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To analyze some magnetic resonance imaging characteristics that impact the formation of peritumoral brain edema in falcine meningiomas. Subjects and methods: A prospective study on 62 patients with falcine meningiomas who underwent navigation-assisted microsurgery between August 2015 and December 2016.
Journal of military pharmaco-medicine no6-2019 ASSESSMENT OF SOME MAGNETIC RESONANCE IMAGE FACTORS INFLUENCING PERITUMORAL EDEMA OF FALCINE MENINGIOMAS Nguyen Xuan Phuong1; Vu Van Hoe1 SUMMARY Objectives: To analyze some magnetic resonance imaging characteristics that impact the formation of peritumoral brain edema in falcine meningiomas Subjects and methods: A prospective study on 62 patients with falcine meningiomas who underwent navigation-assisted microsurgery between August 2015 and December 2016 We evaluated factors related to peritumoral edema: presence of arachnoid plane, shape of tumor margin and the signal intensity of the tumor on T2-weighted image) The edema-tumor volume ratio was calculated by the edema index Results: The average tumor volume was 67.37 ± 66.61 cm³, ranging from to 370 cm³ Peritumoral edema was presented in 28 patients (45.16%) These results suggested that irregular tumor margins and the absence of arachnoid plane on the magnetic resonance images could be an important predictive factors that influence the formation of peritumoral edema in falcine meningiomas (p < 0.05) Conclusion: Irregular tumor margin, absence of arachnoid plane on the magnetic resonance images can be important predictive factors having impact on the formation of peritumoral edema in falcine meningiomas * Keywords: Peritumoral edema; Falcine meningiomas; Magnetic resonance images INTRODUCTION edema accounted of 60% [8] Many factors Falcine meningioma accounts for 8.5% [1] of all intracranial meningiomas and was defined by Cushingas as a meningioma arising from the falx, it is not completely correlated to cortex and superior sagittal sinus related to the development of brain Peritumoral edema is a serious problem in brain edema impacting on intracranial pressure Meningiomas are benign and resonance imaging (MRI) characteristics edema have been studied such as tumor size, location, presence of sex hormone receptors and tumor features on magnetic resonance images (MRI) The aims of this study were: To analyze some magnetic that impact the formation of peritumoral brain edema in falcine meningiomas 103 Military Hospital Corresponding author: Nguyen Xuan Phuong (phuong1030108@yahoo.com.vn) Date received: 08/07/2019 Date accepted: 12/08/2019 203 Journal of military pharmaco-medicine no6-2019 SUBJECTS AND METHODS This study included 62 patients who were treated after having an initial diagnosis of falcine meningioma and underwent surgery at 103 Military Hospital and Vietduc tumor (Vtumor) and the volume of the tumor plus PTBE (Vtumor + edema) were estimated by using of the following formula for a spheroid: V = 4/3p.x/2.y/2 z/2 EI (Edema Index) = (Vtumor + edema)/(Vtumor) Hospital between August 2015 and When the result is under 1, no edema December 2016 All patients had MRI was presented The factors causing edema before surgery MRI features data consists were also evaluated of tumor margin, arachnoid plane and the MRI was used to examine the correlation T2-weighted image signal intensity were between PTBE and the shape of tumor reported margin We divided the tumor margin into irregular and smooth type We defined “smooth margin” with nodularity, indentation or projections in contrast to marginal irregularities Data was analyzed by using commercial software (SPSS version 22.0 for Windows) The relationship between PTBE and each factor was evaluated by univariate analyses Univariate analysis was used initially to identify possible relationships between the outcome and potentially linked factors by use of the X² test All variables with a significance level of p < 0.05 - The volume of the tumor: The maximum perpendicular diameters (x and y) of the tumor and the peritumoral brain edema (PTBE) were measured on the axial and RESULTS Volume The average tumor volume was 67.37 ± 66.61 cm³, ranging from to 370 cm³ sagital image (a and c), and the coronal Edema index diameter (z) was measured on the coronal Peritumoral brain edema was presented images (b and d) The total volume of the 204 in 28 patients (45.16%) Journal of military pharmaco-medicine no6-2019 Tumor margin Table 1: Relationship between the shape of tumor marginand edema index (EI) EI Present Absent Total Smooth (7.14%) 31 (91.18%) 33 (53.23%) Irregular 26 (92.86%) (8.82%) 29 (46.77%) 28 (100%) 34 (100%) 62 (100%) Tumor margin Total p 0.000 Twenty-nine of the 62 cases showed irregular margin and 33 of the 62 cases showed smooth surface An irregular margin was more likely related to PTBE (p < 0.001) Arachnoid plane Table 2: Relationship between the arachnoid plane and EI EI Present Absent Total Present (25%) 30 (88.24%) 37 (59.68%) Absent 21 (75%) (11.76%) 25 (40.32%) 28 (100%) 34 (100%) 62 (100%) Arachnoid plane Total p < 0.001 OR 0.044 r 0.642 The arachnoid plane was absent in 25 cases, and 21 of these 25 cases showed PTBE The arachnoid plane was presented in 37 cases, and only of these 37 cases showed PTBE The results indicated that disappearance of the arachnoid plane was strictly correlated with the development of PTBE (p < 0.05) T2 signal intensity Table 3: Relationship between the T2-weighted image signal intensity and EI EI Present Absent Total High 22 (78.57%) 27 (79.41%) 