Emergency Imaging of Brain Tumors: Complications & Summary

This video is the seventh and final video in an overview about the emergent approach to brain tumor imaging. This video talks about frequent complications you might see in the clinical care and imaging of brain tumor patients. The most important complications you need to be aware of are infarction, herniation, hemorrhage, tumor progression or radiation necrosis, and hydrocephalus.

Post-resection infarct

This patient’s preoperative imaging shows a tumor in the left temporal lobe that you can see on CT and MRI. On post-op imaging, the tumor has been resected, but there is a wedge-shaped periphery of abnormal diffusion posterior to the cavity. Sometimes patients can have a thin rim of DWI abnormality after a resection, but this more than expected. This is a post-operative infarct. Remember, on delayed imaging this can have enhancement, but it will usually have a gyriform pattern which is different from the original tumor.

Tumor progression

This is a patient who is 2 weeks into radiation therapy for a tumor in the right posterior temporal lobe and inferior parietal lobe. Within this time, there is a lot more edema in the tumor bed with small areas of hemorrhage. The differential diagnosis here is acute radiation necrosis or rapidly worsening tumor.  The MRI confirms that there is marked worsening of enhancement, mass effect, and tumor. This was diagnosed as rapid worsening of tumor and the patient was ultimately transferred for palliative care. Remember though that acute radiation necrosis and worsening tumor can have the same appearance.

Post-operative infection and hydrocephalus

This patient had a recent resection of a tumor with implantation of brachytherapy implants. The post-op pneumocephalus has improved, but ge has developed new postdural collections and new hydrocephalus. This was concerning for acute infection, and the patient was also febrile. This patient had an additional surgery to evacuate the fluid collections, wash out the wound, and place a ventricular drain.

Recap of complications

In summary, you can see a number of complications in patients with brain tumors, many of which will be visible on CT. When you have a suspicion for these things, you should communicate with the surgeons and neuro-oncologists as it can precipitate a change in management.

Lecture series summary

In this lecture, we’ve talked about the role of imaging in brain tumor patients, particularly in the emergent settings, including a review of the role of imaging, some common tumors, and common complications to be on the lookout for.

Thanks for tuning in. Be sure to check out the other videos on the brain tumor topic page if you want to learn more about brain tumors. Also check out the Emergency Imaging of Brain Tumors Playlist to see all the videos from this lecture.