Schroeder Tanja, Bittrich Paul, Noebel Clara, Kuhne Jan Felix, Schroeder Julian, Schoen Gerhard, Fiehler Jens, Kniep Helge C, Gellißen Susanne
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Radiology, Schoen Klinik Hamburg Eilbek, Hamburg, Germany.
Front Oncol. 2019 Jul 30;9:695. doi: 10.3389/fonc.2019.00695. eCollection 2019.
To date, imaging studies quantifying the amount of vasogenic edema reduction (VE) in patients with brain metastases (BM) treated with glucocorticoids (GC) have included a very limited number of patients and showed ambiguous results. Here, we aim to determine the radiological effect of GC on VE in BM patients in a large cohort with multiple primary tumor entities in a cross-sectional approach. This monocentric retrospective study includes 299 patients first-ever diagnosed with 2,759 intra-axial BM on the respective MRI. 126/299 patients received GC prior to MRI due to mass effect of edema on cranial CT scan and clinical symptoms (GC-pos) and 173 patients did not (GC-neg). GC dose was documented in 85/126 patients. All BM and their respective VE were semi-automatically segmented on post-contrast T1-weighted images. VE volumes were higher in GC-pos compared to GC-neg ( = 0.009) and did not correlate with GC dose. Multivariate linear regression analysis with interaction terms on the assumption that BM volume and BM number influence the probability of GC administration shows that large and higher numbers of BM under GC treatment generate less VE than without ( < 0.001 and = 0.038, respectively). The primary tumor type and total BM volume did not influence VE volume. Use of GC is especially effective for treatment of VE formation in patients with larger and multiple BM regardless of primary tumor type and dosage. However, based on the present data a direct causative relationship between GC and VE cannot be proven.
迄今为止，对接受糖皮质激素（GC）治疗的脑转移瘤（BM）患者血管源性水肿减少量（VE）进行量化的影像学研究纳入的患者数量非常有限，结果也不明确。在此，我们旨在采用横断面研究方法，确定GC对一大群患有多种原发性肿瘤实体的BM患者VE的放射学影响。这项单中心回顾性研究纳入了299例首次在各自的MRI上被诊断为2759个轴内BM的患者。126/299例患者因水肿对头颅CT扫描的占位效应和临床症状在MRI检查前接受了GC治疗（GC阳性），173例患者未接受（GC阴性）。85/126例患者记录了GC剂量。所有BM及其各自的VE在增强后T1加权图像上进行半自动分割。与GC阴性患者相比，GC阳性患者的VE体积更高（ = 0.009），且与GC剂量无关。基于BM体积和BM数量会影响GC给药概率的假设进行的带有交互项的多变量线性回归分析表明，接受GC治疗的体积大且数量多的BM产生的VE比未接受GC治疗的少（分别为 < 0.001和 = 0.038）。原发性肿瘤类型和总BM体积不影响VE体积。无论原发性肿瘤类型和剂量如何，使用GC对治疗体积大且多发BM患者的VE形成特别有效。然而，根据目前的数据，无法证实GC与VE之间存在直接的因果关系。
