Imaging of brain tumours

Imaging is initiated early in the diagnostic pathway of patients with suspected brain tumours. Symptoms suggestive of an intracranial mass lesion include progressive neurological deficit, seizures, cognitive and behavioural changes. It should be noted that headache in isolation is rarely a presentation of a brain tumour. Typically, patients present via the emergency department and imaging is instigated via a stroke pathway. As a result, CT is often the first-line imaging modality performed. The imaging modality of choice for assessing brain tumours is MRI and if the baseline CT suggests the presence of a mass lesion, the next investigation should be to perform an MRI scan to characterise this further. Performing a contrast-enhanced CT, unless MRI is contra-indicated, is not justified. It exposes the patient to additional radiation and an unnecessary dose of iodinated contrast agent. The MRI should be performed within an appropriate time frame (<72 hours) to help differentiate from tumour mimics such as sub-acute infarction, and gadolinium contrast medium should be administered unless contra-indicated.

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