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Current Medical Imaging


ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

The Reliability of Measuring Early Brain Edema with Computed Tomography

Author(s): Yi-Fang Fan, Mi Shen, Xin-Xin Wang, Xiao-Yuan Liu, Yu-Ming Peng, Pei-Yi Gao and Ru-Quan Han*

Volume 18, Issue 8, 2022

Published on: 17 March, 2022

Page: [830 - 836] Pages: 7

DOI: 10.2174/1573405617666211208124839


Background: Postoperative brain edema is a common complication in patients with high-grade glioma after craniotomy. Both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are applied to diagnose brain edema. Usually, MRI is considered to be better than CT for identifying brain edema. However, MRI is not generally applied in diagnosing acute cerebral edema in the early postoperative stage. Whether CT is reliable in detecting postoperative brain edema in the early stage is unknown.

Objective: This study aimed at investigating the agreement and correlation between CT and MRI for measuring early postoperative brain edema.

Methods: Patients with high-grade glioma who underwent craniotomy in the Beijing Tiantan hospital from January 2017 to October 2018 were retrospectively analyzed. The region of interest and operative cavity were manually outlined, and the volume of postoperative brain edema was measured on CT and MRI. Pearson correlation testing and the Intraclass Correlation Coefficient (ICC) were used to evaluate the association and agreement between CT and MRI for detecting the volume of postoperative brain edema.

Results: Twenty patients were included in this study. The interrater agreement was perfect for detecting brain edema (CT: κ=1, ICC=0.977, P<0.001; MRI: κ=0.866, ICC=0.963, P<0.001). A significant positive correlation and excellent consistency between CT and MRI were found for measuring the volume of brain edema (rater 1: r=0.97, ICC=0.934, P<0.001; rater 2: r=0.97, ICC=0.957, P<0.001).

Conclusion: Substantial comparability between CT and MRI is demonstrated for detecting postoperative brain edema. It is reliable to use CT for measuring brain edema volume in the early stage after surgery.

Keywords: Postoperative, brain edema, computed tomography, magnetic resonance imaging, high-grade glioma, ICC.

