peri tumoral brain edema in meningioma

1. Edema in meningioma
( radiological features)
DR SANJOG CHANDANA

2. Outline
• How does it look like on CT / MRI?
• Grading of edema
• Cortex breach and BBB disruption
• Pre / Perioperative management.

8. • The most reliable feature in
suggesting a non-grade I tumor is
the presence of lower ADC values

10. EDEMA INDEX =
(Tumor size + edema size) / edema size

11. EDEMA INDEX = 1
EDEMA INDEX = 3.1

12. • One promising imaging biomarker of meningioma grade is peritumoral edema
(PTBE), which is best seen on magnetic resonance imaging (MRI) T2 FLAIR
sequence.
• PTBE associated with increased likelihood of
• higher meningioma grade, but PTBE has also been associated with
• increased risk of recurrence,
• increased Ki-67 proliferative index and
• worse postoperative cognitive functioning and
• Karnofsky Performance Status .

14. • Tumor volume, PTBE, and Edema Index were associated with higher
meningioma grade.
• PTBE and Edema Index were associated with histopathologic evidence of
brain invasion.
• There was a positive association between the Edema Index and underlying
mutational burden

15. • PTBE is more prevalent in
• nonskull base meningiomas,
• with the absence of CSF cleft,
• when tumors appear with higher signal intensity on T2WI compared to the
normal gray matter, and in
• G 1 uncommon histological subtypes.
2020

16. PTBE was
judged as
positive if
there was
patchy or
finger-like high
SI surrounding
the tumors on
T2WI and as
negative
otherwise

18. • tumor volume, tumor margins, and intraoperative signs of
arachnoidal and pial invasion to be associated with PTBE in
intracranial meningiomas. Ki67 LI expression correlated with
PTBE. This study showed the resolution of PTBE to depend on
invasive behavior of meningioma and KI67 LI.
• PTBE, pial/cortical and arachnoidal invasion significantly
influence the extent of surgical resection.
2019

19. MANAGEMENT
• STEROIDS
• MANNITOL / HYPERTONIC SALINE
• VEGF

20. VEGF

21. Edema grades
• Edema formation was classified as
• 0: no edema,
• 1: focal edema confined to 1 lobe,
• 2: unilateral edema > 1 lobe,
• 3: bilateral edema,
• 4: global edema with disappearance of sulcal relief, and
• 5: global edema with basal cisterns effacement.

23. Observations
• Tumor brain surface
• CSF cleft
• Irregular margins
• Edema
• Vasogenic ( finger like)
• More extensive ( higher grade)
• Low ADC value
• Low Venous return on DSA / High vascularity

24. Glymphatic function
• PTBE formation in meningiomas may be related to glymphatic
dysfunction.
• Neurosci., 22 April 2021 | https://doi.org/10.3389/fnins.2021.674898
• In the diffusion tensor image analysis along the perivascular space
(DTI-ALPS) method (Taoka et al., 2017), ALPS index, a diffusion
metric that estimates the diffusivity along the perivascular spaces of
medullary veins, has been used to assess glymphatic function.
Alterations of the ALPS index correlate with the Mini-Mental State
Examination score of dementia patients and is thought to reflect
glymphatic dysfunction (Taoka et al., 2017)

25. THANK YOU