Radiologic Evaluation of Intracranial Tumors

Radiologic Evaluation of Intracranial Tumors
Presentation by:Todd Gourdin M-IV

Available Modalities

1)X-ray
2)CT
3)MRI
4)Nuclear Medicine


X-ray
* Primarily of historical interest since the onset of CT in 1974.
* Was useful for detecting increased intracranial pressure and intracranial calcifications.

Craniopharnygioma

CT
* Most intracranial neoplasms are visible on CT
* Tumors may be hypodense, isodense, or hyperdense on a noncontrast CT depending on tumor histology and location
Pilocytic Cerebellar Astrocytoma
Metastatic Lesion
Why not MRI them all???

* MRI is generally preferable to CT for evaluating intracranial neoplasms
* CT is preferred for visualizing tumor calcification or intratumor hemorrhage.

Commonly Calcified and Hemorrhagic Lesions
Glioblastoma Multiforme
MRI
Noncontrast MRI of Meningioma
Advanced MRI Techniques
Proton Magnetic Resonance Spectroscopy
Perfusion weighted MRI
MRI-guided Surgery
MRI guided stereotactic biopsy
Brain surface imaging
Interventional MRI
Brain Surface Imaging
Nuclear Medicine
SPECT(Single Photon Emission Computed Tomography)
Diagnosed by SPECT as a high-grade glioma and confirmed post-resection
PET(Positron Emission Tomography)
Radionuclides useful for PET analysis of intracranial tumors include:
Fluorodeoxyglucose
C methionine
F a-methyl tyrosine
Advantages of PET over SPECT:
Disadvantages of PET:
PET scan of Language Center
Classification of Intracranial Neoplasms
GBM
* Hallmark finding is tumor necrosis
* Often cross the midline
* Extremely poor prognosis
Tumors of Nerve Sheath – Schwannoma, Neurofibroma
Bilateral schwannomas in NF type 2
Meningeal tumors – meningioma
Meningioma
Lymphoma
Lymphoma on noncontrast/contrast CT
Metastasis
Metastases
References

Radiologic Evaluation of Intracranial Tumors.ppt

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Glioblastoma Multiforme Treatment Options

Glioblastoma Multiforme Treatment Options

Glioblastoma multiforme (GBM) is the most common and most aggressive type of primary brain tumor

Patient History
Primary Intracranial CNS Tumors
Gliomas
* Astrocytomas
o Pilocytic Astrocytomas (grade 1)
o Diffuse Astrocytomas (grade 2)
o Anaplastic Astrocytomas (grade 3)
o Glioblastoma Multiforme (grade 4 – 50%)
* Oligodendrogliomas
o Low Grade Oligodendroglioma (grade 2)
o Anaplastic Oligodendroglioma (grade 3)
* Mixed Oligoastrocytomas
o Low Grade Oligoastrocytoma (grade 2)
o Anaplastic Oligodendroglioma (grade 3)

Clinical Presentation
* Symptoms caused by mass effect or destruction of normal tissue
* Symptoms
o Headache
o Seizures
o Neurological Deficits
+ Personality Changes
+ Slowing of Motor Function/Hemiplegia
+ Hallucinations
+ Memory Impairment
+ Vision Impairment

Prognosis for GBM
* Mean survival 12-14 months from diagnosis
* Mean survival 4-5 months from recurrence
* 2 year survival 10%
* Recurrence occurs within 2-3 cm of the margins of the original tumor in 80% of patients

Prognostic Factors in GBM
* Age
* Performance status
* Neurologic functional status

Treatment

* Surgery
* Radiation
* Chemotherapy

Treatment - Surgery
* Surgery done for diagnosis and to relieve symptoms when possible
* Median survival after surgery alone is 3-4 months
* Resections are suboptimal secondary to preservation of normal brain tissue
* Re-excision at recurrence an option in patients with good performance status

