Cerebral metastases: do size, peritumoral edema, or multiplicity predict infiltration into brain parenchyma?

  • Ingo FissEmail author
  • Abdelhalim Hussein
  • Alonso Barrantes-Freer
  • Swetlana Sperling
  • Silvia Hernandez-Duran
  • Christina Wolfert
  • Tobias Pukrop
  • Milena Ninkovic
  • Annalen Bleckmann
  • Veit Rohde
  • Dorothee Mielke
  • Bawarjan Schatlo
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors



Brain metastases (BMs) are the most frequent malignancy of the central nervous system. Previous research suggested that some metastases show infiltrative behavior rather than sharp demarcation. We hypothesized that three magnetic resonance (MR) imaging parameters—(a) tumor size, (b) extent of peritumoral edema, and (c) presence of multiple BMs—are predictors of cellular invasion beyond the surgically identifiable tumor margins.


We performed a post hoc analysis on prospectively collected data of patients with BMs. Biopsies beyond the resection margin and immunohistochemistry were performed to assess infiltration status. The three MR imaging parameters were dichotomized into diameters ≤ 30 mm (“small”) and > 30 mm (“large”), amount of peritumoral edema “extended” and “limited,” and “multiple BMs” and “single BMs,” respectively. The association between infiltration status and imaging parameters was calculated using chi-square test.


Biopsy beyond the resection margin was performed in 77 patients; 49 (63.6%) had supramarginal infiltration and 28 patients (36.4%) showed no infiltration. Histological evidence of tumor infiltration was found in 25/41 patients with smaller lesions (61%) and in 24/36 with larger lesions (66.7%, p = 0.64), in 28/44 patients with limited (63.6%) and in 21/33 patients with extended edema (63.6%, p = 1.0), in 28/45 patients (62.2%) with single BM and in 21/32 patients (65.6%) with multiple BMs (p = 0.81).


Based on the post hoc analysis of our prospective trial data, we could not confirm the hypothesis that infiltration of brain parenchyma beyond the glial pseudocapsule is associated with the MR imaging parameters tumor size, extent of edema, or multiplicity of metastases.


Brain metastases Peritumoral edema Multiple brain metastases Supramarginal infiltration 



The authors are grateful for the contributions of Prof. Florian Stockhammer, Dr. Laila Siam, and Daniela Egert to the present study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ingo Fiss
    • 1
    Email author
  • Abdelhalim Hussein
    • 1
  • Alonso Barrantes-Freer
    • 2
  • Swetlana Sperling
    • 1
  • Silvia Hernandez-Duran
    • 1
  • Christina Wolfert
    • 1
  • Tobias Pukrop
    • 3
  • Milena Ninkovic
    • 1
  • Annalen Bleckmann
    • 4
  • Veit Rohde
    • 1
  • Dorothee Mielke
    • 1
  • Bawarjan Schatlo
    • 1
  1. 1.Department of Neurosurgery, Medical CenterGeorg August University of GöttingenGöttingenGermany
  2. 2.Department of NeuropathologyMedical Center, Leipzig UniversityLeipzigGermany
  3. 3.Department of Internal Medicine III, Hematology and Medical OncologyUniversity Hospital RegensburgRegensburgGermany
  4. 4.Department of Internal Medicine, Hematology and Oncology, Medical CenterGeorg August University of GöttingenGöttingenGermany

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