Peritumoral Brain Edema in Metastases May Be Related to Glymphatic Dysfunction

Cheng Hong Toh*, Tiing Yee Siow, Mauricio Castillo

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

13 Scopus citations


Objectives: The proliferation of microvessels with increased permeability is thought to be the cause of peritumoral brain edema (PTBE) in metastases. The contribution of the glymphatic system to the formation of PTBE in brain metastases remains unexplored. We aimed to investigate if the PTBE volume of brain metastases is related to glymphatic dysfunction. Materials and Methods: A total of 56 patients with brain metastases who had preoperative dynamic susceptibility contrast-enhanced perfusion-weighted imaging for calculation of tumor cerebral blood volume (CBV) and diffusion tensor imaging for calculations of tumor apparent diffusion coefficient (ADC), tumor fractional anisotropy (FA), and analysis along perivascular space (ALPS) index were analyzed. The volumes of PTBE, whole tumor, enhancing tumor, and necrotic and hemorrhagic portions were manually measured. Additional information collected for each patient included age, sex, primary cancer, metastasis location and number, and the presence of concurrent infratentorial tumors. Linear regression analyses were performed to identify factors associated with PTBE volume. Results: Among 56 patients, 45 had solitary metastasis, 24 had right cerebral metastasis, 21 had left cerebral metastasis, 11 had bilateral cerebral metastases, and 11 had concurrent infratentorial metastases. On univariable linear regression analysis, PTBE volume correlated with whole tumor volume (β = -0.348, P = 0.009), hemorrhagic portion volume (β = -0.327, P = 0.014), tumor ADC (β = 0.530, P <.001), and ALPS index (β = -0.750, P <.001). The associations of PTBE volume with age, sex, tumor location, number of tumors, concurrent infratentorial tumor, enhancing tumor volume, necrotic portion volume, tumor FA, and tumor CBV were not significant. On multivariable linear regression analysis, tumor ADC (β = 0.303; P = 0.004) and ALPS index (β = -0.624; P < 0.001) were the two independent factors associated with PTBE volume. Conclusion: Metastases with higher tumor ADC and lower ALPS index were associated with larger peritumoral brain edema volumes. The higher tumor ADC may be related to increased periarterial water influx into the tumor interstitium, while the lower ALPS index may indicate insufficient fluid clearance. The changes in both tumor ADC and ALPS index may imply glymphatic dysfunction, which is, at least, partially responsible for peritumoral brain edema formation.

Original languageEnglish
Article number725354
JournalFrontiers in Oncology
StatePublished - 13 10 2021

Bibliographical note

Publisher Copyright:
© Copyright © 2021 Toh, Siow and Castillo.


  • ALPS (analysis along perivascular space) index
  • apparent diffusion coefficient
  • brain metastasis
  • cerebral blood volume
  • diffusion tensor imaging
  • dynamic susceptibility contrast-enhanced perfusion-weighted imaging
  • glymphatic system
  • peritumoral brain edema


Dive into the research topics of 'Peritumoral Brain Edema in Metastases May Be Related to Glymphatic Dysfunction'. Together they form a unique fingerprint.

Cite this