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Łajczak P, Matyja J, Jóźwik K, Nawrat Z. Accuracy of vestibular schwannoma segmentation using deep learning models - a systematic review & meta-analysis. Neuroradiology 2024:10.1007/s00234-024-03449-1. [PMID: 39179652 DOI: 10.1007/s00234-024-03449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024]
Abstract
Vestibular Schwannoma (VS) is a rare tumor with varied incidence rates, predominantly affecting the 60-69 age group. In the era of artificial intelligence (AI), deep learning (DL) algorithms show promise in automating diagnosis. However, a knowledge gap exists in the automated segmentation of VS using DL. To address this gap, this meta-analysis aims to provide insights into the current state of DL algorithms applied to MR images of VS. METHODOLOGY Following 2020 PRISMA guidelines, a search across four databases was conducted. Inclusion criteria focused on articles using DL for VS MR image segmentation. The primary metric was the Dice score, supplemented by relative volume error (RVE) and average symmetric surface distance (ASSD). RESULTS The search process identified 752 articles, leading to 11 studies for meta-analysis. A QUADAS- 2 analysis revealed varying biases. The overall Dice score for 56 models was 0.89 (CI: 0.88-0.90), with high heterogeneity (I2 = 95.9%). Subgroup analyses based on DL architecture, MRI inputs, and testing set sizes revealed performance variations. 2.5D DL networks demonstrated comparable efficacy to 3D networks. Imaging input analyses highlighted the superiority of contrast-enhanced T1-weighted imaging and mixed MRI inputs. DISCUSSION This study fills a gap in systematic review in the automated segmentation of VS using DL techniques. Despite promising results, limitations include publication bias and high heterogeneity. Future research should focus on standardized designs, larger testing sets, and addressing biases for more reliable results. DL have promising efficacy in VS diagnosis, however further validation and standardization is needed. CONCLUSION In conclusion, this meta-analysis provides comprehensive review into the current landscape of automated VS segmentation using DL. The high Dice score indicates promising agreement in segmentation, yet challenges like bias and heterogeneity must be addressed in the future research.
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Affiliation(s)
- Paweł Łajczak
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Mekelweg 5, Zabrze, 40-043,, Poland.
| | - Jakub Matyja
- TU Delft, Mekelweg 5,, Delft 2628 CD,, Netherlands
| | - Kamil Jóźwik
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Mekelweg 5, Zabrze, 40-043,, Poland
| | - Zbigniew Nawrat
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Mekelweg 5, Zabrze, 40-043,, Poland
- Foundation of Cardiac Surgery Development, Zabrze, 41-808, Poland
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Nernekli K, Persad AR, Hori YS, Yener U, Celtikci E, Sahin MC, Sozer A, Sozer B, Park DJ, Chang SD. Automatic Segmentation of Vestibular Schwannomas: A Systematic Review. World Neurosurg 2024; 188:35-44. [PMID: 38685346 DOI: 10.1016/j.wneu.2024.04.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Vestibular schwannomas (VSs) are benign tumors often monitored over time, with measurement techniques for assessing growth rates subject to significant interobserver variability. Automatic segmentation of these tumors could provide a more reliable and efficient for tracking their progression, especially given the irregular shape and growth patterns of VS. METHODS Various studies and segmentation techniques employing different Convolutional Neural Network architectures and models, such as U-Net and convolutional-attention transformer segmentation, were analyzed. Models were evaluated based on their performance across diverse datasets, and challenges, including domain shift and data sharing, were scrutinized. RESULTS Automatic segmentation methods offer a promising alternative to conventional measurement techniques, offering potential benefits in precision and efficiency. However, these methods are not without challenges, notably the "domain shift" that occurs when models trained on specific datasets underperform when applied to different datasets. Techniques such as domain adaptation, domain generalization, and data diversity were discussed as potential solutions. CONCLUSIONS Accurate measurement of VS growth is a complex process, with volumetric analysis currently appearing more reliable than linear measurements. Automatic segmentation, despite its challenges, offers a promising avenue for future investigation. Robust well-generalized models could potentially improve the efficiency of tracking tumor growth, thereby augmenting clinical decision-making. Further work needs to be done to develop more robust models, address the domain shift, and enable secure data sharing for wider applicability.
