Which imaging modalities are recommended for the initial investigation of suspected neuro-oncological conditions?

Recommended imaging modalities for initial investigation of suspected neuro-oncological conditions:

• For suspected glioma, offer standard structural MRI as the initial diagnostic test. This MRI should include T2 weighted, FLAIR, DWI series, and T1 pre- and post-contrast volume sequences, unless MRI is contraindicated.
• For suspected meningioma, offer standard structural MRI with the same sequences as above as the initial diagnostic test, unless MRI is contraindicated.
• For suspected brain metastases, MRI is also the preferred imaging modality.
• For suspected spinal metastases or metastatic spinal cord compression, MRI of the spine should be performed as soon as possible, including sagittal T1 and/or STIR sequences of the whole spine, sagittal T2-weighted sequences, and supplementary axial imaging through any significant abnormality.
• If MRI is contraindicated, CT scan is recommended for suspected spinal metastases or metastatic spinal cord compression, with myelography reserved for specific cases and only performed at specialist centres.

Summary: Standard structural MRI is the first-line imaging modality for suspected primary brain tumours (glioma, meningioma) and brain metastases. For spinal metastases, urgent MRI of the spine is recommended, with CT as an alternative if MRI is contraindicated.

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