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MRI REPORT: CAVERNOUS ANGIOMA OR GLIOMA?


  Thanks for providing such an excellent service!
  I recently had an enhanced MRI performed following a first time seizure. The MRI was "generalized", and as such, did not focus on a specific area of the brain. Two probable DX have been made by two Neurologists at different hospitals, based on the images captured: the first (who ordered the MRI) felt glioma was the strongest possibility;  the second (whos care I have since been transfered to) read the same MRI and the previous doctors report and concluded cavernous angioma was the most likely DX.
  I have questioned why two different opinions were reached by equally qualified Nuerologists, and according to my current doctor, differences in opinion are not uncommon prior to a more localized MRI to provide a more detailed image of the tumor.
  I have researched both types of tumors, and understand both present different characteristics on an MRI scan.
  I am unclear as to how two different tumor types could be concluded (both Doctors had the same personal and medical history to consider), and further, how a classification or DX can be made at this point as both Neurologists have reminded me the images collected to date are crude and require shaper definition.
  Any assistance would be much appreciated!  
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It is quite common for two observers to give differing interpretations of the same film, textbooks tend to give classical descriptions of lesions, however unfortunately not everyone fits textbook ecxamples and the variation in interpretation is very wide. This is why the definitive diagnosis in most cases is dependent on biopsy as interpretation of images can be very subjective and vary widely among different observors.
Ultimately the diagnosis depends on a biopsy because this is the only test which visualized the makup of a lesion directly.
It is usually possible to fit a lesion into broad categories of stroke, tumor, hemorrhage or inflammation on the basis of shape , surrounding edema, presence of blood, distortion of normal structures, but the precise
labelling of subtype is much more difficult and less reliable.





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