Mechanisms of tumor-related brain edema

Stummer, Walter

doi:10.3171/foc.2007.22.5.9

Cited by 112 publications

(81 citation statements)

References 88 publications

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“…Weber et al (109) reported elevated Cho/NAA ratios in the perifocal T2-weighted hyperintense region in cases of gliomas but no in metastases, in accordance with our results. These results support the previous findings that peritumoral edema associated with HGGs is characterized by extensive infiltration of tumor cells (170), whereas peritumoral region in metastases contained no tumor cells or vascular endothelial proliferation but almost purely vasogenic edema (106,109,157,171). …”

Section: Mrsi In the Peritumoral Tumor Regionsupporting

confidence: 92%

“…In other words, in metastatic tumors, there is no histologic evidence of tumor beyond the outer margin of the tumor (158,169). In contrast to edema surrounding metastases, peritumoral edema associated with HGGs is characterized by extensive infiltration of tumor cells (170). A recent paper by Engelhorn et al (168) showed that the so-called perifocal edema not only includes invading tumor cells but also is associated with glial alterations in vital brain tissue.…”

Section: Magnetic Resonance Perfusion In the Peri-enhancing Region: Gmentioning

confidence: 99%

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Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

et al. 2009

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Background: Conventional magnetic resonance (MR) imaging has a number of limitations in the diagnosis of the most common intracranial brain tumors, including tumor specification and the detection of tumoral infiltration in regions of peritumoral edema. Purpose: To prospectively assess if diffusion-weighted MR imaging (DWI) could be used to differentiate between different types of brain tumors and to distinguish between peritumoral infiltration in high-grade gliomas, lymphomas, and pure vasogenic edema in metastases and meningiomas. Material and Methods: MR imaging and DWI was performed on 93 patients with newly diagnosed brain tumors: 59 patients had histologically verified high-grade gliomas (37 glioblastomas multiforme, 22 anaplastic astrocytomas), 23 patients had metastatic brain tumors, five patients had primary cerebral lymphomas, and six patients had meningiomas. Apparent diffusion coefficient (ADC) values of tumor (enhancing regions or the solid portion of tumor) and peritumoral edema, and ADC ratios (ADC of tumor or peritumoral edema to ADC of contralateral white matter, ADC of tumor to ADC of peritumoral edema) were compared with the histologic diagnosis. ADC values and ratios of high-grade gliomas, primary cerebral lymphomas, metastases, and meningiomas were compared by using ANOVA and multiple comparisons. Optimal thresholds of ADC values and ADC ratios for distinguishing high-grade gliomas from metastases were determined by receiver operating characteristic (ROC) curve analysis. Results: Statistically significant differences were found for minimum and mean of ADC tumor and ADC tumor ratio values between metastases and high-grade gliomas when including only one factor at a time. Including a combination of in total four parameters (mean ADC tumor, and minimum, maximum and mean ADC tumor ratio) resulted in sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of 72.9, 82.6, 91.5, and 54.3% respectively. In the ROC curve analysis, the area under the curve of the combined four parameters was the largest (0.84), indicating a good test. Conclusion: Our results suggest that ADC values and ADC ratios (minimum and mean of ADC tumor and ADC tumor ratio) may be helpful in the differentiation of metastases from high-grade gliomas. It cannot distinguish high-grade gliomas from lymphomas, and lymphomas from metastases. ADC values and ADC ratios in peritumoral edema cannot be used to differentiate edema with infiltration of tumor cells from vasogenic edema when measurements for high-grade gliomas, lymphomas, metastases, and meningiomas were compared.

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Section: Mrsi In the Peritumoral Tumor Regionsupporting

confidence: 92%

Section: Magnetic Resonance Perfusion In the Peri-enhancing Region: Gmentioning

confidence: 99%

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

et al. 2009

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“…Alterações intracranianas como edema, hidrocefalia e hemorragia podem ocorrer secundariamente (Kraft & Gavin 1999, Stummer 2007. Convulsão é o sinal neurológico mais comum em cães e gatos (Snyder et al 2006, Tomek et al 2006, mas recentemente relatou-se a alteração de consciência como o sinal clínico de maior ocorrência (Santos et al 2012).…”

Section: Introductionunclassified

Meningiomas em cães: aspectos clínicos, histopatológicos e imuno-histoquímicos

et al. 2015

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Resumo: As neoplasias no sistema nervoso central (SNC) de animais de companhia são frequentemente diagnosticadas, no entanto dados sobre prevalência são escassos. O objetivo deste estudo foi avaliar retrospectivamente a ocorrência de neoplasias primárias de SNC em cães atendidos em um Hospital-Escola Veterinário e descrever aspectos clínicos, histopatológicos e imuno-histoquímicos dos tumores mais frequentes. Quatorze casos (prevalência de 0,27%) de neoplasias primárias de SNC foram identificados no período de 1998 a 2013 e destes, 11 tiveram o diagnóstico de meningiomas. A idade média dos animais com meningioma foi 10 anos, sendo machos (7/11) e a raça Boxer (3/11) os mais afetados. Sete meningiomas eram espinhais e quatro intracranianos, sendo os principais sinais clínicos alteração na locomoção e convulsões, respectivamente. Metástase pulmonar ocorreu em dois casos. Em seis animais com meningioma espinhal foi realizada a mielografia, sendo que em um também foi realizada a tomografia. Em todos os casos os exames foram efetivos na visualização de desvio ou interrupção da coluna de contraste, com alterações sugestivas da presença de massa. Em cinco animais realizou-se cirurgia exploratória visando a confirmação da suspeita clínica ou retirada da massa, sendo que a sobrevida variou de 85 a 960 dias. Na avaliação histopatológica, os meningiomas foram classificados em transicional (4/11), meningotelial (2/11), papilar (2/11), angiomatoso (1/11), microcístico (1/11) e anaplásico (1/11). Destes, oito (8/11) apresentaram marcação positiva para tricrômio de Masson e um para vermelho congo nas técnicas histoquímicas. No painel imuno-histoquímico, todos os casos apresentaram imunomarcação positiva para vimentina, mas imunomarcação negativa para fator VIII e p53. A imunomarcação para S100 (6/11), GFAP (5/11) e pancitoqueratina (3/11) foi de intensidade variável. Na graduação histológica, dez meningiomas eram grau I e um grau III. O índice médio de proliferação celular foi de 3,2 figuras de mitose e 3,4% avaliando a expressão de Ki-67. Os resultados confirmaram que os meningiomas são a neoplasia primária de SNC mais prevalente em cães, com variação nos subtipos histológicos. A caracterização histoquímica e imuno-histoquímica contribuiu com a determinação do diagnóstico, no entanto, estudos envolvendo a expressão de outros genes são necessários para auxiliar no prognóstico dessas neoplasias.

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“…12,27 Therefore, the peritumoral T2 prolongation of GBM is caused by a combination of vasogenic edema and tumoral infiltration simultaneously. 28 Further research demonstrated that the perifocal T2 prolongation of GBM not only includes invading tumor cells but also is associated with glial alterations in vital brain tissue. 29 These differences in the mechanism of peritumoral T2 prolongation formation may explain our finding that the peritumoral nSI of GBM is higher than that of MET.…”

Section: Figmentioning

confidence: 99%