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Affiliation(s)
- Kerem Nernekli
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Amit R Persad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yusuke S Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ulas Yener
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | | | - Alperen Sozer
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | - Batuhan Sozer
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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Cornelissen S, Schouten SM, Langenhuizen PPJH, Lie ST, Kunst HPM, de With PHN, Verheul JB. Defining tumor growth in vestibular schwannomas: a volumetric inter-observer variability study in contrast-enhanced T1-weighted MRI. Neuroradiology 2024:10.1007/s00234-024-03416-w. [PMID: 38980343 DOI: 10.1007/s00234-024-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE For patients with vestibular schwannomas (VS), a conservative observational approach is increasingly used. Therefore, the need for accurate and reliable volumetric tumor monitoring is important. Currently, a volumetric cutoff of 20% increase in tumor volume is widely used to define tumor growth in VS. The study investigates the tumor volume dependency on the limits of agreement (LoA) for volumetric measurements of VS by means of an inter-observer study. METHODS This retrospective study included 100 VS patients who underwent contrast-enhanced T1-weighted MRI. Five observers volumetrically annotated the images. Observer agreement and reliability was measured using the LoA, estimated using the limits of agreement with the mean (LOAM) method, and the intraclass correlation coefficient (ICC). RESULTS The 100 patients had a median average tumor volume of 903 mm3 (IQR: 193-3101). Patients were divided into four volumetric size categories based on tumor volume quartile. The smallest tumor volume quartile showed a LOAM relative to the mean of 26.8% (95% CI: 23.7-33.6), whereas for the largest tumor volume quartile this figure was found to be 7.3% (95% CI: 6.5-9.7) and when excluding peritumoral cysts: 4.8% (95% CI: 4.2-6.2). CONCLUSION Agreement limits within volumetric annotation of VS are affected by tumor volume, since the LoA improves with increasing tumor volume. As a result, for tumors larger than 200 mm3, growth can reliably be detected at an earlier stage, compared to the currently widely used cutoff of 20%. However, for very small tumors, growth should be assessed with higher agreement limits than previously thought.
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Affiliation(s)
- Stefan Cornelissen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Sammy M Schouten
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patrick P J H Langenhuizen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Suan Te Lie
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Peter H N de With
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jeroen B Verheul
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Ruiz-García C, Lassaletta L, López-Larrubia P, Varela-Nieto I, Murillo-Cuesta S. Tumors of the nervous system and hearing loss: Beyond vestibular schwannomas. Hear Res 2024; 447:109012. [PMID: 38703433 DOI: 10.1016/j.heares.2024.109012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Hearing loss is a common side effect of many tumor treatments. However, hearing loss can also occur as a direct result of certain tumors of the nervous system, the most common of which are the vestibular schwannomas (VS). These tumors arise from Schwann cells of the vestibulocochlear nerve and their main cause is the loss of function of NF2, with 95 % of cases being sporadic and 5 % being part of the rare neurofibromatosis type 2 (NF2)-related Schwannomatosis. Genetic variations in NF2 do not fully explain the clinical heterogeneity of VS, and interactions between Schwann cells and their microenvironment appear to be critical for tumor development. Preclinical in vitro and in vivo models of VS are needed to develop prognostic biomarkers and targeted therapies. In addition to VS, other tumors can affect hearing. Meningiomas and other masses in the cerebellopontine angle can compress the vestibulocochlear nerve due to their anatomic proximity. Gliomas can disrupt several neurological functions, including hearing; in fact, glioblastoma multiforme, the most aggressive subtype, may exhibit early symptoms of auditory alterations. Besides, treatments for high-grade tumors, including chemotherapy or radiotherapy, as well as incomplete resections, can induce long-term auditory dysfunction. Because hearing loss can have an irreversible and dramatic impact on quality of life, it should be considered in the clinical management plan of patients with tumors, and monitored throughout the course of the disease.
