Functional imaging has come a long way from being a demanding research tool to becoming an integral part of clinical MRI protocols essential for the decision-making process and therefore management of various CNS diseases. In this exciting session, we will explore the spectrum of its use from research to clinical practice in 3 distinct diseases: stroke, brain tumours, and small vessel diseases.
1. To be aware of relevant functional studies in the emergency room.
2. To learn about the most useful functional parameter to be quantified.
3. To learn about the impact of functional data for patient management.
Brain imaging is an emergency when an acute stroke is clinically suspected. Such acute imaging is crucial (i) to establish the diagnosis of an ischemic or hemorrhagic stroke while ruling out stroke mimics, (ii) to provide etiological and prognosis clues and mainly (iii) to guide the acute therapeutic strategies. Either computer tomography (CT) or magnetic resonance imaging (MRI) can be used depending on their availability. The protocol is typically multimodal including for CT: non-contrast acquisition, angio-CT of head and neck vessels and brain perfusion CT; and for MRI: FLAIR, diffusion, T2*, angio-MR of head and neck vessels and brain perfusion MR. In ischemic stroke, the functional information provided by diffusion and/or perfusion can now be used to select the appropriate candidates for mechanical recanalisation within an extended time window (up to 24h after stroke onset) based on the concept of penumbra.
1. To learn about how functional data may help in characterising brain tumours.
2. To understand significance of quantitative data patient management.
3. To become familiar with limitations and pitfalls of functional technics.
There are quite many advanced MR imaging techniques which are currently available in the majority of MRI centres and can be used in daily routine. They offer different kinds of functional data resulting from their physical basis which can be helpful in differentiation between brain tumours and other pathological items as well as in the determination of tumour types and grades. They are also the source of vital information for clinicians to provide the most effective and safe ways of treatment. The essentials of main functional methods will be introduced including diffusion and perfusion technics, functional MRI and just a touch of susceptibility weighted imaging. The selection of technics will be discussed, and some diagnostic algorithms will be proposed. The examples of clinical cases will be presented to illustrate the validity of multiparametric imaging in practice. Lastly, future perspectives will be mentioned, e.g. - randomised and use of machine learning developments.