Brain Tumor Diagnosis

When a brain tumor is suspected, Roswell Park’s Neuro-Oncology team gathers as much information as possible to confirm the diagnosis and describe the tumor: How large is it? Is it malignant (cancer) or benign (not cancer)? Did it start in the brain or travel to the brain from another part of the body? Our experts in Neuroradiology and Neuropathology help answer those questions to determine your best treatment options.

Your doctor may conduct one or more of the following tests if a brain tumor is suspected:

  • Neurologic exam: Your vision, hearing, alertness, muscle strength, coordination and reflexes may be checked, and your eyes may be examined for swelling that might be caused by increased pressure inside the head.
  • Visual Field Testing: Depending on the location of your tumor, you may have your vision tested by using a special instrument that examines how much each eye can see by using a series of lights in different fields of view.
  • Laboratory blood tests: Your doctor may order a number of blood tests to aid in diagnosis or treatment. Blood tests commonly ordered include hormone testing, tumor markers, electrolytes, and blood counts.
  • Magnetic resonance imaging (MRI): This type of scan uses an SUV-sized device, built around a powerful magnet and linked to a computer, to make detailed pictures of the interior of your head or spine. In some cases, a harmless dye is injected through a blood vessel in your arm or hand to help highlight the differences between brain tissues during the scan.
  • Computed Tomography (CT) scan/3-D imaging: An advanced computer-assisted x-ray machine makes detailed pictures of the interior of your head. In some cases, a harmless dye is injected through a blood vessel in your arm or hand to help highlight the differences between brain tissues during the scan. A CT scan can also be used to examine the blood vessels in the head and neck, and their relationship to the tumor.
  • Digital Subtraction Angiography: During a minimally invasive procedure done under an x-ray machine, a harmless dye is injected sterilely through a small catheter that is threaded through a blood vessel in your leg. The catheter is passed up to the head and neck, and images are taken as the dye flows.  Often this is used to visualize the blood vessels that feed a tumor.
  • Lumbar Puncture: Your surgeon may want to obtain cerebrospinal fluid (CSF) to aid in the diagnosis or treatment plan. This is obtained by a small procedure performed sterilely in the clinic or by the radiologist under x-ray, by inserting a small needle sterilely between the bones in the low back.
  • Biopsy: Taking an actual sample of the suspicious tissue (biopsy) is the most conclusive way to diagnose a brain tumor and plan appropriate treatment. After other diagnostic tests confirm that there is a tumor and where it is located, a neurosurgeon may perform a biopsy as a first diagnostic step. This may be done in cases where the tumor is deep inside the brain, in a location where surgery will not be possible, or when surgery may not be necessary but a diagnosis is needed. This is generally done under general anesthesia in the operating room, using CT or MRI scans to find the best route to the tumor. This is known as a stereotactic biopsy, and a small hollow needle is used to take a small tissue sample through a small incision in the scalp and small hole in the skull.

An accurate diagnosis is essential for identifying the best treatment plan. Our Neuroradiology and Neuropathology teams will play key roles in this process.

What Is Neuroradiology?

Neuroradiologists are specially trained doctors who have years of additional training that prepares them to create and interpret images of the brain, spine, head and neck, in order to:

  • Guide medical instruments to the location of a tumor to obtain biopsies.
  • Make a diagnosis by showing specific features of the tumor.
  • Target the tumor’s precise location to plan radiosurgery treatment.
  • Guide the surgeon along the most direct path to the tumor so it can be removed safely, and confirm afterward that the entire tumor has been removed.
  • Provide some types of interventional pain relief.
  • Provide minimally invasive treatment for such neurological disorders as arteriovenous malformations.

Both of Roswell Park’s neuroradiologists — Ronald Alberico, MD, Director of Neuroradiology/Head & Neck, and Ahmed Belal, MD — are fellowship-trained and board-certified in diagnostic radiology.

Neuropathology: What Difference Does It Make?

There are more than 120 different types of brain tumors and disorders. Pinpointing the specific type is crucial for choosing the right treatment options, but because brain tumors account for fewer than 5% of all cancers, most pathologists will see very few of them over the course of their careers.

Jingxin Qiu, MD, PhD, who heads Roswell Park’s Neuropathology Service, is an exception. He is a fellowship-trained, board-certified neuropathologist — an expert who has had highly specific training in the diagnosis of diseases of the central nervous system, including the brain. He sees many different types of brain tumors every single day.

In addition to identifying and classifying a tumor, he can test for tumor markers or chromosome abnormalities that can help predict whether or not your tumor is likely to respond to chemotherapy. The information he provides the rest of the medical team will help determine the best treatment plan for you.

Roswell Park’s Pathology Department is the largest and most comprehensive in the region, supporting your neuropathologist with a staff of more than 200 experts.