Brain Imaging

Question: I have to get an MRI on Friday and I have concerns about gad. I am getting tested for MS I am not diagnosed, but I obviously hope I don’t have it. My understanding is that whether an MRI is given with or without contrast the lesions would show up regardless. The difference with contrast is that active ones would glow to show that they are active. But either way with or without the same lesions would show overall is that correct? I am sacred to put gad into my body if not needed.

Answer: Hello, this is a very important question. I feel the best person that can actually help you solve it is your neurologist.

You are correct, the images can show if there is disease without the addition of contrast, but it is very important to know if there is active disease which is better noted with contrast media.

First it will change the approach to the management, and second it can allow your care provider determine whether the treatment is working in your follow-up examinations.

Question: I had a recent MRI due to vision loss. I was told at the time that I had Empty Sella (which is incidental and would have nothing to do with vision loss). I have now been diagnosed with Cushings, but I have been told that my pituitary is fine and there is no tumor. How can they see a minute tumor if the pituitary is flat? Is there a more detailed scan for a flattened pit to get a closer view?

Answer: Thank you so much for your question to our site. At this time, we are unable to completely answer your questions without being able to view your scans. Our suggestion would be to either send a copy of your films for a second opinion, which we would be happy to assist you with. Or you may contact the physician that ordered the scan and ask for more clarification in this matter. If we can be of further assistance, please feel free to contact us.

Question: My doctor, not associated with UT Houston, who is treating me for chronic Lyme disease has recommended that I get a SPECT scan. Since my endocrinologist is on the UT staff, I thought of asking if UT does a SPECT scan and is it covered under Medicare?

Answer: Thank you for contacting the Neuro Imaging Ask an Expert forum. Our experts tell us that a standard Brain SPECT using Technetium is being studied for Chronic Lyme Disease with excellent results, but is not performed commonly for this indication. They recommend that your physician speak directly to the board-certified UT nuclear medicine physicians at the Memorial Hermann Hospital-TMC imaging department to discuss what he or she is looking for, for example, perfusion defects, or vascular abnormalities. When an imaging procedure is ordered by a physician at the Memorial Hermann Hospital, the scheduling team will contact your insurer, such as Medicare, to confirm whether the imaging will be covered, and this is done on a case-by-case basis.

Question: Hi, I’ve been trying to get an autism spectrum disorder diagnoses, but the neuropsychologist that did my evaluation said she couldn’t diagnose me or rule it out and suggested I find a neurologist that can do neuroimaging for autism. I’m having an incredibly hard time finding someone in the Houston area that can do this. Do you know of anybody who can perform the MRI, so that I can either be diagnosed or ruled out? Thank you.

Answer: Thank you for contacting the Neuro Imaging Ask an Expert forum with this important and frustrating question. Imaging of Autism Spectrum Disorder (ASD) is being done in a number of research studies in the United States and overseas. A quick search of www.clinicaltrials.gov looking for “Autism AND imaging” turned up a few studies using MRI, but none in Texas. Other types of imaging for Autism Spectrum Disorder (ASD) would also be considered research. However, our UT experts in ASD feel that a firm diagnosis is not needed in order to get beneficial therapy. UTHealth has a clinic that may be of benefit to you, called Changing Lives through Autism Spectrum Services (CLASS). Adult Clinic: new patients call 713-486-2525, or 713-486-2666.

Question: Hello. I had an MRI of 8th cranial nerves. This was done to see if there is a vessel in the cerebellopontine angle that may be the cause for the existing pulsatile tinnitus. I’d like to have a second opinion as to what is seen on the images. I have selected relevant files of the study available for review. Thank you.

Answer: Thank you for contacting the Neuro Imaging Ask an Expert Forum. It is sometimes a good idea to ask an expert to look a second time at images that have been taken. UT Radiology offers this service for any type of image—Mammogram, MRI, x-ray, or CT—for a flat fee of $99.

