Pathophysiology: disturbance of vascular permeability –> plasma fluid and protein escapes –> increase in extracellular space volume
- Vasogenic edeme represents reactive changes rather than permanent cell damage, and are therefore reversible.
Peritumoral edema: nonenhancing area of abnormality surrounding enhancing tumor core
- mets or noninfiltrative primary tumors (meningiomas) – peritumoral edema is synonymous with vasogenic edema (no tumor cells are present)
- Gliomas – peritumoral edema better referred to as infiltrative edema because it represents both vasogenic edema and infiltrating tumor cells behing the BBB and invading the white matter tracts
- brain tumors identified by abnormal density +/- distortion of adjacent structures
- tumor-induced vasogenic edema extends along white matter extracellular fluid spaces and appear hypodense
- contrast enhancement: defines the tumor border (if tumor is contrast enhancing)
Noncontrast CT showing vasogenic edema surrounding a brain tumor.
- T1-weighted with contrast – edema may be subtle
- T2-weighted – edema readily apparent
- FLAIR – CSF signal suppressed to make lesions adjacent to ventricles more conspicuous
- DWI – differentiates cytotoxic edema from vasogenic edema
A = noncontrast T1W; B = T1W with contrast; C=T2W; D= FLAIR
Esquenazi, Y., V. P. Lo, and K. Lee. “Critical Care Management Of Cerebral Edema In Brain Tumors”.Journal of Intensive Care Medicine (2015): n. pag. Web.