International Journal of Current Research and Review
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IJCRR - 5(22), November, 2013

Pages: 64-73

Date of Publication: 04-Dec-2013


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DIAGNOSTIC IMAGING OF INTRACRANIAL NEOPLASMS: HOW FREQUENT ARE INDICATIVE FINDINGS IN CT AND MRI?

Author: Ravinder Kumar , Jyoti

Category: Healthcare

Abstract:Objective: This study aims to compare the ability of computed tomography and magnetic resonance imaging for detection, characterization and localization of intracranial neoplasms. Material and Methods: Total 60 cases with clinical suspicion of intracranial neoplasm of all age groups and either sex were evaluated. All MR images were obtained with a 1.5-T superconducting system (SIEMENS) using a circularly polarized head coil. Pre and post contrast CT was done in all cases on 64 Slice Helical Seimens Somatom CT scanner machine. Results: CT proved to be superior in demonstrating calcifications and a typical tumor density. On the other hand, MRI was better suited for identifying the extraaxial location of tumors, the broad contact of tumors to the meninges, tumor capsules and contrast enhancement adjacent to the tumors. Both methods provided nearly equal results in demonstrating mass effects, hyperostoses, intensive and homogeneous contrast enhancement, and smooth tumor contours after contrast administration. On the whole, neither of the two methods demonstrated a universal superiority for the diagnosis of intracranial neoplasms. Rather, each method displayed distinct advantages. Conclusion: Application of a diagnostic algorithm that integrates advanced imaging features with conventional imaging findings may help the practicing radiologist make a more specific diagnosis for an intracranial tumor.

Keywords: Computed tomography, intracranial neoplasm, intratumoral calcification, Magnetic resonance imaging, supratentorial.

Full Text:

INTRODUCTION

Intracranial neoplasms can be detected at an early stage with the help of diagnostic modalities. The goals of diagnostic imaging in the patient with suspected intracranial tumour include:

  1. Detection of the presence of a neoplasm.
  2. Localization of the extent of tumour. (Including definition of involvement of key structures and assessment of the presence and severity of secondary changes.)
  3. Characterization of neoplasm.1

In 1970, CT emerged as primary diagnostic screening modality for the detection of intracranial disease. Areas of structural abnormality appeared on CT as regions of altered tissue radiographic density. Accuracy of localization with CT exceeded the accuracy that could be achieved by cerebral angiography or any other invasive diagnostic procedures.2

Since introduction of Magnetic Resonance Imaging (MRI) as clinically practicable diagnostic   modality in 1980, it has rapidly earned recognition as the optimal screening technique for the detection of most intracranial neoplasms. Early experience suggested that 3% to 30% more focal intracranial lesions could be identified on MRI than on CT.

Compared with CT, MRI using spin echo, gradient echo and combination of spin and gradient echo pulsing sequences before and after intravenous administration of paramagnetic contrast agents provides inherently greater contrast resolution between structural abnormalities and adjacent brain parenchyma and has fuelled the development of MR from an in vitro laboratory tool to an in vivo diagnostic instrument. Even with current state of the art equipment utilizing very high magnetic fields and rapidly switching gradient coils, MR nevertheless suffers two disadvantages:

  1. MRI requires significantly large image acquisition time.
  2. Abnormalities involving cortical bone, intratumoral calcification and hyperacute haemorrhage are more clearly and accurately assessed with CT.

As both CT and MRI are helpful in the diagnosis of intracranial neoplasms. Hence this study is undertaken to compare the role of computed tomography and magnetic resonance imaging in intracranial neoplasms

MATERIAL and METHODS

Sixty patients with clinical suspicion of intracranial neoplasm attending the various surgical and medicine outpatient departments (OPDs) and wards of our hospital were included in the study.

cOMPUTED TOMOGRAPHY (CT)

Pre and post contrast CT was done in all cases on 64 Slice Helical Seimens Somatom   CT scanner machine, time of which is 0.4 seconds.

magnetic RESONANCE IMAGING (MRI)

All the studies were conducted on 1.5 Tesla super conducting magnet, SIEMENS, Head coil was used. Parameters used for analysis were shown in Table 1

