A COMPARATIVE STUDY BETWEEN COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF BRAIN TUMOR (USING NATIONAL HOSPITAL, ABUJA AS CASE STUDY)

LIST OF TABLES

Table 1: CT findings of the patient

Table 2:  MRI findings of the patient

Table 3: Biopsy findings of the patient

Table 4: Comparison between CT findings and MRI findings

Table 5:Chi-square test of Comparison between CT findings and MRI findings

Table 6: Comparison between biopsy findings and CT findings

Table 7: Comparison between biopsy findings and MRI findings

Table 8: Comparison of accuracy, sensitivity and specificity of MRI

and CT findings using biopsy as goal standard.

ABSTRACT

This study sought to equip clinician’s on the imaging modality of choice between CT and MRI in the diagnosis of brain tumor. The comparison of the two imaging modalities was accessed using biopsy as goal standard. This research study involved 40 patients who underwent CT, MRI and biopsy one at a time in National hospital, Abuja. Data were collected via secondary source using patient’s folder; hospital records. The result revealed that MRI which has an accuracy, sensitivity and specificity of 67.5%, 65.22% and 70.65% respectively is more accurate than CT which had a sensitivity and specificity of 15%, 13.04% and 17.65% respectively in the diagnosis of brain tumour. Knowledge of the clinician on which modality of choice to use is evaluated.

TABLE CONTENT

Title page  …………………………………………………………….i

Approval page  ……………………………………………………….ii

Certification  ………………………………………………………….iii

Dedication  ……………………………………………………………iv

Acknowledge  …………………………………………………………v

List of tables  ………………………………………………………….vi

Abstract  ………………………………………………………………vii

Table of content  ………………………………………………………viii

Chapter One

1.1 Introduction  ……………………………………………………….1

1.2 Statement of problem  ……………………………………………..3

1.3 General objective  ………………………………………………….3

1.4 Specific objective  ………………………………………………….3

1.5 Hypothesis  ………………………………………………………….3

1.6 Significance of study  ………………………………………………4

1.7 Scope of study  ……………………………………………………..4

1.8 Literature review  ……………………………………………………4

Chapter Two 

2.1 CT and its principles of operation  ……………………………….12

2.2 MRI and its principles of operation  ………………………………13

2.3 Anatomy and physiology of the brain  ……………………………15

2.4 Pathophysiology of brain tumuor ………………………………….19

2.5 Conditions that mimic Brain tumour  ……………………………..19

2.6 Cause, symptoms and types of Brain tumour  ……………………20

2.7 How CT of the brain is done and clinical presentation of Brain

tumour on CT radiograph  ……………………………………….24

2.8 How MRI of the brain is done and clinical presentation of

Brain tumour MRI radiograph  ………………………………………….26

Chapter Three

3.0 Design of the study  ……………………………………………………….29

3.2 Population  …………………………………………………………………29

3.2.1 Area of study  …………………………………………………………….29

3.2.2 Target population  ………………………………………………………..29

3.2.3 Subject selection criteria  ………………………………………………….29

3.3 Method of data collection  …………………………………………………..30

3.3.1 Equipments  ………………………………………………………………..30

3.3.2 Procedure for data collection  ………………………………………………30

3.4 Data analysis …………………………………………………………………..31

Chapter Four:

Data Presentation  …………………………………………………………………32

Chapter five: Discussion, Recommendations,

Summary of Findings and Conclusion

5.1 Discussion  …………………………………………………………………….37

5.2 Summary of findings  …………………………………………………………41

5.3 Recommendations  …………………………………………………………….42

5.4 Conclusion ……………………………………………………………………..42

5.5 Areas of further studies  ……………………………………………………….43

5.6 Limitations of the study  ……………………………………………………….43

References

Appendix

CHAPTER ONE

1.1   INTRODUCTION

Brain tumours are abnormal and uncontrolled proliferation of cells¹. Some originate in the brain itself, in which they are termed primary. Others spread to this location from somewhere else in the body through metastases and are termed secondary. Primary brain tumours do not spread to other body sites, and can be malignant or benign. Secondary brain tumours are always malignant. Because the space inside the skull is limited, their growth increase intracranial pressure, and may, cause edema, reduced blood flow, and displacement with consequent degeneration, of healthy tissue that controls vital function.²

Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the intracranial cavity3. However, brain tumors (even malignant ones) are not invariably fatal, especially lipomas which are inherently benign. Brain tumors or intracranial neoplasms can be cancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or benign neoplasms differ from those commonly used in other types of cancerous or non-cancerous neoplasms in the body. Its threat level depends on the combination of factors like the type of tumor, its location, its size and its state of development. Because the brain is well protected by the skull, the early detection of a brain tumor only occurs when diagnostic tools are directed at the intracranial cavity. Usually detection occurs in advanced stages when the presence of the tumor has caused unexplained symptoms.

A good evaluation of the patient with a suspected brain tumour needs a complete history, exact physical examinations especially neurologic ones, and suitable diagnostic neuroimaging studies. The differential diagnosis of patients with signs and symptoms of brain tumours includes both neoplastic and non-neoplastic conditions.4

Computed tomography is the most widespread diagnostic tool for the localization and staging of brain tumour. It has an advantage of being widely available. Computed tomography is faster than magnetic resonance imaging making it study of choice in cases of trauma and emergencies.

MRI provides detailed info about brain tumour anatomy, cellular structure and vascular supply, making it an important tool for effective diagnosis, treatment and monitoring of brain tumour⁵. MRI does not use ionizing radiation, and thus preferred over CT in patient requiring multiple imaging examinations.

1.2     STATEMENT OF PROBLEM

Most patients undergo both the CT and MRI as radiological investigation for the diagnosis of brain tumour. This however could be prevented if the referring clinician knew which modality is better in terms of diagnostic quality.

1.3     GENERAL OBJECTIVE

The aim of this study is to compare the diagnostic quality of computed tomography and magnetic resonance imaging.

• SPECIFIC OBJECTIVES

• To determine which imaging modality best demonstrates the brain tumour –computed tomography and magnetic resonance imaging.
• To determine which imaging modality is more sensitive in the diagnosis of brain tumour computed tomography and magnetic resonance imaging.
• To determine which imaging modality is more specific in the diagnosis of brain tumour –computed tomography and magnetic resonance imaging.

1.5     SIGINIFICANCE OF STUDY

• This study will help us to know the imaging modality that is more accurate in the management and diagnosis of brain tumour.
• This study will eliminate any additional test the patient will undergo to obtain final diagnosis so as to minimize cost and the stay of patient in the hospital.
• This study will aid in minimizing radiation to patient and radiation safety of the radiographers can be improved, since only the right examination will be carried out.

1.6 HYPOTHESIS

There is no difference between CT and MRI in the diagnosis of brain tumour.

1.7 SCOPE OF STUDY

This study involves patients who had both, CT and MRI in the diagnosis of brain tumour at National hospital, Abuja.

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