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Affiliation(s)
- Carmen Ruiz-García
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; PhD Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain
| | - Pilar López-Larrubia
- Biomedical Magnetic Resonance, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain
| | - Isabel Varela-Nieto
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
| | - Silvia Murillo-Cuesta
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
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Troude L, Ogando YE, Balossier A, Baucher G, Régis J, Roche PH. Surgical management of large lower cranial nerves schwannomas: long term results of a less aggressive resection strategy. Neurosurg Rev 2024; 47:171. [PMID: 38639892 DOI: 10.1007/s10143-024-02416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
In an effort to reduce the high morbidity and life-threatening complications after radical resection in large schwannoma surgery, alternative strategies of nontotal resections have emerged. To evaluate the long term clinical and oncological outcome after lower cranial nerves (LCN) schwannoma surgery operated on with a cranial nerve-sparing technique. Single center retrospective cohort study of 8 consecutive patients harboring LCN schwannomas operated on between March 2005 and October 2021. The mean LCN schwannoma diameter was 33 mm (range 26-51). Seven patients (87,5%) underwent a modified retrosigmoid approach. Three patients underwent gross total resection (37,5%), 3 had received neartotal resection (mean tumor residue 0,25 cc) and subtotal resection in 2 patients who presented with an extracranial extension of the tumor (mean tumor residue 2,44 cc). Both patients had received upfront additional GKRS. The three patients who presented with preoperative CN IX & X injuries recovered within 6 months after surgery. All of the five patients freed from any preoperative CNs IX & X symptoms experienced transient (80%) or definitive (one patient) disturbances after surgery. They all improved within 6 months but one who required long term gastrostomy feeding tube. This patient harbored a schwannoma originating from the glossopharyngeal nerve, which could not be anatomically preserved during surgery. Tumor control was achieved in 100% of cases with a mean follow-up of 91 months. LCN schwannomas could be surgically removed through a less aggressive non-radical resection strategy with acceptable functional results and excellent tumor control.
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Affiliation(s)
- Lucas Troude
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France.
| | - Yamaurys Esther Ogando
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
| | - Anne Balossier
- Department of Neurosurgery, Timone University Hospital, APHM-AMU - 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Guillaume Baucher
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
| | - Jean Régis
- Department of Neurosurgery, Timone University Hospital, APHM-AMU - 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Pierre-Hugues Roche
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
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Suresh K, Luo G, Bartholomew RA, Brown A, Juliano AF, Lee DJ, Welling DB, Cai W, Crowson MG. An External Validation Study for Automated Segmentation of Vestibular Schwannoma. Otol Neurotol 2024; 45:e193-e197. [PMID: 38361299 DOI: 10.1097/mao.0000000000004125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To validate how an automated model for vestibular schwannoma (VS) segmentation developed on an external homogeneous dataset performs when applied to internal heterogeneous data. PATIENTS The external dataset comprised 242 patients with previously untreated, sporadic unilateral VS undergoing Gamma Knife radiosurgery, with homogeneous magnetic resonance imaging (MRI) scans. The internal dataset comprised 10 patients from our institution, with heterogeneous MRI scans. INTERVENTIONS An automated VS segmentation model was developed on the external dataset. The model was tested on the internal dataset. MAIN OUTCOME MEASURE Dice score, which measures agreement between ground truth and predicted segmentations. RESULTS When applied to the internal patient scans, the automated model achieved a mean Dice score of 61% across all 10 images. There were three tumors that were not detected. These tumors were 0.01 ml on average (SD = 0.00 ml). The mean Dice score for the seven tumors that were detected was 87% (SD = 14%). There was one outlier with Dice of 55%-on further review of this scan, it was discovered that hyperintense petrous bone had been included in the tumor segmentation. CONCLUSIONS We show that an automated segmentation model developed using a restrictive set of siloed institutional data can be successfully adapted for data from different imaging systems and patient populations. This is an important step toward the validation of automated VS segmentation. However, there are significant shortcomings that likely reflect limitations of the data used to train the model. Further validation is needed to make automated segmentation for VS generalizable.