49 (79.03%) Iso (17.86%) (8.83%) (12.9%) Low (5.88%) (3.23%) (3.57%) (5.88%) (4.84%) 28 (100%) 34 (100%) 62 (100%) p T2 signal intensity Complex Total > 0.05 Forty-nine cases had higher T2 signal intensity, and 22 of theses 49 cases showed PTBE The results illustrated that higher-signal intensity accompanied with the incidence of PTBE not more signifcantly than iso and lower signal intensity (p > 0.05) 205 Journal of military pharmaco-medicine no6-2019 DISCUSSION Previous researches on the relationship between tumor location and PTBE had not demonstrated consistent results In our study, there were 45.16% of patients with peritumoral edema According to Takashi Tamiya, PTBE can range from 45 to 92% in different studies Most authors did not observe a significant correlation between the age or sex of patient and PTBE [4, 6] Our analysis showed two statistical significant factors for the development of PTBE These were the disappearance of the arachnoid plane and the irregular margin And this was similar to other authors in the world Lobato [3] reported that meningiomas with irregular margins were associated more stricly with PTBE than those with smooth margins Several authors agreed that the tumor-brain interface was one of the most critical factors in the formation of PTBE Reseach of Salpietro et al [7] showed a positive correlation between the grade of edema and cortical penetration and noted that the cerebral cortex was disrupted by invasive meningiomas As part of the blood-cerebrospinal fluid barrier, the arachnoid membrane prevents the infiltration The arachnoid membrane works as a physiological barrier seems to be a critical structure Intact leptomeninges layer and cerebrospinal fluid can help prevent edema-inducing macromolecules from infiltrating adjacent normal brain tissue When the arachnoid layer disappears, angiogenic factors may act on the leptomeninges and induce 206 neovascularization from the pial arteries to the meningioma Several authors had demonstrated a correlation between the vascular of meningiomas and the grade of PTBE [2] We studied about relationship between the T2-weighted image signal intensity and peritumoral brain edema by comparing to the SI of the tumor in T2WI with brain gray matter We realized that the was no correlation between the T2-weighted image and the incidence of PTBE However, we agreed that higher incidence of PTBE had a tendency of being associated with T2weighted signal intensities Our result resembled the other studies in the world Ildan et al [5] reported that the signal intensity on T2-weighted scans was correlated with the amount of PTBE They also confirmed that the signal intensity of meningiomas on T2-weighted scans was a predictor of histological type CONCLUSION The edema associated with falcine meningiomas is a potential cause of significant morbidity Edema not only caused the increases in intracranial pressure but also rising risk of surgical trauma to the adjacent brain tissue The peritumoral brain edema impacts the result of operation Peritumoral edema was present in 28 patients (45.16%) This suggested that irregular tumor margins and absence of arachnoid plane on the MRI could be an important predictive factors, that impacted the formation of peritumoral edema in falcine meningiomas Journal of military pharmaco-medicine no6-2019 REFERENCES Chung S.B et al Falx meningiomas: Surgical results and lessons learned from 68 cases J Korean Neurosurg Soc 2007, 42 (4), pp.276-280 Hou J et al Peritumoral brain edema in intracranial meningiomas: The emergence of vascular endothelial growth factor-directed therapy Neurosurg Focus 2013, 35 (6), p.E2 Lobato R.D, Alday R, Gomez P.A, Rivas J.J, Dominguez J, Cabrera A, Madero S, Ayerbe J Brain oedema in patients with intracranial meningioma: Correlation between clinical, radiological, and histological factors and the presence and intensity of oedema Acta Neurochir (Wien) 1996, 138, pp.485-493 Nakano T, Asano K, Miura H, Itoh S, Suzuki S Meningiomas with brain edema: Radiological characteristics on MRI and review of the literature Clin Imaging 2002, 26, pp.243-249 Ildan F, Tuna M, Gocer A.I, Boyer B, Bagdatoglu H, Sen O Correlation of the relationships of brain-tumor interfaces, magneticresonance imaging, andangiographic findings to predict cleavage of meningiomas J Neurosurg 1999, 91, pp.384-390 Tamiya T, Ono Y, Matsumoto K, Ohmoto T Peritumoral brain edema in intracranial meningiomas: E ects of radiological and histological factors Neurosurgery 2001, 49, pp.1046-1051; discussion 1051-1052 Salpietro F.M, Alafaci C, Lucerna S, Iacopino D.G Peritumoral edema in meningiomas: Microsurgical observations of different brain tumor interfaces related to computed tomography Neurosurgery 1994, 35, pp.638-641 Simis A et al Peritumoral brain edema in benign meningiomas: Correlation with clinical, radiologic, and surgical factors and possible role on recurrence Surg Neuro 2008, 70 (5), pp 471-477; discussion 477 207 ... the vascular of meningiomas and the grade of PTBE [2] We studied about relationship between the T2-weighted image signal intensity and peritumoral brain edema by comparing to the SI of the tumor... the amount of PTBE They also confirmed that the signal intensity of meningiomas on T2-weighted scans was a predictor of histological type CONCLUSION The edema associated with falcine meningiomas. .. factors, that impacted the formation of peritumoral edema in falcine meningiomas Journal of military pharmaco-medicine no6-2019 REFERENCES Chung S.B et al Falx meningiomas: Surgical results and