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DIAGNOSTIC RADIOLOGY TESTS INFORMATION

MRI with Contrast is the preferred scan for suspected cancers. Given the high resolution of MRI,
and the ability to so clearly outline the blood vessels, an "MRA" (Magnetic Resonance
Angiography) obtained at the same time allows good determination of whether crucial blood
vessels are blocked or tortuous from aneurysm, narrowing, or tumor.

Historically angiography was done as a separate test to evaluate blood vessels by putting contrast
dye into them, but it can now be done with the same technique as MRI with Contrast. MRI is in
general the better test to look at the brain, soft tissues in the body, and extent of tumor
penetration into organs than CT Scan. Since it does not use radiation, there is no concern about
the radiation exposure with repetitive testing. It is however more expensive than CT (about 3
times as costly) and so is more judiciously ordered. MRI is seldom done on the whole body, but
instead in distinct regions as with CT Scan:

MRI of the Head - This frequently ordered test is usually gotten following a CT Scan which is
suspicious, or if the CT of the brain does not show anything but the doctor is still suspecting a
lesion in the brain. Tumors starting within the brain, or cancer spreading to the brain from other
organs, are easily seen using MRI with contrast. Since tumors tend to have a rich blood supply,
they commonly enhance brightly when contrast is given. Also, areas of swelling around the
tumor, called "peritumoral edema" will enhance. For malignant tumors, there are often cancer
cells found in this surrounding edema fluid. MRI helps the physicians determine the feasibility of
surgically removing the tumor - that is its "resectability". Although a tumor can be very
suspicious as being cancerous by MRI, no scan can make a diagnosis of cancer - it is still
necessary to get a piece of it ("biopsy") for examina- tion under the pathologist's microscope.
MRI can help direct the biopsy; today the commonest method used is a fine needle inserted
under exacting ("stereotaxic") direction.

The needle is placed through a small burr hole drilled in the skull, and guided into the tumor. The
rate of complications of this "stereotaxic biopsy" is very low; the death rate ("mortality") from
the procedure is less than 1%. MRI Scan of the Head is particularly useful for imaging the
posterior and lower portions of the brain - the cerebellum and brainstem. Small tumors may be
detected there that were invisible on CT Scan. MRI is excellent for designing radiation therapy
fields to treat tumors; the MRI gives good indication of how much "margin" needs to be added to
the radiation field to treat possible cancer cells escaped from the tumor. An MRA (Magnetic
Resonance Angiography) gotten at the same time as the MRI can help a surgeon determine the
location and character of blood vessels within the brain, and clearly show abnormalities like
aneurysm. MRI of the Head may be periodically repeated after treatment to gauge the progress of
therapy or detect a recurrence of cancer. It can be difficult to distinguish between recurrent tumor
and changes in the brain due to aggressive treatment - a PET scan (discussed below) can usually
make this important distinction.

MRI of the Spine - This test is routine when "epidural spinal cord compression" ("ESCC") is
suspected. This just means that the spinal cord is being compressed, either by benign or
cancerous conditions. Since the spinal cord transmits signals to the entire body below the neck,
compression of it can cut off these vital signals. With partial and temporary compression (e.g.
less than 24 hours) damage may be reversible, but with complete or long term compression loss
of sensory and motor function will be experienced to all areas under the lesion. In a patient
diagnosed with cancer, new back pain (especially in the upper midback or "thoracic" region) will
indicate spinal cord compression due to tumor spread 60% of the time. If any patient comes to
the doctor with new back pain (the 2nd most common reason for doctor office visits in America)
then the chance is 1 in 1200 that the cause is a new cancer in the spine. Cancer commonly first
spreads to the vertebral bodies, that is the skeleton of the spine, and afterward will compress the
spinal cord proper.

The important aspect of spinal cord compression is quick recognition and treatment, to avoid
permanent paralysis and loss of bowel and bladder function. MRI Scan is the definitive test to
visualize spinal cord compression. No other test can show the spinal cord and surrounding
vertebral bones as clearly as MRI. Any small area(s) of compression is obvious on "lateral" MRI
films, which show the spinal column as though one is looking through it from the side. MRI with
contrast lights up the fluid around the spine ("cerebral spinal fluid") and makes the cord even
easier to see.

Other tests included in the complete report are on X-Rays, Computerized Axial Tomography (CT
or CAT Scan), Magnetic Resonance Imaging (MRI), Ultrasound, Barium Swallow, Small Bowel
Follow Through, Lower Tract Studies, IntraVenous Pyelogram (IVP), retrograde urethrography,
Venography, Lymphangiography, Pulmonary Function Tests, Angiography, Digital Subtraction
Angiography (DSA), Myelography, Contrast Myelography CT Scan, Ventilation-Perfusion Scan
("VQ" Scan), Pulmonary Arteriography, Nuclear Medicine Imaging Tests, PET Scans, Bone
Scans, Tagged Red Cell Study, Liver Spleen Scan, Indium Scan, Gallium Scan, Thallium Scan
and Thyroid Scan.