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Affiliation(s)
- Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Guibo Luo
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Ryan A Bartholomew
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Schouten SM, Cornelissen S, Langenhuizen PPHJ, Jansen TTG, Mulder JJS, Derks J, Verheul JB, Kunst HPM. Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas: A longitudinal volumetric study. Neurooncol Adv 2024; 6:vdad144. [PMID: 38187870 PMCID: PMC10771273 DOI: 10.1093/noajnl/vdad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth. Methods Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of ≥10%. Results Among 215 tumors with a median size (IQR) of 2.7 cm3 (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; P-value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; P < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; P = .01) at diagnosis were significantly associated with an increased likelihood of growth. Conclusions Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.
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Affiliation(s)
- Sammy M Schouten
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Stefan Cornelissen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick P H J Langenhuizen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Thijs T G Jansen
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jef J S Mulder
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jolanda Derks
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jeroen B Verheul
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
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Neve OM, Romeijn SR, Chen Y, Nagtegaal L, Grootjans W, Jansen JC, Staring M, Verbist BM, Hensen EF. Automated 2-Dimensional Measurement of Vestibular Schwannoma: Validity and Accuracy of an Artificial Intelligence Algorithm. Otolaryngol Head Neck Surg 2023; 169:1582-1589. [PMID: 37555251 DOI: 10.1002/ohn.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Validation of automated 2-dimensional (2D) diameter measurements of vestibular schwannomas on magnetic resonance imaging (MRI). STUDY DESIGN Retrospective validation study using 2 data sets containing MRIs of vestibular schwannoma patients. SETTING University Hospital in The Netherlands. METHODS Two data sets were used, 1 containing 1 scan per patient (n = 134) and the other containing at least 3 consecutive MRIs of 51 patients, all with contrast-enhanced T1 or high-resolution T2 sequences. 2D measurements of the maximal extrameatal diameters in the axial plane were automatically derived from a 3D-convolutional neural network compared to manual measurements by 2 human observers. Intra- and interobserver variabilities were calculated using the intraclass correlation coefficient (ICC), agreement on tumor progression using Cohen's kappa. RESULTS The human intra- and interobserver variability showed a high correlation (ICC: 0.98-0.99) and limits of agreement of 1.7 to 2.1 mm. Comparing the automated to human measurements resulted in ICC of 0.98 (95% confidence interval [CI]: 0.974; 0.987) and 0.97 (95% CI: 0.968; 0.984), with limits of agreement of 2.2 and 2.1 mm for diameters parallel and perpendicular to the posterior side of the temporal bone, respectively. There was satisfactory agreement on tumor progression between automated measurements and human observers (Cohen's κ = 0.77), better than the agreement between the human observers (Cohen's κ = 0.74). CONCLUSION Automated 2D diameter measurements and growth detection of vestibular schwannomas are at least as accurate as human 2D measurements. In clinical practice, measurements of the maximal extrameatal tumor (2D) diameters of vestibular schwannomas provide important complementary information to total tumor volume (3D) measurements. Combining both in an automated measurement algorithm facilitates clinical adoption.
