A study on peritumoural brain oedema around meningiomas by CT and MRI scanning

Summary

There is a great variability in the amount of peritumoural brain oedema accompanying meningiomas. In a previous study it was found that the degree of brain oedema in the white matter around meningiomas correlated with disruption of the layers (especially the cerebral cortex), which separate the tumour from the white matter, as well as with the size and histological subtype of the tumour.

In the present study comprising 9 meningiomas, the volume of oedema was calculated by integration of the cross-sectional oedematous areas on serial MRI slices. The volume of oedema was zero in 3 cases and ranged from 11 to 176.4 ml in the other 6 cases. The MRI-scans also showed disruption of the cortex in all cases, ranging from slight to severe. T₁ and T₂ measurements were made at the level of maximum extension, using a mixed sequence at a field strength of 1.5 T. From the T₂ values tissue water content in % was calculated using the equations: WC=39.36/(R₂ + 37.2) for cortex, and WC=29.63/(R₂ + 27.8) for white matter. These had been obtained by correlating water content with relaxation rates, measured in vitro on human brain autopsy specimens which were subjected to hydration with distilled water or dehydration by hyperosmolar solutions. Mean water content amounted to 82.53% for normal cortex, 74.72% for normal white matter, and 84.59% for oedematous white matter around the tumour.

On the assumption that the spread of contrast agent marks the advancement of the front of oedema produced by the tumour, CT-studies were made before, and at 1 1/2, 3 and 6h after contrast infusion. The increase in diameter of the contrast-stained area on the CT-scan allows calculation of the excess of oedema production per unit tumour volume. Of 6 tumours with oedema (mean peritumoural water content of 91% and mean volume of oedema of 69.2 ml) the production excess at the steady-state was 0.18–1.08 ml/h/cm³ tumour volume, whereas 3 tumours without associated oedema had a production excess of 0.03–0.12 ml/h/cm³. Moreover, penetration of the cortex seems to constitute a separate factor determinig the spread of oedema.