Question: I would like to find out if you have any research for which you are looking for patient volunteers for brain scan. 41 yo F and I live near the med center. If not for research, what type of indication would warrant such an image, and is it covered by insurance? (bcbs-ppo)I find the field facinating and would be interested in participating and analyzing activity. Kind regards.

Answer: Thank you for contacting the Neuro Imaging Ask an Expert Forum. It appears that you are looking for a scan of your brain, possibly because of something concerning you. We applaud your interest in being a subject for a research study. Many important findings from past research studies are now used to help people every day. However, we would like to be clear about the fact that NO imaging method is, by itself, able to give a diagnosis. A physician’s evaluation is a necessary part of finding out what the problem might be. That being said, many research studies provide you not only with the imaging procedure being tested, but access to the doctor that oversees the study. You can find out whether there are any studies that fit your needs on this website

The “brain scan” you mentioned is performed in the nuclear medicine department. The most common kind of brain scan uses an injection of a measured amount of a radioisotope called technetium combined with a drug that helps it get past the blood -brain barrier, then waiting a prescribed amount of time before lying on a scanning bed while the “gamma camera” circles your head taking many pictures. The end result is a three-dimensional picture of your brain called a brain SPECT, which can be used together with other diagnostic methods, to diagnose stroke or brain ischemia (low blood flow to an area), epilepsy, hyperactivity, mood disorders, or tumors. There are other types of “brain scans”, including a new radiopharmaceutical being used for Parkinson’s, and imaging using special radioisotopes made for PET imaging, some for standard care and some for research studies on the diagnosis of things like Alzheimer’s and migraines. Other kinds of brain imaging use computed tomography (CT) or magnetic resonance (MRI), usually with a contrast injected during the procedure. These are usually not called “brain scans” but can be very useful for diagnosis, and may be used in research studies which might be of interest to you.

If your search of the research studies available does not come up with anything fitting your needs, we would recommend that you still contact your physician to discuss any issue that is concerning you. Most non-research imaging procedures ARE covered by insurance. It is also possible that a doctor can do something about your concern without any kind of imaging. If you need to find a board-certified physician, visit UT Physicians or call 1-888-488-3627.

Question: I have an astrocytoma that has been treated with surgery and radiation, recurred and was treated with surgery and chemo, it is showing possible growing activity on most recent MRI. Is there an imaging technique that could tell me how much it is growing? and somewhat a what rate it is doing so,Is it possible to tell apart scar tissue from growing tissue? Can I know if the involved tissue is white or gray matter? Thanks.

Answer: Thank you for contacting the Neuro Imaging Ask an Expert Forum. MRI imaging with contrast still remains the best method to follow primary malignancies of the brain such as high grade astrocytoma. In judging whether or not there has been progression of the lesion, we typically look at two things, one, the three-dimensional measurement of the enhancing portion of the tumor, and secondly, the degree of surrounding edema. (In patients on therapy with Avastin, the degree of edema is particularly important, as this drug often decreases the amount of tumor enhancement.) If either one of these things has changed, we need to consider the possibility of tumor progression or, if there has been recent radiation treatment, effects of that treatment such as swelling or necrosis/scarring of the tumor. If there has been recent radiation, in the last six months, then radiation effects should be considered as a serious possibility. Typically, when there is a change in the tumor, and there is question whether it is recurrence or treatment effect, a short interval follow-up MRI examination will be obtained to try and establish a trend. If there is further growth, recurrence is often the diagnosis, however, if there is regression of the findings, then it was clearly related to the treatment and not tumor progression. Unfortunately, waiting another 4 to 6 weeks for a follow-up is often the best way to get the answer, although I cannot imagine how difficult that wait must be for somebody who is ill.

If there is recurrence, a series of scans can be compared to get an idea of the rate of growth. When tumors recur, there is quite a bit of variability here. Some tumors are very well controlled with chemotherapy and come back very slowly. Others grow very quickly despite best available therapy.

