit significantly from the use of the most current imaging technologies, ensuring high-quality clinical practice.
State-of-the-art imaging techniques are instrumental in ensuring high-quality clinical practice for the treatment of brain tumors.
Common skull base tumors, particularly meningiomas, are examined in this article, which details imaging techniques, findings, and how to apply these to surveillance and treatment planning.
An increase in the accessibility of cranial imaging has resulted in a heightened incidence of incidentally detected skull base tumors, calling for careful evaluation to determine the most suitable approach, either observation or active treatment. Anatomical displacement and tumor involvement are determined by the site of the tumor's initiation and expansion. Detailed study of vascular compression on CT angiograms, including the form and magnitude of bone invasion from CT scans, assists in refining treatment plans. Future quantitative analyses of imaging, like radiomics, might further clarify the connections between a person's physical traits (phenotype) and their genetic makeup (genotype).
The synergistic application of computed tomography (CT) and magnetic resonance imaging (MRI) improves the accuracy in identifying skull base tumors, pinpointing their location of origin, and specifying the required treatment extent.
The integration of CT and MRI imaging techniques offers a more effective approach to diagnosing skull base tumors, illuminating their origin and guiding the scope of necessary treatment.
The International League Against Epilepsy's Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol is key to the analysis in this article of the essential role of optimal epilepsy imaging, in addition to the utilization of multimodality imaging in patients with drug-resistant epilepsy. one-step immunoassay This methodical approach details the evaluation of these images, specifically in the light of accompanying clinical information.
Rapid advancements in epilepsy imaging necessitate high-resolution MRI protocols for the assessment of newly diagnosed, long-standing, and treatment-resistant epilepsy. The article considers the wide spectrum of MRI findings pertinent to epilepsy, and their subsequent clinical import. health biomarker Multimodality imaging integration serves as a potent instrument for pre-surgical epilepsy evaluation, especially in cases where MRI reveals no abnormalities. Utilizing a multifaceted approach that combines clinical phenomenology, video-EEG, positron emission tomography (PET), ictal subtraction SPECT, magnetoencephalography (MEG), functional MRI, and sophisticated neuroimaging techniques such as MRI texture analysis and voxel-based morphometry, the identification of subtle cortical lesions, such as focal cortical dysplasias, is improved, optimizing epilepsy localization and selection of ideal surgical candidates.
A distinctive aspect of the neurologist's role lies in their detailed exploration of clinical history and seizure phenomenology, critical factors in neuroanatomic localization. Advanced neuroimaging, when integrated with clinical context, significantly affects the identification of subtle MRI lesions, particularly in cases of multiple lesions, helping pinpoint the epileptogenic one. Patients with lesions highlighted by MRI scans have a 25-fold increased likelihood of becoming seizure-free post-epilepsy surgery, relative to patients without such lesions.
The neurologist's understanding of the patient's history and seizure occurrences provides the crucial groundwork for accurate neuroanatomical localization. Subtle MRI lesions, particularly the epileptogenic lesion in instances of multiple lesions, are significantly easier to identify when advanced neuroimaging is integrated within the clinical context. Epilepsy surgery, when employed on patients exhibiting an MRI-identified lesion, presents a 25-fold greater prospect for seizure eradication compared with patients lacking such an anatomical abnormality.
This article seeks to familiarize the reader with the diverse categories of nontraumatic central nervous system (CNS) hemorrhages, along with the diverse neuroimaging approaches employed in their diagnosis and treatment planning.
The 2019 Global Burden of Diseases, Injuries, and Risk Factors Study found that intraparenchymal hemorrhage accounts for a substantial 28% of the total global stroke burden. Within the United States, 13% of all strokes are attributable to hemorrhagic stroke. Intraparenchymal hemorrhage occurrence correlates strongly with aging; consequently, improved blood pressure management strategies, championed by public health initiatives, haven't decreased the incidence rate in tandem with the demographic shift towards an older population. Autopsy reports from the most recent longitudinal study on aging demonstrated intraparenchymal hemorrhage and cerebral amyloid angiopathy in a substantial portion of patients, specifically 30% to 35%.
