Evaluation of possible or probable brain tumor in adults

MRI: magnetic resonance imaging; CT: computed tomography; abd: abdomen; CNS: central nervous system; LP: lumbar puncture; IgH: immunoglobulin heavy chain; MR: magnetic resonance.
* MRI with contrast is the optimal study for resolution of brain tumors. CT with contrast should be obtained in patients with a contraindication to MRI (eg, pacemaker). Refer to related UpToDate content for the evaluation of brain masses in patients with human immunodeficiency virus (HIV).
¶ Lumbar puncture is not advised for large lesions associated with midline shift, obstructive hydrocephalus, or mass effect on the fourth ventricle.
Δ Urgency of neurosurgical evaluation for newly discovered brain tumor depends on the clinical stability of the patient, symptom severity, tumor size and location, and suspicion for malignancy. Patients should be referred to a high-volume center with subspecialty neurosurgical expertise in brain tumors, when possible.
◊ Differential diagnosis of brain tumors on neuroimaging varies based on location and whether the lesion is enhancing or nonenhancing. Refer to related UpToDate content on the evaluation and diagnosis of brain tumors in adults for additional details.