There are newer MRI techniques such as MRI spectroscopy and perfusion imaging that can help distinguish the difference between scarring/treatment effects and true progression. They may also be able to detect tumor in areas that are nonenhancing. However, the accuracy of these techniques is still not 100%. Even the most necrotic tumor can still contain small numbers of living cells that can go on and grow at a later date. If you are interested, you may discuss the possibility of integrating these techniques at your next examination if you feel that will give you and your doctors more information to make decisions.

In terms of involvement of the gray and white matter, that can easily be determined, but what is more relevant is whether or not the progression involves areas of the brain that would result in significant disability if they were to be surgically removed. This is definitely a discussion you can have with your oncologist and your neurosurgeon and get their opinion on whether or not additional resection is an option. Since you have already had two resections this may not be an option for you, but every patient is different and every tumor is different. This is also a good opportunity to talk about experimental clinical trials if you’re interested.

I would encourage you to raise any questions about your imaging reports with your oncologist. He or she can then consult with the radiologist directly if needed . Almost every case of primary brain tumor at this university is discussed by a panel including a surgeon, oncologist, a radiologist, and a radiation therapy specialist as well as a pathologist .This is an excellent forum to get a consensus opinion on what the imaging means and what its implications are for therapeutic options.

Question: how to detect a blood clot in brain where a persistent pain occurs

Answer: Thank you for contacting the Neuro Imaging Ask an Expert forum. A blood clot in the brain can be caused by a stroke, or a serious bump on the head. Headaches can be caused by many things, many of which are not serious or life threatening. If you are concerned about a blood clot that could cause a stroke, the UT physicians have an excellent stroke program, and you can read a detailed description of symptoms or a stroke at this website.

A headache after a serious bump on the head is one sign of a possible concussion. Usually, a mild concussion will heal on its own with rest, but persistent headache pain that lasts more than a day or two after the injury, or severe head trauma should be seen by a doctor. The doctor will often ask you to have a CT scan, which will show any blood clots. Other imaging tests may be done, if needed, to determine what treatments may be needed. If you have a concern about the cause of a headache, you can ask for an appointment to see one of the UT neurologists at 713-572-8122.

Question: I heard that there was a new test that could tell if my tremors mean I have Parkinson’s or something else that is not as serious. Do you do that test?

Answer: Thank you for contacting the Neuro Imaging Ask an Expert forum. The test you are referring to is called a DATscan, which is performed in the nuclear medicine department at the Memorial Hermann Hospital, and interpreted by a specially trained UT radiologist. As you correctly said, the results of the scan are used to tell whether a person’s tremor is caused by a benign condition called Essential Tremor, or the more serious and progressive condition called Parkinson’s Disease or a related Parkinsonian Disorder. Knowing the correct diagnosis earlier will help your doctor prescribe the correct medicines to treat your symptoms.

The DATscan injection is made of a well-known radioactive substance called Iodine-123 which has been attached to a made-for-imaging drug called Ioflupane. This procedure must be ordered by your doctor, and scheduled at least a week in advance. The DATscan injection is specially ordered for you. When you arrive in the nuclear medicine department for the DATscan injection, you will be given a non-radioactive iodine pill or liquid, which keeps the radioactive iodine out of your thyroid gland. After about an hour, the DATscan injection is given by the technologist into a vein in your arm. After the injection, you must wait about 3 hours for the DATscan to attach itself to the parts of your brain that are related to the use of dopamine, which is a chemical made by your body that controls movement. While you are waiting, you are free to do whatever and go wherever you would like. When you return to the nuclear medicine area, you will lie down on a narrow bed which is positioned so that only your head is inside the imaging areas of the Gamma camera. Once the scan begins, the heads of the camera (flat surfaces that record where the DATscan went) will slowly rotate so that a three-dimensional picture of your brain is taken. This is called a SPECT scan. The scan takes about 45 to 60 minutes. Drinking lots of liquids afterwards will help the body eliminate the DATscan from your body quickly.

Your doctor will determine whether a DATscan is right for you after an examination of your symptoms, taking a history of your allergies, and reviewing all your medicines. Your doctor will tell you about the scan, and you should discuss any concerns you have with your doctor before scheduling the scan. For more information, please visit the DaTscan website.