Cortical hemosiderin is associated with seizures in patients with newly diagnosed malignant brain tumors

Roelcke, Ulrich; Boxheimer, Larissa; Fathi, Ali Reza; Schwyzer, Lucia; Ortega, Marcos; Berberat, Jatta; Remonda, Luca
December 2013
Journal of Neuro-Oncology;Dec2013, Vol. 115 Issue 3, p463
Academic Journal
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.


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