Neuro-oncology · 2025
Dynamic contrast-enhanced and diffusion-weighted MR imaging for predicting tumor growth of sporadic vestibular schwannomas: A prospective study.
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Schouten Sammy M, Lewis Daniel, Cornelissen Stefan, Li Ka-Loh, Zhu Xiaoping, Maas Marnix C, Pegge Sjoert, Jansen Thijs T G, Mulder Jef J S, Waterval Jérôme J, Postma Alida A, Pathmanaban Omar, Coope David J, Derks Jolanda M M, Langenhuizen Patrick P J H, King Andrew T, Verheul Jeroen B, Kunst Henricus P M
Аннотация
BACKGROUND: Advanced MR imaging, such as diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) imaging, may provide valuable noninvasive information on intrinsic tumor biology. This study aims to evaluate apparent diffusion coefficient (ADC) and DCE-MRI-derived microvascular parameter values (Ktrans, ve, and vp) as potential imaging predictors for future sporadic vestibular schwannoma (VS) growth.
METHODS: In this prospective cohort study, patients with newly diagnosed unilateral sporadic VS and an initial wait-and-scan strategy were enrolled between January 2021 and January 2023. Patients underwent a single timepoint comprehensive MRI protocol, including DWI and DCE-MRI sequences. The estimated values of ADC, Ktrans, ve, and vp were calculated using established pipelines on a voxelwise basis within the delineated tumor region of interest. Associations of the estimated parameter values with volumetric growth were evaluated in uni- and multivariable logistic regression and survival analyses.
RESULTS: Of the 110 analyzed patients, 70 (64%) exhibited growth during follow-up. A significant correlation was primarily observed between the DCE-MRI-derived parameters and VS growth. The combination of mean Ktrans (P < .001) and ve (P < .001) tumor values provided an internally validated model with an AUC of 0.85 for growth, yielding a sensitivity of 89% and specificity of 73% at the optimized cutoff value. Only the mean ADC values were found to be significantly higher in shrinking tumors (P = .04).
CONCLUSIONS: The strongly significant correlation observed between VS growth and Ktrans and ve tumor values indicate the great potential of the noninvasive DCE-MRI for individualized VS management in clinical practice. External validation is needed to further substantiate these findings.
METHODS: In this prospective cohort study, patients with newly diagnosed unilateral sporadic VS and an initial wait-and-scan strategy were enrolled between January 2021 and January 2023. Patients underwent a single timepoint comprehensive MRI protocol, including DWI and DCE-MRI sequences. The estimated values of ADC, Ktrans, ve, and vp were calculated using established pipelines on a voxelwise basis within the delineated tumor region of interest. Associations of the estimated parameter values with volumetric growth were evaluated in uni- and multivariable logistic regression and survival analyses.
RESULTS: Of the 110 analyzed patients, 70 (64%) exhibited growth during follow-up. A significant correlation was primarily observed between the DCE-MRI-derived parameters and VS growth. The combination of mean Ktrans (P < .001) and ve (P < .001) tumor values provided an internally validated model with an AUC of 0.85 for growth, yielding a sensitivity of 89% and specificity of 73% at the optimized cutoff value. Only the mean ADC values were found to be significantly higher in shrinking tumors (P = .04).
CONCLUSIONS: The strongly significant correlation observed between VS growth and Ktrans and ve tumor values indicate the great potential of the noninvasive DCE-MRI for individualized VS management in clinical practice. External validation is needed to further substantiate these findings.