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.
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 Alzheimers 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, go to this website or call 1-888-488-3627.
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.
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 or at this website.
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 look at this website.