SYNOPSIS

OF

DISSERTATION

DR.RAM PRAKASH . G

DEPARTMENT OF RADIODIAGNOSIS

VYDEHI INSTITUTE OF MEDICAL SCIENCES AND

RESEARCH CENTER,

WHITEFIELD, BANGALORE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

1. / NAME OF THE CANDIDATE & ADDRESS
(IN BLOCK LETTERS) / Dr. RAM PRAKASH .G
DEPARTMENT OF RADIODIAGNOSIS,
VIMS & RC, EPIP AREA, WHITEFIELD, BANGALORE– 560066.
2. / NAME OF THE INSTITUTION / VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE
3. / COURSE OF STUDY & SUBJECT / M.D. RADIODIAGNOSIS
4. / DATE OF ADMISSION TO COURSE / 25thMay, 2012
5. / TITLE OF THE TOPIC / MAGNETIC RESONANCE IMAGING EVALUATION OF SUPRATENTORIAL TUMORS

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

6. Brief resume of the intended work

6.1 Need for the study

Brain neoplasms can be classified by location as supratentorial, infratentorial and mid-line

tumors . Of the supratentorial tumors meningiomas are the most frequent

neoplasms.

MRI has earned recognition as the optimal screening technique for the detection of most

intracranial neoplasms. MRI using spin echo, gradient echo, and combination spin echo

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 proved to be more sensitive

in the detection of focal lesions of the brain .Moreover, the multiplanar capability of MR is

very helpful to determine the anatomic site of origin of lesions and to demarcate extension

into adjacent compartments and brain structures.

There is a need to determine and develop the accuracy of a magnetic resonance (MR) in

diagnosis of supratentorial masseswith histopathological correlation.

The outcome of this study will help in the development of imaging strategy for evaluation of

supratentorial tumors1 .

6.2Review Of Literature

In a study done by Joachim M. Baehring , Joseph M. Piepmeier ,Robert K. Fulbright on 89

patients for malignant glioma , diffusion weighted imaging (DWI) was helpful in the early

decision making process of a subset of cases where in the diagnosis in the early stages was

challenging .Henceinformation obtained through DWI should be incorporated in the clinical

decision-making process.2

In a study done byIshtiaq A Chishty , Muhammad Zafar and Rafique, Munawar Hussain on Fifty-three patients having different neurological symptoms referred to Radiology DepartmentAga Khan University Hospital for MRI examination were included in the study. These patientswere provisionally diagnosed radiologically having intra-axial brain tumor or subsequentlyfound to have pathologically proven primary intra-axial brain tumors. MRI scans wereevaluated for location, consistency, hemorrhage, necrosis, margins, edema, MRI signals contrastenhancement and any additional features for staging the tumor. Preoperative diagnosis was compared with post-operative pathological diagnosis by using person’s chi-square test.

Accuracy of magnetic resonance imaging in diagnosing and staging the brain tumors was determined. Sensitivity, specificity, accuracy, positive predictive value and negative predictivevalue of MRI in characterizing the lesion was also calculated.

MRI was very accurate in preoperative diagnosis, staging and assessing the tumor

characteristics of primary intra-axial brain tumors. It can be used reliably in our usual clinical

practice.3

In a study done by Al-okaili RN ,Woo JH, et on 111 patients to develop and retrospectively determine the accuracy of a magnetic resonance (MR) imaging strategy to differentiate intraaxial brain masses, with histologic findings or clinical diagnosis as the reference standard.A strategy was developed on the basis ofconventional MR imaging, diffusion-weighted MR imaging,perfusion MR imaging, and proton MR spectroscopy toclassify intraaxial masses as low-grade primary neoplasms,high-grade primary neoplasms, metastatic neoplasms, abscesses,lymphomas, tumefactive demyelinating lesions(TDLs), or encephalitis. The strategy was evaluated by using data from 111 patients (46 women, 65 men; mean

age, 48.9 years) with imaging results available on a departmentalpicture archiving and communication system froma 5-year search period.

Search results identified 44 patients with high-grade and14 with low-grade primary neoplasms, 24 with abscesses,

12 with lymphoma, 11 with TDLs, five with metastases,and one with encephalitis who had undergone conventionaland advanced MR imaging.4

6.3Objectives Of Study

  • To study the distribution of various supratentorial neoplasms.
  • To study MRI features of supratentorial neoplasms
  • To develop imaging strategy for evaluation of supratentorial tumors

Materials And Methods :

7.1 Source of Data

a)All cases referred to Department of Radiodiagnosis and Imaging in Vydehi institute

ofmedical science for radiological evaluation with h/o intracranial space occupying

lesions.

b)Duration of study : December 2012- September 2014 (minimum of 30 cases)

c)Inclusion criteria: Clinically diagnosed patients above 18 years of age groups with supratentorial tumors will be included.

d)Exclusion criteria: All cases with-

  • Supratentorial pathology and sympatomatology due to infections
  • Pediatric age group
  • Congenital malformations
  • Trauma or cerebrovascular accidents will be excluded.

7.2 Method Of Collection Of Data

It is a cross sectional study.All patients will be subjected to a multiplanar,multisequential

MRI Scan of the brain in a 1.5 Tesla Philips Achieva Machine and further follow up of

patients for histopathological correlation wherever possible .

Statistical Analysis : All data will be expressed in percentage .

Data will be analysed using SPSS software and with chi-square test.

7.3 Does The Study Require Any Investigations Or Interventions To Be

Conducted On Patients Or Other Humans Or Animals ?

All patients will be subjected to

-MRI Scancontrast study (gadolinium -after test dose)

-Informed consent

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes , Copy enclosed

REFERENCES:

  1. Young RJ Knoop EA : Brain MRI : Tumor Evaluation :Department of Radiology, New York University Medical Center, New York, New York 10016, USA2006 Oct;24(4):709-24
  2. Joachim M. Baehring ,Wenya Linda Bi ,Serguei Bannykh :Diffusion MRI in the early diagnosis of malignant gliomaReceived: 3 May 2006 / Accepted: 13 September 2006 Published online: 7 October 2006Springer Science+Business Media B.V. 2006:J Neurooncol (2007) 82:221–225
  3. Ishtiaq A Chishty , Muhammad Zafar Rafique, Munawar Hussain:MRI Characterization and Histopathological Correlation of Primary Intra-axial Brain GliomaJuly 2004 to June 2006 JLUMHS MAY-AUGUST 2010; Vol: 09 No. 02
  4. Al-Okaili RN ,krejza J , Woo JH et al : Intracranial brain masses : MR imaging-based diagnostic stratergy- intial experience. Radiology 243:539-550, 2000 Radiology: Volume 243: Number 2—May 2007

.

9 / Signature of the Candidate
10 / Remarks of the Guide
11 / 11.1 Name and Designation of the Guide
11.2 Signature
11.3 Co guide (1)
11.4 Signature
11.5 Co guide (2)
11.3 Head of the Department
11.4 Signature / DR .Indira.N
MBBS MDRD
PROFESSOR
DEPARTMENT OF RADIODIAGNOSIS
VIMS BANGALORE
DR. Ram Prakash.H.V
MBBS MDRD
PROFESSOR & HOD
DEPARTMENT OF RADIODIAGNOSIS
VIMS BANGALORE
12 / 12.1 Remarks of the Principal
12.2 Signature

1