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Affiliation(s)
- Olaf M Neve
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephan R Romeijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yunjie Chen
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Larissa Nagtegaal
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marius Staring
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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9
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Balossier A, Delsanti C, Troude L, Thomassin JM, Roche PH, Régis J. Assessing Tumor Volume for Sporadic Vestibular Schwannomas: A Comparison of Methods of Volumetry. Stereotact Funct Neurosurg 2023; 101:265-276. [PMID: 37531945 DOI: 10.1159/000531337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The size of vestibular schwannomas (VS) is a major factor guiding the initial decision of treatment and the definition of tumor control or failure. Accurate measurement and standardized definition are mandatory; yet no standard exist. Various approximation methods using linear measures or segmental volumetry have been reported. We reviewed different methods of volumetry and evaluated their correlation and agreement using our own historical cohort. METHODS We selected patients treated for sporadic VS by Gammaknife radiosurgery (GKRS) in our department. Using the stereotactic 3D T1 enhancing MRI on the day of GKRS, 4 methods of volumetry using linear measurements (5-axis, 3-axis, 3-axis-averaged, and 1-axis) and segmental volumetry were compared to each other. The degree of correlation was evaluated using an intraclass correlation test (ICC 3,1). The agreement between the different methods was evaluated using Bland-Altman diagrams. RESULTS A total of 2,188 patients were included. We observed an excellent ICC between 5-axis volumetry (0.98), 3-axis volumetry (0.96), and 3-axis-averaged volumetry (0.96) and segmental volumetry, respectively, irrespective of the Koos grade or Ohata classification. The ICC for 1-axis volumetry was lower (0.72) and varied depending on the Koos and Ohata subgroups. None of these methods were substitutable. CONCLUSION Although segmental volumetry is deemed the most accurate method, it takes more effort and requires sophisticated computation systems compared to methods of volumetry using linear measurements. 5-axis volumetry affords the best adequacy with segmental volumetry among all methods under assessment, irrespective of the shape of the tumor. 1-axis volumetry should not be used.
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Affiliation(s)
- Anne Balossier
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Christine Delsanti
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
| | - Lucas Troude
- Department of Neurosurgery, AP-HM, North University Hospital, Marseille, France
| | - Jean-Marc Thomassin
- Department of Head and Neck Surgery, AP-HM, Timone Hospital, Marseille, France
| | - Pierre-Hugues Roche
- Department of Neurosurgery, AP-HM, North University Hospital, Marseille, France
| | - Jean Régis
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
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10
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Schnurman Z, Benjamin CG, Miceli M, Sen C. Clival Chordomas in the Endoscopic Endonasal Era: Comparison With Management With Open Skull Base Approaches. Neurosurgery 2023; 92:756-761. [PMID: 36729618 DOI: 10.1227/neu.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/03/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The most significant paradigm shift in surgical management of skull base chordomas has been the adoption of the endoscopic endonasal approach, but the impact on patient outcomes compared with open skull base approaches remains unclear. OBJECTIVE To compare a large series of patients treated by a single surgeon using primarily endoscopic endonasal approaches with previously published outcomes by the same surgeon using open skull base approaches. METHODS Between 2006 and 2020, 68 patients with skull base chordoma underwent resection using primarily endoscopic endonasal approaches. Outcomes and complications were compared with previously published results of resection of chordomas from 1991 to 2005 using open skull base approaches. RESULTS Compared with the prior cohort, the current principally endoscopic cohort demonstrated similar rates of OS ( P = .86) and progression-free survival ( P = .56), but patients undergoing first-time resection had significantly higher rates of radical resection (82.9% compared with 64.3%, P = .05) and required fewer staged surgeries (9.8% compared with 33.3%, P = .01). CONCLUSION There was no difference in survival rates for patients treated in the current era, primarily using endoscopic endonasal techniques, compared with previously published results using open skull-base approaches by the same surgeon. Although use of endoscopic endonasal approach resulted in higher rates of radical resection, patients undergoing first-time resection and fewer staged surgeries were required.