RESULTS

Sixty cases comprising of various type of primary and secondary neoplasms were studied. Since, metastases showed fewer incidences in our study because most of the patients with a known primary were subjected to one imaging modality either CT or MRI. So, these patients were excluded from the study as our study was based on comparative evaluation of CT and MRI in intracranial neoplasms. Overall observations were following:

Table II summarizes the general comparison of various features of intracranial neoplasms as follow:

CT failed to demonstrate the lesion in two cases and showed only hydrocephalus whereas MRI showed the lesion in medulla .MRI demonstrated the CSF cleft and pial vessels in 8 out of 10 cases of meningioma and in two cases of dural based metastases and acoustic schwannoma, however these findings were not demonstrated on CT.

Tumor extension into sellar region was noted in 12 cases with MRI while it was observed with 8 cases on CT. There were 18 cases of posterior fossa tumors in our series of 60 cases. MRI displayed the full extent including the inferior extent in 18/18 cases whereas; CT demonstrated the full extent in 10 cases only. In two cases of dural based metastases inferior extent of the base of skull lesion was better demonstrated by MRI.

Extension into internal auditory canal and left orbit in cases of acoustic schwannoma and dural based metastases respectively were better demonstrated on MRI than CT.

MRI showed peritumoral edema in 30 cases while on CT it was observed in 26 cases. Intratumoral hemorrhage was seen in 6 cases with MRI, while on CT it was observed in two cases. CT was able to detect only acute intratumoral hemorrhage while MRI demonstrated both acute and chronic intratumoral haemorrhages.Better demonstration of 

acute intratumoral hemorrhage was seen with CT than MRI.

Calcification was noted in 12 cases on CT. MRI failed to depict the calcification in all cases. Bony changes were noted in 8 cases on CT while MRI showed it in6 cases. MRI failed to depict the hyperostosis in a case of meningioma.

MRI showed contrast enhancement in 50 cases while it was observed in 48 cases on CT. CT failed to detect the tumor in two cases in which MRI showed mild enhancement.

Frequency Distribution of Intracranial Neoplasms

Commonest intracranial neoplasms were gliomas (30%), followed by meningioma (16.6%), metastases (10%), medulloblastoma (6.6%) and others.

Age and Sex Distribution of Intracranial Neoplasms

Incidence peaks of gliomas and meningiomas were seen predominantly in 3rd – 4th decade of life. 20% of all intracranial tumour occurred in paediatric age group under 20 years of age. Also we observed one patient presented in Ist decade of life. Men were found to be affected more than women in present study (17:13) except for meningioma with female predominance (1.5:1).

Location Distribution

In present study supratentorial location (40 /60) was found to be more common than infratentorial locations with both CT and MRI. We observed that MRI was more accurate in lesion localisation than CT. In a case of dural based metastases, two out of three metastatic lesions were observed as located infratentorially on CT.Whereas MRI, clearly demonstrated the lesion in supratentorial location on saggital images.

Gliomas

There were eighteen cases of glioma. Most of these were hypodense on NCCT and were hypointense on T1- weighted and hyperintense on T2 – weighted images on MRI. We found that MRI was better in tumour detection, localization, demarcation from normal brain parenchyma, identification of sub acute / chronic intratumoral haemorrhage and degree of enhancement than CT. However, calcification was better seen on CT. (Figure IV and V).

Posterior Fossa Neoplasms

MRI   found to be more sensitive than CT.

Meningioma was the most common extra-axial tumour in present study.

MRI provided more information than CT on pituitary morphology and neighbouring structures in sellar, suprasellar, parasellar and juxtasellar neoplasms. MR was superior to CT in assessment of extent of tumour, in demonstration of tumour relationship to vessels, optic chiasma and adjacent structures of brain. (Figure VI). However, CT was superior to MRI in detecting the presence of calcification which is diagnostic in case of craniopharyngioma.

In our two cases of colloid cyst, MR was more sensitive than CT to the presence of tumour and in demonstration of heterogeneity of tumour. (Figure VIII)

In cases of metastases, we made the observation that MR was superior to CT in localisation, assessment of extent of lesion and in degree of enhancement. While, CT demonstrated early intratumoral hemorrhage better than MRI. (Figure VII)

DISCUSSION

Lesion detection:-

McConachie et al4 and Atlas et al1 reported that MR imaging is more sensitive than CT for detection of brain tumors.However, in our study, CT and MRI detected all the cases but in one case of metastasis MRI detected one more lesion.

