Brain tumor protocol

MRI protocol for brain tumor assessment is a group of MRI sequences put together to best approach CNS tumors in general.

A good protocol for this purpose involves at least:

T1 weighted

plane: axial and sagittal (or volumetric 3D)

sequence: fast spin echo (T1 FSE) or gradient (T1 MPRAGE)

purpose: anatomical overview, which includes the soft tissues below the base of the skull

T2 weighted

plane: axial

sequence: T2 FSE

purpose: evaluation of basal cisterns, ventricular system, and subdural spaces, evaluation of vasogenic edema, and good visualization of flow voids in vessels

FLAIR

plane: axial

sequence: FLAIR

purpose: assessment of white-matter tumor involvement and related vasogenic edema

Diffusion-weighted imaging (DWI)

plane: axial

sequence: DWI: B=0, B=1000 and ADC

purpose: evaluation of the tumor cellularity

Postcontrast sequences

plane: axial and coronal (at least two different planes or volumetric 3D)

sequence: post-contrast fast-spin echo (T1 FSE) or gradient (T1 MPRAGE). A fat-saturated sequence is considered in at least one plane, especially when the tumor involves the skull's base

Gadolinium-based contrast agents (GBCAs) for CNS

gadoterate meglumine (Dotarem®)

gadobutrol (Gadavist®)

gadopentetate dimeglumine (Magnevist®)

gadobenate dimeglumine (MultiHance®)

gadodiamide (Omniscan®)

gadoversetamide (OptiMARK®)

gadoteridol (ProHance®)

all these GBCAs are approved by FDA at identical administered total doses of 0.1mmol/kg body weight

susceptibility weighted imaging (SWI)

plane: axial

sequence: susceptibility weighted imaging (ideal) or T2