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Affiliation(s)
- Zane Schnurman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | | | - Mary Miceli
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Chandranath Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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11
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Pseudoprogression of Vestibular Schwannoma after Stereotactic Radiosurgery with Cyberknife ®: Proposal for New Response Criteria. Cancers (Basel) 2023; 15:cancers15051496. [PMID: 36900290 PMCID: PMC10000564 DOI: 10.3390/cancers15051496] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
(1) Background: Transient increase in volume of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) is common and complicates differentiation between treatment-related changes (pseudoprogression, PP) and tumor recurrence (progressive disease, PD). (2) Methods: Patients with unilateral VS (n = 63) underwent single fraction robotic-guided SRS. Volume changes were classified according to existing RANO criteria. A new response type, PP, with a >20% transient increase in volume was defined and divided into early (within the first 12 months) and late (>12 months) occurrence. (3) Results: The median age was 56 (range: 20-82) years, the median initial tumor volume was 1.5 (range: 0.1-8.6) cm3. The median radiological and clinical follow-up time was 66 (range: 24-103) months. Partial response was observed in 36% (n = 23), stable disease in 35% (n = 22) and PP in 29% (n = 18) of patients. The latter occurred early (16%, n = 10) or late (13%, n = 8). Using these criteria, no case of PD was observed. (4) Conclusion: Any volume increase after SRS for vs. assumed to be PD turned out to be early or late PP. Therefore, we propose modifying RANO criteria for SRS of VS, which may affect the management of vs. during follow-up in favor of further observation.
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12
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Tang H, Bie Z, Wang B, Yang Z, Li P, Wang X, Liu P. The characteristics of brain structural remodeling in patients with unilateral vestibular schwannoma. J Neurooncol 2023; 162:79-91. [PMID: 36808599 DOI: 10.1007/s11060-023-04247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Brain structural remodeling alters related brain function. However, few studies have assessed morphological alterations of unilateral vestibular schwannoma (VS) patients. Therefore, this study examined the characteristics of brain structural remodeling in unilateral VS patients. METHODS We recruited 39 patients with unilateral VS (19 left, 20 right) and 24 matched normal controls (NCs). We obtained brain structural imaging data using 3T T1-weighted anatomical and diffusion tensor imaging scans. Then, we evaluated both gray and white matter (WM) changes using FreeSurfer software and tract-based spatial statistics, respectively. Furthermore, we constructed a structural covariance network to assess brain structural network properties and the connectivity strength between brain regions. RESULTS Compared with NCs, VS patients showed cortical thickening in non-auditory areas (e.g., the left precuneus), especially left VS patients, along with reduced cortical thickness in the right superior temporal gyrus (auditory areas). VS patients also showed increased fractional anisotropy in extensive non-auditory-related WM (e.g., the superior longitudinal fasciculus), especially right VS patients. Both left and right VS patients showed increased small-worldness (more efficient information transfer). Left VS patients had a single reduced-connectivity subnetwork in contralateral temporal regions (right-side auditory areas), but increased connectivity between some non-auditory regions (e.g., left precuneus and left temporal pole). CONCLUSION VS patients exhibited greater morphological alterations in non-auditory than auditory areas, with structural reductions seen in related auditory areas and a compensatory increase in non-auditory areas. Left and right VS patients show differential patterns of brain structural remodeling. These findings provide a new perspective on the treatment and postoperative rehabilitation of VS.
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Affiliation(s)
- Hanlu Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhixu Bie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Peng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China.