Either a computed tomography (CT) scan of the head or a magnetic resonance imaging (MRI) of the brain is essential for the prompt identification of CNS hemorrhage, which includes intraparenchymal, intraventricular, and subarachnoid hemorrhages. Upon detection of hemorrhage in a screening neuroimaging study, the configuration of the blood within the image, when considered in conjunction with the patient's history and physical assessment, can influence subsequent neuroimaging, laboratory, and ancillary tests needed to understand the cause. Identifying the cause allows for the primary treatment goals to be focused on controlling the extent of the hemorrhage and preventing subsequent complications, including cytotoxic cerebral edema, brain compression, and obstructive hydrocephalus. Furthermore, the topic of nontraumatic spinal cord hemorrhage will also be examined in a concise manner.
To swiftly identify central nervous system (CNS) hemorrhage, encompassing intraparenchymal, intraventricular, and subarachnoid hemorrhages, either a head computed tomography (CT) scan or a brain magnetic resonance imaging (MRI) scan is necessary. If a hemorrhage is discovered during the initial neuroimaging, the blood's configuration, coupled with the patient's history and physical examination, can help determine the subsequent neurological imaging, laboratory, and supplementary tests needed for causative investigation. Upon identifying the root cause, the primary objectives of the therapeutic approach are to curtail the enlargement of hemorrhage and forestall subsequent complications, including cytotoxic cerebral edema, brain compression, and obstructive hydrocephalus. Besides this, the subject of nontraumatic spinal cord hemorrhage will also be addressed in brief.
Acute ischemic stroke symptom presentation is assessed by the imaging procedures discussed in this article.
Acute stroke care underwent a significant transformation in 2015, owing to the widespread acceptance of mechanical thrombectomy as a treatment. A subsequent series of randomized controlled trials in 2017 and 2018 demonstrated a significant expansion of the thrombectomy eligibility criteria, utilizing imaging to select patients, and consequently resulted in a marked increase in the use of perfusion imaging within the stroke community. Years of routine use have not settled the ongoing debate surrounding the necessity of this additional imaging and its potential to create delays in the critical window for stroke treatment. Neuroimaging techniques, their applications, and their interpretation now demand a stronger understanding than ever before for practicing neurologists.
Acute stroke patient evaluations often begin with CT-based imaging in numerous medical centers, due to its ubiquity, rapidity, and safety. For the purpose of deciding whether to administer IV thrombolysis, a noncontrast head CT scan alone is sufficient. The high sensitivity of CT angiography allows for the dependable identification of large-vessel occlusions, making it a valuable diagnostic tool. In specific clinical situations, additional information for therapeutic decision-making can be gleaned from advanced imaging modalities, encompassing multiphase CT angiography, CT perfusion, MRI, and MR perfusion. All cases necessitate the urgent performance and interpretation of neuroimaging to enable the timely provision of reperfusion therapy.
Because of its wide availability, rapid performance, and inherent safety, CT-based imaging forms the cornerstone of the initial assessment for stroke patients in many medical centers. A noncontrast head computed tomography scan of the head is sufficient to determine if IV thrombolysis is warranted. CT angiography, with its high sensitivity, is a dependable means to identify large-vessel occlusions. Multiphase CT angiography, CT perfusion, MRI, and MR perfusion, components of advanced imaging, offer valuable supplementary data relevant to treatment decisions within specific clinical settings. In order to allow for prompt reperfusion therapy, the rapid performance and analysis of neuroimaging are indispensable in all cases.
MRI and CT are instrumental in the examination of neurologic patients, each providing specialized insights relevant to particular clinical needs. Although both of these imaging methodologies have impressive safety records in clinical practice resulting from concerted and sustained efforts, certain physical and procedural risks still remain, as detailed further in this report.
The field of MR and CT safety has witnessed substantial progress in comprehension and risk reduction efforts. Dangerous projectile accidents, radiofrequency burns, and detrimental effects on implanted devices are potential consequences of MRI magnetic fields, with documented cases of serious patient injuries and fatalities.