Graphical Abstract
Ostrom QT, Cioffi G, Gittleman H, et al. CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro-Oncol 2019; 21(Suppl. 5): v1-v100.
[] [PMID: 31675094]
Lawrie TA, Gillespie D, Dowswell T, et al. Long-term neurocognitive and other side effects of radiotherapy, with or without chemotherapy, for glioma. Cochrane Database Syst Rev 2019; 8: CD013047.
[] [PMID: 31425631]
Wang DP, Kang K, Lin Q, Hai J. Prognostic significance of preoperative systemic cellular inflammatory markers in gliomas: A systematic review and meta-analysis. Clin Transl Sci 2020; 13(1): 179-88.
[] [PMID: 31550075]
Choi BD, Curry WT, Carter BS, Maus MV. Chimeric antigen receptor T-cell immunotherapy for glioblastoma: Practical insights for neurosurgeons. Neurosurg Focus 2018; 44(6): E13.
[] [PMID: 29852773]
Komori T. The 2016 WHO classification of tumours of the central nervous system: The major points of revision. Neurol Med Chir (Tokyo) 2017; 57(7): 301-11.
[] [PMID: 28592714]
Malouff TD, Peterson JL, Mahajan A, Trifiletti DM. Carbon ion radiotherapy in the treatment of gliomas: A review. J Neurooncol 2019; 145(2): 191-9.
[] [PMID: 31571113]
Jin WR, Zhang FE, Diao BZ, Zhang YY. Clinical outcomes of Wulingsan subtraction decoction treatment of postoperative brain edema and fever as a complication of glioma neurosurgery. Evid Based Complement Alternat Med 2016; 2016: 5078689.
Kaal EC, Vecht CJ. The management of brain edema in brain tumors. Curr Opin Oncol 2004; 16(6): 593-600.
[] [PMID: 15627023]
Avrahami E, Katz R, Rabin A, Friedman V. CT diagnosis of non- traumatic subarachnoid haemorrhage in patients with brain edema. Eur J Radiol 1998; 28(3): 222-5.
[] [PMID: 9881256]
Förster A, Ssozi J, Al-Zghloul M, Brockmann MA, Kerl HU, Groden C. A comparison of CT/CT angiography and MRI/MR angiography for imaging of vertebrobasilar dolichoectasia. Clin Neuroradiol 2014; 24(4): 347-53.
[] [PMID: 24132554]
Muscari A, Faccioli L, Lega M V, et al. Predicting cerebral edema in ischemic stroke patients. Neurolog Sci 2019; 40: 745-52.
Kucinski T, Väterlein O, Glauche V, et al. Correlation of apparent diffusion coefficient and computed tomography density in acute ischemic stroke. Stroke 2002; 33(7): 1786-91.
[] [PMID: 12105353]
von Kummer R, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology 2017; 59(6): 545-53.
[] [PMID: 28540400]
Osawa T, Tosaka M, Nagaishi M, Yoshimoto Y. Factors affecting peritumoral brain edema in meningioma: Special histological subtypes with prominently extensive edema. J Neurooncol 2013; 111(1): 49-57.
[] [PMID: 23104516]
Li S, Sun H, Liu X, et al. Mannitol improves intraoperative brain relaxation in patients with a midline shift undergoing supratentorial tumor surgery: a randomized controlled trial. J Neurosurg Anesthesiol 2020; 32(4): 307-14.
[] [PMID: 30789384]
Sherchan P, Kim CH, Zhang JH. Surgical brain injury and edema prevention. Acta Neurochir Suppl (Wien) 2013; 118: 129-33.
[PMID: 23564118]
Bardutzky J, Schwab S. Antiedema therapy in ischemic stroke. Stroke 2007; 38(11): 3084-94.
[] [PMID: 17901384]
Doi K, Kawano T, Morioka Y, Fujita Y, Nishimura M. Various irrigation fluids affect postoperative brain edema and cellular damage during experimental neurosurgery in rats. Surg Neurol 2006; 66(6): 565-71.
[] [PMID: 17145310]
McBride DW, Wang Y, Adam L, et al. Correlation between subacute sensorimotor deficits and brain edema in rats after surgical brain injury. Acta Neurochir Suppl (Wien) 2016; 121: 317-21.
[] [PMID: 26463968]
Kim CH, McBride DW, Sherchan P, et al. Crotalus helleri venom preconditioning reduces postoperative cerebral edema and improves neurological outcomes after surgical brain injury. Neurobiol Dis 2017; 107: 66-72.
[] [PMID: 28286182]
Yamaguchi M, Jadhav V, Obenaus A, Colohan A, Zhang JH. Matrix metalloproteinase inhibition attenuates brain edema in an in vivo model of surgically-induced brain injury. Neurosurgery 2007; 61(5): 1067-75.
[] [PMID: 18091283]
Sengupta A, Agarwal S, Gupta PK, et al. On differentiation between vasogenic edema and non-enhancing tumor in high-grade glioma patients using a support vector machine classifier based upon pre and post-surgery MRI images. Eur J Radiol 2018; 106: 199-208.
[] [PMID: 30150045]
Spille DC, Sporns PB, Heß K, Stummer W, Brokinkel B. Prediction of high-grade histology and recurrence in meningiomas using routine preoperative magnetic resonance imaging: A systematic review. World Neurosurg 2019; 128: 174-81.
[] [PMID: 31082555]
Heiss WD, Malignant MCA. Malignant MCA infarction: Pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis 2016; 41(1-2): 1-7.
[] [PMID: 26581023]
Latini F, Larsson EM, Ryttlefors M. Rapid and accurate MRI segmentation of peritumoral brain edema in meningiomas. Clin Neuroradiol 2017; 27(2): 145-52.
[] [PMID: 26603998]
Stall B, Zach L, Ning H, et al. Comparison of T2 and FLAIR imaging for target delineation in high grade gliomas. Radiat Oncol 2010; 5: 5.
[] [PMID: 20109218]
Kimura H, Taniguchi M, Mori T, Hosoda K, Kohmura E. World Neurosurg 2017; 97: 754.e717.
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(4): 243-9.
[] [PMID: 12140153]
Saha B N, Ray N, Greiner R, Murtha A, Zhang H. Meningiomas with brain edema: Radiological characteristics on MRI and review of the literature. Clinical Imaging 2012; 26: 243-9.
Wang D, Wang ML, Li YH. Quantitative MRI study of the permeability of peritumoral brain edema in lung cancer patients with brain metastases. Brain Res 2017; 1669: 126-30.
[] [PMID: 28633995]
Mehdiratta M, Kumar S, Hackney D, Schlaug G, Selim M. Association between serum ferritin level and perihematoma edema volume in patients with spontaneous intracerebral hemorrhage. Stroke 2008; 39(4): 1165-70.
[] [PMID: 18292378]

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