Treatment - Radiation
* Radiation after surgery extends median survival to 9-11 months
* CNS tumors infiltrate into surrounding normal brain tissue up to 3 cm or more
* Radiation delivered on a focal field including the tumor bed with a 2-3 cm margin with total dose of 58-60 Gy

Treatment - Chemotherapy
* Nitrosoureas (BCNU/CCNU)
o Best known chemotherapy agents
o Metaanalysis showed increase in median survival of 2 months over surgery and radiation alone
o BCNU impregnated wafers show similar results to systemic therapy
* PVC (Procarbazine, CCNU, Vincristine)
* Temozolomide
* Thalidomide
* Tamoxifen
* BCNU + O6-Benzylguanine
* Gleevec

Conclusions
* Glioblastoma multiforme continues to have a dismal prognosis
* Significant work has been done to identify genetic pathways in glioma progression
* Genetic information being used to identify targets for therapies and has potential to identify chemotherapy responsive tumors

Glioblastoma Multiforme Treatment Options.ppt

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Abnormal Uterine Bleeding

Abnormal Uterine Bleeding
Presentation by:Lloyd Holm, D.O., FACOG
Associate Professor
Department of Obstetrics and Gynecology
University of Nebraska Medical Center

Abnormal Uterine Bleeding
* Definitions
* Etiologies
* Evaluation and workup
* Case presentation
* Management and options

Definitions
Normal
abnormal
Average blood loss with menstruation
Definitions
Menorrhagia
Prolonged
Synonymous with hypermenorrhea
Metrorrhagia
Oligomenorrhea:
Amenorrhea
Etiologies
* Organic
o Systemic
o Reproductive tract disease
o Iatrogenic
* Dysfunctional
o Ovulatory
o Anovulatory

Systemic Etiologies
* Coagulation defects
* Leukemia
* ITP
* Thyroid dysfunction

Most Common Causes of Reproductive Tract AUB
Reproductive Tract Causes
* Gestational events
* Malignancies
* Benign
o Atrophy
o Leiomyoma
o Polyps
o Cervical lesions
o Foreign body
o Infections
* Gestational events
o Abortions
o Ectopic pregnancies
o Trophoblastic disease
o IUP
* Malignancies
o Endometrial
o Ovarian
o Cervical
Incidence of Endometrial Cancer in Premenopausal Women
Reproductive Tract Causes of Benign Origin
* Atrophy
* Leiomyoma
* Polyps
* Cervical lesions
* Foreign body
* Infection

Proposed Etiologies of Menorrhagia with Leiomyoma
* Increased vessel number
* Increased endometrial surface area
* Impeded uterine contraction with menstruation
* Clotting less efficient locally

Leiomyoma in any location is associated with increased risks of gushing or high pad/tampon use.
Iatrogenic Causes of AUB
* Intra-uterine device
* Oral and injectable steroids
* Psychotropic drugs
To determine if DUB is ovulatory or anovulatory
Evaluation and Work-up: Early Reproductive Years/Adolescent
Evaluation and Work-up: Women of Reproductive Age
Evaluation and Work-up: Post-menopausal Women
EMB
Incidence of Endometrial Cancer in Premenopausal Women
Endometrial Cancer Risk Factors
Possible Path Reports with EMB
Hysteroscopy
Management
Management Options:
* Progestins
* Estrogen
* OCs
* NSAIDs
* Antifibrinolytics
* Surgical
Progestins: Mechanisms of Action
Management: Progesterone
Progestational Agents
Intrauterine System
Treatment of menorrhagia with IUD vs endometrial resection
Endometrial Hyperplasia
Management: Estrogen
Management: NSAIDs
Cyclooxygenase Pathway
Arachidonic Acid
Prostaglandins
Thromboxane
Prostacyclin*
Antifibrinolytics:
Surgical Options:
* Laser ablation
* Thermal ablation
* Resection
* Hysterectomy
Comparison of Ablative Techniques
Case Presentation
Summary

Abnormal Uterine Bleeding.ppt

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