Effects of dexamethasone on peritumoural oedematous brain: a DT-MRI study

Objectives: Glucocorticoids ( dexamethasone) are thought to reduce peritumoural brain oedema by decreasing the permeability of neoplastic capillaries and/or enhancing the clearance of extracellular water. Diffusion tensor magnetic resonance imaging (DT-MRI) was used to measure the water diffusion parameters of oedematous and normal brain in a group of patients with intracranial tumours before and after steroid treatment. Methods: Fifteen patients with intracranial tumours ( seven with high-grade glioma, four with metastatic carcinoma and four with meningioma) were examined before and 48 – 72 h after dexamethasone treatment ( 16 mg/day). The mean diffusivity () and fractional anisotropy ( FA) were measured for oedematous brain and apparently normal contralateral white matter before and after steroid therapy. Results: In all three patient groups there was a significant decrease in, D. of oedematous brain after steroid treatment ( p< 0.01). There was no significant change in FA of oedematous brain after treatment in any of the three groups. There was also no significant change in either, D. or FA of apparently normal contralateral white matter after treatment. Conclusion: These data indicate that dexamethasone produces a localised reduction in the magnitude of extracellular water molecule mobility, and hence water content, in peritumoural oedematous brain. Furthermore, the magnitude of these changes is similar for both intra- and extra-axial tumours.