TUMOR IMAGING:

APPROACH TO
DIAGNOSIS
MARIAEM M. ANDRES, MD
Institute of Radiology
St. Luke’s Medical Center, Quezon City and Global City
OBJECTIVES

■ Provide brief history of imaging of tumors in different organ systems

– Head and neck
– Chest
– Abdomen

■ Present current imaging modalities utilized in cancer detection and staging

BRAIN TUMOR IMAGING
 Brain Tumor in Ancient Times

Fatal Battlefield Injuries Incas first performed craniectomy in 19th century Meningioma in
Ancient Egyptian skull
1904

• Xrays for brain in farctions and

tumors

• Calcifications

• Oligodendroglioma
• Astrocytoma
• Meningioma
• Choroid plexus neoplasia
• Pituitary tumors

Radiography of calcified tumor of chorois plexus in

27-year old woman
Brain Tumor Imaging: CT
■ Contrast enhanced brain CT, in 1960’s
– First major advanced neuroimaging approach to diagnosis
Brain tumor Imaging: MRI
■ First human MR images were reported in 1977
■ Radiology journal published MR imaging brain tumors in 1984
Brain Tumor Imaging: DTI
■ DTI was introduced during 1991
Brain Tumor Imaging: DTI
Brain Tumor Imaging: Spectroscopy
Brain Tumor Imaging: Spectroscopy

■ H metabolites: choline- containing molecules (Cho), creatine (Cr), phosphocreatine

(PCr), and N-acetylaspartate (NAA)

■ INDICATIONS:
– Tumor profiling
– Differentiating post-radiation scar tissue from tumor recurrence
– Metabolic white matter diseases or adrenoleukodystrophy
– Non-inherited metabolic disorders i.e.HIE
Brain Tumor Imaging:
PET/CT
■ FLUORINE-18-DEOXUGLUCOSE (FDG)
■ Measures metabolic activity of tumors
■ Establishes a diagnosis
■ Assesses response to therapy
■ Prognosticates
Department of Neurosurgery
Alder Hey Children’s Hospital
Liverpool, England
Multimodal display of
intraoperative MRI with BrainLAB
sotware for neuronavigation.
Neurosurgeon's view of a large
cerebral tumour through the
operating microscope is displayed
with corresponding
axial
sagittal
coronal
SKULLBASE AND NECK
H&N Tumor Imaging: CT and MRI

■ In descending head and neck structures, the advantages of MRI decrease and
those of CT increase

■ MRI preferred for skullbase and pharyngeal regions

■ CT is preferred lower neck
 H&N Tumor Imaging: MR Advantages
Compared to CT for Cancer Depiction
Component Advantages Disadvantages
NEURAL Tumor extension into the cavernous, dura and perineural
tumor spread
SINONASAL Delineation of tumor from inflammatory disease
BONE/ Superior sensitivity for invasion especially into the bone
CARTILAGE marrow
MUSCLES/ Delineation of tumor invasion of fascia and small
FASCIAL PLANES muscles
VESSELS Relationship of tumor to vessels – infiltration, Flow artifacts
encasement
ORAL CAVITY Better delineation of tumor in the tongue Metallic artifacts from
dental amalgam and
prosthesis
POST TREATMENT Better distinction of scar tissue from recurrent cancer
H&N Tumor Imaging: Nodes and distant
Metastases
■ Cervical nodal metastases are staged at the same time as the primary tumor
■ Ultrasound is helpful for detection of metastatic nodes
– Ultrasound guided biopsy
■ Distant Metastases
– 10-25% risk
– May occur within 2 years of diagnosis
– FDG-PETCT has low specificity but high sensitivity
CHEST WALL
Chest Wall Tumor Imaging
Chest Wall Tumor Imaging

■ CHONDROSARCOMA
– Most common primary malignant bone tumor of the chest wall
– Accounts for 33% all primary rib tumors
– 2nd most common rib tumor: myeloma

■ Malignant bone tumors are best depicted with CT

■ Extraosseous mass formations are best visualized with MRI
■ Metastases can be detected with PETCT
Chest Wall Tumor Imaging

■ CHONDROSARCOMA
– Matrix is nodular, peripheral

■ OSTEOSARCOMA
– Matrix is dense, cloudy
– Greatest at the center
Chest Wall Tumor Imaging
■ LIPOMA
– Most common benign soft tissue tumor of the chest wall
■ MALIGNANT FIBROUS HISTIOCYTOMA
– Most common malignant soft tissue tumor of chest wall
■ RHABDOMYOSARCOMA
– Most common malignant soft tissue
tumor in children
LUNG TUMORS
Lung Tumor Imaging

■ Leading cause of cancer-related deaths for both men and women across the
developed world
■ Overall survival for all stages at 15%
■ Majority present with cough, hemoptysis, chest pain and even pneumonia

■ IMAGING:
– CHEST RADIOGRAPH –first line of investigation
– CHEST CT –cornerstone of lung cancer imaging
Common CT Presentation of Lung
Tumors
Atypical CT Presentation of Lung
Tumors
TNM CLASSIFICATION OF LUNG TUMOR

Based on recommendations by
the International
Association for Study
of Lung Cancer (IASLC)
TNM CLASSIFICATION OF LUNG TUMOR

■ STAGE I - cancer is confined to the lungs

■ STAGE II - cancer that involves the lungs and the ipsilateral hilar, peribronchial
and bronchopulmonary nodes
■ STAGE III
– A - cancer that has spread to ipsilateral mediastinal nodes or
contiguously involving structures like chest wall and pericardium that
can be resected
– B - non resectable cance that involves contralateral mediastinal or
supraclavicular nodes
■ STAGE IV - infiltrative and/ or distant metastases
T1-T2 in TNM Classification
T4 in TNM Classification
Lung Tumor Imaging: PETCT
ABDOMINAL TUMORS
COLON CARCINOMA
■ Majority arise from benign adenomatous polyps
– Increase in polyp size, increase in developing adenocarcinoma
– Surveillance via colonoscopy –45 years old
– COLONOSCOPY – gold standard for detection
CT COLONOGRAPHY

■ VIRTUAL COLONOGRAPHY
– Non invasive, no sedation
– Just like CT scan but air is pumped into the colon
– Structural examination of ENTIRE COLON
■ No limitation of not being able to advance due to stricture or tortuosity of colon
– 2D and 3D evaluation of multiple planes
– Minimal risk for bleeding and perforation
VIRTUAL COLONOSCOPY

Sensitivity for polyps

detection
< 5 mm: 84%

> 10 mm: 100%

RADIOLOGIC MODALITIES
XRAY

NUCLEAR ULTRASOUND
MEDICINE

PETCT CT/MRI
THANK YOU FOR LISTENING.