This particular article purposes to review the clinical applications of some of the newer techniques that can be used to screen and image brain tumors, including “…magnetic resonance (MR) diffusion and diffusion tensor imaging with tractography, perfusion imaging, MR spectroscopy, and functional imaging using the blood oxygenation level-dependent (BOLD) technique” (Shangvi, 2009, p. 82). The review is aimed at an audience comprising of “neurosurgeons, neuro physicians, and oncologists,” that is, the object is to outline the clinical applications of the above-named techniques rather than detailing the physics of each procedure (Shangvi, 2009, p. 82).
Relevancy of Article
The relevancy of this article can never be underestimated especially due to the serious nature of brain tumors. New insights and knowledge on brain tumors are essentially needed to facilitate the health professionals to fully take charge of an otherwise fatal medical condition. As such, the fundamental insights presented in this article will not only assist the professionals to facilitate their therapeutic decisions concerning brain tumors but will also help greatly in “noninvasive, preoperative grading of tumors, biopsy planning surgery, and radiation portal planning as well as prognostication” (Shangvi, 2009, p. 82).
List of Key Concepts
- Modern advances in brain tumor imaging allow health professionals to not only evaluate anatomical information on the tumors but also the pathophysiological information
- The diffusion tensor MR imaging technique is the only known noninvasive in vivo routine for plotting white matter fiber tract pathways or trajectories in the brain.
- In brain tumors, the diffusion-weighted (DW) imaging technique is useful in the preoperative, noninvasive, radiological ranking of gliomas, lymphoma, epidermoid cysts, medulloblastoma, ependymoma, and meningioma. According to Shangvi (2009 ), all the above brain tumors typically demonstrate restricted diffusion of water molecules
- Diffusion tensor imaging (DTI) has extensive clinical applications in the field of Neurology and Neurosurgery such as evaluating the relation of a brain lump to the neighboring white matter tracts. This in turn assists to direct the surgical procedure and scope of resection.
- Shangvi (2009) says DTI , “…by improving the recognition and characterization of white matter tracts, offers a glimpse into the brain microstructure at a scale that is not easily accessible with other modalities” (p. 8 4)
- According to Shangvi (2009), “…the two important clinical settings in which perfusion imaging is used in modern clinical practice are: in the evaluation of brain tumors and for the depiction of the penumbra in hyperacute ischemic strokes, to direct thrombolytic therapy” (p. 84).
- Consecutive studies reveal that perfusion imaging techniques can noninvasively rank a brain tumor’s histology preoperatively.
- MR Perfusion imaging can be used to aid in distinguishing a high-grade principal tumor from alone cerebral metastasis (Shangvi, 2009).
- An estimated one-third of high-grade lumps are under-diagnosed at stereotactic biopsy basically because the biopsy may not have been obtained from the most belligerent segment of the lesion
- The perfusion imaging technique is effective in the delineation of lump reappearance from radiation necrosis, which can be fundamentally confusing on normal MR imaging (Shangvi, 2009).
- MR Spectroscopy (MRS) “…is the only non-invasive technique capable of measuring chemicals within the body” (Shangvi, 2009, p. 85). The technique differentiates diverse metabolites based on their slightly dissimilar chemical shifts
- According to Shangvi (2009), “…MR spectroscopy is useful in establishing the diagnosis of the tumor by demonstration of elevated choline, a metabolite that is found in the normal brain and raised in tumors due to high cell turnover” (p. 86).
- The limitations of MR spectroscopy are that it is often a victim of poor spatial resolution and is often nonspecific
- In clinical settings, functional MR imaging (F MRI) is fundamentally employed for the preoperative assessment of the association between a brain lump and an eloquent cortex (Shangvi, 2009).
- Functional MR imaging is useful in directing surgical preparation and mapping, in so doing, reducing the scope and duration of craniotomy
Strengths & Weaknesses
The article is very clear on the clinical implications of the discussed imaging techniques, and how the different techniques fit in diverse situations. As such, the article broadens the scope for health professionals in evaluating which technique to employ in particular situations. Second, the article uses well-elaborated diagrams and graphics to depict the different brain tumors and how well they can be addressed. The article, however, fails to undertake a comparative analysis on the techniques to determine their advantages and disadvantages vis-à-vis other traditional techniques that have been in use. The article also fails to offer a primary discussion of how the methods have been successful, largely depending on secondary data for its analysis of the efficacy of the procedures. Lastly, the radiological component of the techniques is vaguely discussed.
Resources to Support Author’s Viewpoint
The author largely depends on secondary sources of information to support his standpoint on the various imaging techniques. It is, however, imperative to note that the resources used comes from credible journals and medical textbooks that depicts some of the experiments conducted on the imaging techniques to determine their efficacy
It is to conclude that the 21st century will bring many more innovations and new techniques to assist in the imaging of brain tumors. Some of the techniques discussed herein bordered on the unimaginable a couple of years ago, but they have been made possible, courtesy of concerted efforts by medical professionals and scientists. More advances and sophistication in the imaging of human brain tumors are likely to be made as we near the end of the first decade of the 21st century, thereby providing new and stimulating insights into the treatment and management of brain tumors. Consequently, I totally agree with the author’s conclusion that these procedures will have fundamental implications in planning therapy for brain tumors and in prognostication (Shangvi, 2009).
Shangvi, D.A. (2009). Recent advances in imaging of brain tumors. Indian Journal of Cancer, Vol. 46, Issue 2, pp. 82-87