Department of Neurology, Neurooncology, Cantonal Hospital, 5001, Aarau, Switzerland,
J Neurooncol. 2013 Dec;115(3):463-8. doi: 10.1007/s11060-013-1247-7. Epub 2013 Sep 18.
Hemorrhage is common in brain tumors. Due to characteristic magnetic field changes induced by hemosiderin it can be detected using susceptibility weighted MRI (SWI). Its relevance to clinical syndromes is unclear. Here we investigated the patterns of intra-tumoral SWI positivity (SWI(pos)) as a surrogate for hemosiderin with regard to the prevalence of epilepsy. We report on 105 patients with newly diagnosed supra-tentorial gliomas and brain metastasis. The following parameters were recorded from pre-operative MRI: (1) SWI(pos) defined as dot-like or fine linear signal changes; (2) allocation of SWI(pos) to tumor compartments (contrast enhancement, central hypointensity, non-enhancing area outside contrast-enhancement); (3) allocation of SWI(pos) to include the cortex, or SWI(pos) in subcortical tumor parts only; (4) tumor size on T2 weighted and gadolinium-enhanced T1 images. 80 tumors (76 %) showed SWI(pos) (4/14 diffuse astrocytoma WHO II, 5/9 anaplastic astrocytoma WHO III, 41/46 glioblastoma WHO IV, 30/36 metastasis). The presence of SWI(pos) depended on tumor size but not on patient's age, medication with antiplatelet drugs or anticoagulation. Seizures occurred in 60 % of patients. Cortical SWI(pos) significantly correlated with seizures in brain metastasis (p = 0.044), and as a trend in glioblastoma (p = 0.062). Cortical SWI(pos) may confer a risk for seizures in patients with newly diagnosed brain metastasis and glioblastoma. Whether development of cortical SWI(pos) induced by treatment or by the natural course of tumors also leads to the new onset of seizures has to be addressed in longitudinal studies in larger patient cohorts.
出血是脑肿瘤的常见现象。由于含铁血黄素引起的特征性磁场变化，可使用磁敏感加权成像（SWI）进行检测。但它与临床症状的相关性尚不清楚。本研究旨在通过研究肿瘤内 SWI 阳性（SWI(pos)）的模式来探讨含铁血黄素作为一种替代物，以评估其与癫痫发生的相关性。我们报告了 105 例新诊断的幕上胶质瘤和脑转移瘤患者的情况。从术前 MRI 中记录了以下参数：（1）SWI(pos)定义为点状或线状细信号改变；（2）SWI(pos)在肿瘤区的分布（强化区、中心低信号区、强化区外无强化区）；（3）SWI(pos)累及皮层或仅累及皮层下肿瘤部分；（4）T2 加权和钆增强 T1 图像上的肿瘤大小。80 个肿瘤（76%）显示 SWI(pos)（4/14 例弥漫性星形细胞瘤 WHO II 级、5/9 例间变性星形细胞瘤 WHO III 级、41/46 例胶质母细胞瘤 WHO IV 级、30/36 例转移瘤）。SWI(pos)的存在与肿瘤大小有关，但与患者年龄、抗血小板药物或抗凝药物的使用无关。60%的患者发生癫痫。脑转移瘤中皮质 SWI(pos)与癫痫显著相关（p=0.044），在胶质母细胞瘤中呈趋势相关（p=0.062）。皮质 SWI(pos)可能使新诊断的脑转移瘤和胶质母细胞瘤患者发生癫痫的风险增加。SWI(pos)是由治疗还是肿瘤的自然病程引起的，以及是否会导致新的癫痫发作，这需要在更大的患者队列中进行纵向研究来确定。
