Shining a Light on Brain Tumour Diagnosis: An Interview with Neuroradiologist Dr Péter Barsi

March marks Brain Tumour Awareness Month, a time dedicated to raising awareness, fostering support, and advancing research efforts for this complex condition. 

Accurately diagnosing brain tumours can be challenging due to their diverse characteristics. At Unilabs, our neuroradiologists confront numerous cases daily and collaborate closely, ensuring top-notch reports and optimal patient care. With over three decades of experience in neuroradiology, Unilabs’ TMC Consultant Neuroradiologist, Dr Péter Barsi, sheds light on some critical aspects of brain tumours and the challenges faced in daily practice.

What advancements in neuroradiology have significantly impacted the diagnosis and treatment of brain tumours in recent years?

 In recent years, several advancements in neuroradiology have significantly influenced the diagnosis and treatment of brain tumours.

One of the greatest challenges in neuroradiology is the profession’s rapid and continuous development. New equipment, such as photon-counting computed tomography (CT), higher field strength (7.0 Tesla) and emerging MRI (magnetic resonance imaging) sequences, are typical examples of advancements in the field.

Additionally, techniques that have been present for a long time, like MR perfusion and spectroscopy, have now found their way into everyday practice for the differential diagnostics of brain tumours. Other techniques have discovered new applications, such as the three-dimensional FLAIR sequence after the administration of contrast material to detect tumorous involvement of the layers covering the skull and brain (meninges), or susceptibility-weighted imaging (SWI) to demonstrate abnormal microvascularisation in malignant tumours.

Developments in the diffusion tensor imaging technique provide more reliable visualisation of white matter tracts, thus helping to avoid significant complications during surgery.

In your experience, what are some common difficulties encountered in the daily practice of neuroradiology, particularly concerning the diagnosis and characterisation of brain tumours?

One of the most significant challenges in neuroradiology is the relatively low incidence of brain tumours, which stands at 14.8 per 100,000 individuals annually in Europe. While this rarity offers some reassurance, it also means that acquiring sufficient expertise in the differential diagnosis of tumours and the use of advanced diagnostic techniques can be challenging. In such cases, referring the patient to a specialised neuroradiology and neurosurgery centre after the initial diagnosis based on basic imaging may be beneficial. This allows for the application and evaluation of advanced methods by experienced specialists.

Another potential difficulty arises from patients feeling unwell or confused, which can lead to lower image quality. The quality of our images is crucial as it directly impacts on our ability to provide accurate diagnostic reports.

As an experienced teacher who has led numerous classes and educational programmes, what innovative teaching methodologies or strategies do you believe are most effective in imparting complex neuroradiology concepts to aspiring medical professionals, particularly in the context of brain tumour diagnosis and management to help our patients in the best way possible? 

In my view, a comprehensive educational approach involving dedicated lectures and hands-on workshops facilitated by experienced experts, coupled with the reading of selected literature, followed by the work-up and reporting of a significant number of cases by the trainee, and subsequent second-reads by those experts, is the best way to establish a well-grounded and firm knowledge suitable for everyday practice in any field, including brain tumour imaging. Additionally, a network of experts offering second opinions on difficult cases provides invaluable support to trainees, enabling them to gain the confidence needed for clinical practice.