Is an Magnetic Resonance Imaging (MRI) of the brain indicated to rule out cancer in a patient with a headache (ha)?

From the Guidelines

For patients with headaches (ha) to rule out cancer, an MRI of the brain is recommended if there are concerning features such as sudden severe headache, changes in headache pattern, neurological symptoms, or a history of cancer. The diagnostic work-up of patients with suspected brain metastases (BMs) should include at minimum cranial MRI with pre- and post-contrast T1-weighted, T2-weighted and/or T2-fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences 1. Some key points to consider when evaluating headaches in the context of potential cancer include:

• A thorough clinical evaluation is usually sufficient for typical headaches without concerning features.
• Warning signs such as sudden severe headache, headaches that worsen with exertion, new headaches in patients over 50, changes in headache pattern, neurological symptoms, headaches with fever or stiff neck, or headaches in patients with cancer history or immunosuppression may indicate a more serious condition requiring imaging.
• MRI is preferred over CT for brain imaging because it provides better visualization of brain tissue and doesn't use radiation.
• The sensitivity of MRI for the detection of BMs depends on the technique employed, with influencing factors being field strength, contrast agent type and dose, delay between contrast agent administration and data acquisition, and in- and through-plane resolution 1.
• If you're experiencing headaches and are concerned about cancer, discuss your specific symptoms with your healthcare provider who can determine if imaging is appropriate based on your clinical presentation and risk factors 1. It's also worth noting that many headaches are due to benign causes like tension, migraines, or cluster headaches rather than brain tumors, which are relatively rare causes of headache. In patients with a high risk of BMs, such as those with lung cancer, melanoma, or breast cancer, screening with MRI may be justified 1. However, for patients without these risk factors, a thorough clinical evaluation and consideration of other causes of headache are usually sufficient before proceeding to imaging. Ultimately, the decision to perform an MRI of the brain in patients with headaches should be based on a thorough clinical evaluation and consideration of individual risk factors, with the goal of minimizing unnecessary testing while promptly identifying those with serious underlying conditions.

From the Research

MRI for Brain Cancer Diagnosis

• The use of MRI in diagnosing brain cancer has been extensively studied, with various techniques showing promise in detecting and characterizing brain tumors 2, 3, 4, 5.
• A study published in 2021 found that MRI plain scan signals, including T1WI, T2WI, T2WI/FLAIR, and DWI, can help differentiate between brain metastatic tumors and non-metastatic tumors 2.
• Another study from 2021 used radiomics features from T2-FLAIR, DWI, and DKI to predict histological grade and Ki-67 proliferation index in gliomas, achieving high predictive performance 3.
• Advanced brain tumor imaging techniques, such as T1-weighted post-contrast and T2-weighted FLAIR MRI, can provide more specific information on tissue physiology than standard MRI 4.
• A study from 2017 compared the diagnostic accuracy of T1-weighted dynamic contrast-enhanced-MRI and DWI-ADC for differentiating glioblastoma and primary CNS lymphoma, finding that ADC was superior to dynamic contrast-enhanced-MR imaging perfusion in making this distinction 5.

Key Findings

• The combination of MRI plain scan signals and contrast enhancement MRI examination can improve the diagnostic efficacy of predicting brain metastases 2.
• Radiomics features from multi-parameter MRI can generate highly predictive models for glioma stratification 3.
• Advanced imaging modalities, such as diffusion-weighted imaging and dynamic contrast-enhanced-MR imaging, can provide valuable information for brain tumor diagnosis and treatment 4, 5.
• The use of MRI in multiple sclerosis patients can help identify differences in demographic, brain anatomical regions, and contrast enhancement between patients with increased diffusion lesions and those with diffusion restriction 6.