Imaging in Vasogenic Edema

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

CT Scan:

  • 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)

F5.small
Noncontrast CT showing vasogenic edema surrounding a brain tumor.

MRI:

  • 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

F6.large.jpegA = noncontrast T1W;  B = T1W with contrast; C=T2W; D= FLAIR

 

References

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.

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