CSF Cleft / Pial vessels:-

Schubeus et al5 studied fifty cases of meningioma and concluded that MRI appears to be better than CT in demonstrating extraaxial location of the tumour, with the identification of tumour capsule, consisting  of CSF margin and displaced vessels and relationship to the meninges.

Similar results were noted in present study as MRI demonstrated the CSF cleft and Pial vessels in eight 

out of ten cases of meningioma and in two cases of dural based metastases and acoustic schwannoma, however these findings were not demonstrated on CT. (Figure I, II andIII).

Extent of tumour

Gusnor and Atlas et al 1 reported that MR has the advantage of being able to better define tumour extent than CT because of its greater contrast resolution and multiplanar capability.

Similar results have been found in present study with better demonstration of extent of posterior fossa, base of skull, sellar, parasellar and juxtasella neoplasms on MR than CT.

Peritumoral edema

We observed that FLAIR images showed better demarcation between tumour and edema than conventional MR sequences and CT. In four cases, mild peritumoral edema was seen only on flair images.

Tsuchiya et al also reported the same in their study of 34 patients that FLAIR images showed peritumoral edema more clearly than T2- weighted images when the tumour itself was not hyperintense.

Intratumoral hemorrhage:-

Kieffer and chang described that MRI has greater sensitivity for detection of subacute and chronic haemorrhages whereas early intratumoral or peritumoral haemorrhages are more clearly defined with greater certainty on CT than on MRI.

Similar results were seen in present study, as in two cases where CT failed to detect the intratumoral haemorrhage were found to have subacute / chronic hemmorhage on MRI. In four other cases both CT and MRI showed the early intratumoral haemorrhage but it was more clearly defined with CT than MRI.

Calcification

Lee and Tassel, McConachie et al4  in their studies concluded that CT is highly sensitive in detecting calcification whereas MR cannot reliably demonstrate or exclude its presence. Lovener also found the same that CT is more sensitive than MRI in detecting the presence of calcification. We also observed the same in our study as CT demonstrated calcification in twelve cases whereas MRI was unable to demonstrate it.

Bony changes

Kieffer and Chang, Master and Zimmerman, Yeakley et al reported that CT is superior to MR in demonstration of bone changes like hyperostosis or bone destruction. We also found the same as MRI failed to demonstrate the bony change in a case of meningioma in which CT showed hyperostosis of underlying sphenoid bone. In all other cases, both CT and MRI were equally good in demonstration of bony changes.

Contrast enhancement

Graif et al in their study of seventeen cases of malignant brain tumour compared degree of enhancement with CT and MRI and noted that MRI showed greater degree of enhancement than CT in eight cases. Present study also showed the similar results as MRI showed more enhancement than CT in eight cases, six cases with moderate enhancement and two cases with mild enhancement on CT showed intense enhancement on MRI. In two cases CT was unable to show contrast enhancement while MRI showed mild enhancement.

CONCLUSION

Summarizing, MR has many advantages over CT all without the need of ionizing radiation and iodinated contrast media in imaging of intracranial neoplasms.  The multiplanar capability and superior contrast resolution of MRI  makes it a better technique than CT in imaging of  intracranial neoplasms  in terms of  tumour detection, localization,  assessment of extent of tumour, identification of subacute / chronic intratumoral hemorrhage, degree of enhancement  and demonstration  of tumour relationship to adjacent structures of brain. MR nevertheless, requires significantly longer image acquisition times than CT. MR is inferior to CT in identification of bony changes, intratumoral calcification and early intratumoral hemorrhage. 

Hence, we conclude that MR is the preferable method for evaluation of intracranial neoplasms and CT is useful as a supplementary modality when detailed information about bony anatomy and calcification is required. Also application of a diagnostic algorithm that integrates advanced imaging features with conventional imaging findings may help the practicing radiologist make a more specific diagnosis for an intracranial tumour.

ACKNOWLEDGEMENT

We acknowledge to Geetanjali Medical College and Hospital for their immense support.

Conflict of Interest: None declared

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A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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