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The demonstration of glomus tumours by subtraction MRI
G A Lloyd1, A D Cheesman, P D Phelps
1Royal National Throat Nose and Ear Hospital, London, UK.
Abstract:
Thirteen patients with 14 glomus tumours have been examined by subtraction gadolinium-enhanced magnetic resonance imaging (MRI), with T1-weighted MR sequences before and after intravenous gadolinium-DTPA. To eliminate movement between subtraction pairs, the patient remains in the tunnel of the imager during administration of the contrast medium, and the venepuncture is made into the dorsum of the foot. The effect of the subtraction process is to remove the NMR signal from the final image so that the photographic densities recorded are dependent on the vascularity of the tissue concerned, normal or abnormal. A particular advantage is the removal of fat signal: the low vascularity of adipose tissue ensures that it is recorded as of minimal density. The extent of skull base glomus tumours has been shown optimally by this technique. Subtraction can also help differentiate glomus tympanicum from glomus jugulare lesions, which may be of crucial importance when deciding the surgical approach. In addition to diagnosis, the technique is also important post-operatively, when imaging is needed to show residual or recurrent tumour and to monitor the effects of radiotherapy.
Insights
Subtraction gadolinium-enhanced MRI effectively visualizes glomus tumors, aiding surgical planning and post-operative monitoring. This technique optimizes imaging by removing signals from fat and normal tissues, highlighting tumor vascularity.
Area of Science:
- Radiology
- Oncology
- Neurosurgery
Background:
- Glomus tumors, particularly skull base lesions, present diagnostic challenges.
- Accurate tumor delineation is crucial for surgical approach determination and treatment monitoring.
Purpose of the Study:
- To evaluate the efficacy of subtraction gadolinium-enhanced MRI in visualizing glomus tumors.
- To assess the technique's utility in differentiating tumor types and guiding surgical decisions.
Main Methods:
- Thirteen patients with 14 glomus tumors underwent T1-weighted MRI before and after gadolinium-DTPA contrast administration.
- Subtraction imaging was employed to remove background signals, emphasizing vascularity.
- Patients remained in the scanner during contrast injection to minimize motion artifacts.
Main Results:
- Subtraction MRI effectively highlighted tumor vascularity by removing signals from fat and normal tissues.
- The technique optimally demonstrated the extent of skull base glomus tumors.
- Subtraction imaging aided in differentiating glomus tympanicum from glomus jugulare lesions.
Conclusions:
- Subtraction gadolinium-enhanced MRI is a valuable tool for diagnosing and characterizing glomus tumors.
- This technique improves surgical planning and is essential for post-operative surveillance of residual or recurrent tumors.
