Effect of barrier opening on brain edema in human brain tumors.
Blood-brain barrier (BBB) opening was carried out in 10 patients with cerebral lesions, and the MRI findings were evaluated following the barrier opening. An intra-arterial injection of 10% glycerol (4 ml/kg, 1 approximately 2 ml/s) was given as a hyperosmotic solution. T2-weighted MRI was undertaken using a TOSHIBA 22A at 30 minutes after BBB opening. Barrier-opening MRI was performed 10 times in 10 patients, including 5 cases of glioblastoma multiforme, 2 cases of astrocytoma, 1 case of malignant lymphoma, 1 case of cerebral contusion and 1 case of neurinoma. The high-intensity area (HIA) was compared with that in MRI without barrier opening. Three types of changes of HIA in MRI were observed after BBB opening as follows. Type 1: Expansion of the HIA was noted in 4 of 5 cases of glioblastoma multiforme, the 1 case of malignant lymphoma and the 1 case of cerebral contusion. Type 2: Almost no change was observed in the 1 case of neuronoma. Type 3: A decrease in HIA was noted in the 2 cases of astrocytoma and in 1 case of glioblastoma multiforme. The MRI following BBB opening evidently showed 3 types of changes according to the degree of BBB disruption. Glioblastoma multiforme or contusion with a severely disrupted BBB revealed an increase in HIA following barrier opening. Benign posterior fossa neurinoma showed no change in HIA after barrier opening. Moderate malignant tumors exhibited a decrease in HIA on barrier-opening MRI. It was concluded that malignant tumors have a severely damaged BBB, which is readily disrupted by osmotic barrier opening.
Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Gunma, Japan.
S
S
Sato
S
S
Suga
K
K
Yunoki
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B
Mihara
D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000503:physiopathology; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000502:physiology*; D001921:Brain / Q000473:pathology; D001924:Brain Concussion / Q000503:physiopathology; D001929:Brain Edema / Q000175:diagnosis / Q000503:physiopathology*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000503:physiopathology; D005990:Glycerol / Q000008:administration & dosage; D006801:Humans; D006982:Hypertonic Solutions; D007269:Injections, Intra-Arterial; D008223:Lymphoma / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000503:physiopathology; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D006982:Hypertonic Solutions; D005990:Glycerol