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13
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Cass ND, Lindquist NR, Zhu Q, Li H, Oguz I, Tawfik KO. Machine Learning for Automated Calculation of Vestibular Schwannoma Volumes. Otol Neurotol 2022; 43:1252-1256. [PMID: 36109146 DOI: 10.1097/mao.0000000000003687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Machine learning-derived algorithms are capable of automated calculation of vestibular schwannoma tumor volumes without operator input. BACKGROUND Volumetric measurements are most sensitive for detection of vestibular schwannoma growth and important for patient counseling and management decisions. Yet, manually measuring volume is logistically challenging and time-consuming. METHODS We developed a deep learning framework fusing transformers and convolutional neural networks to calculate vestibular schwannoma volumes without operator input. The algorithm was trained, validated, and tested on an external, publicly available data set consisting of magnetic resonance imaging images of medium and large tumors (178-9,598 mm 3 ) with uniform acquisition protocols. The algorithm was then trained, validated, and tested on an internal data set of variable size tumors (5-6,126 mm 3 ) with variable acquisition protocols. RESULTS The externally trained algorithm yielded 87% voxel overlap (Dice score) with manually segmented tumors on the external data set. The same algorithm failed to translate to accurate tumor detection when tested on the internal data set, with Dice score of 36%. Retraining on the internal data set yielded Dice score of 82% when compared with manually segmented images, and 85% when only considering tumors of similar size as the external data set (>178 mm 3 ). Manual segmentation by two experts demonstrated high intraclass correlation coefficient (0.999). CONCLUSION Sophisticated machine learning algorithms delineate vestibular schwannomas with an accuracy exceeding established norms of up to 20% error for repeated manual volumetric measurements-87% accuracy on a homogeneous data set, and 82% to 85% accuracy on a more varied data set mirroring real world neurotology practice. This technology has promise for clinical applicability and time savings.
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Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
| | - Qibang Zhu
- Department of Computer Science, Vanderbilt University
| | | | | | - Kareem O Tawfik
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
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14
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Volumetry improves the assessment of the vestibular aqueduct size in inner ear malformation. Eur Arch Otorhinolaryngol 2022; 280:2155-2163. [PMID: 36216913 PMCID: PMC10066110 DOI: 10.1007/s00405-022-07681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Enlarged vestibular aqueduct (EVA) is a common finding associated with inner ear malformations (IEM). However, uniform radiologic definitions for EVA are missing and various 2D-measurement methods to define EVA have been reported. This study evaluates VA volume in different types of IEM and compares 3D-reconstructed VA volume to 2D-measurements. METHODS A total of 98 high-resolution CT (HRCT) data sets from temporal bones were analyzed (56 with IEM; [cochlear hypoplasia (CH; n = 18), incomplete partition type I (IPI; n = 12) and type II (IPII; n = 11) and EVA (n = 15)]; 42 controls). VA diameter was measured in axial images. VA volume was analyzed by software-based, semi-automatic segmentation and 3D-reconstruction. Differences in VA volume between the groups and associations between VA volume and VA diameter were assessed. Inter-rater-reliability (IRR) was assessed using the intra-class-correlation-coefficient (ICC). RESULTS Larger VA volumes were found in IEM compared to controls. Significant differences in VA volume between patients with EVA and controls (p < 0.001) as well as between IPII and controls (p < 0.001) were found. VA diameter at the midpoint (VA midpoint) and at the operculum (VA operculum) correlated to VA volume in IPI (VA midpoint: r = 0.78, VA operculum: r = 0.91), in CH (VA midpoint: r = 0.59, VA operculum: r = 0.61), in EVA (VA midpoint: r = 0.55, VA operculum: r = 0.66) and in controls (VA midpoint: r = 0.36, VA operculum: r = 0.42). The highest IRR was found for VA volume (ICC = 0.90). CONCLUSIONS The VA diameter may be an insufficient estimate of VA volume, since (1) measurement of VA diameter does not reliably correlate with VA volume and (2) VA diameter shows a lower IRR than VA volume. 3D-reconstruction and VA volumetry may add information in diagnosing EVA in cases with or without additional IEM.
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15
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Spontaneous Volumetric Tumor Regression During Wait-and-Scan Management of 952 Sporadic Vestibular Schwannomas. Otol Neurotol 2022; 43:e1034-e1038. [PMID: 36001695 DOI: 10.1097/mao.0000000000003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Spontaneous tumor shrinkage during wait-and-scan management of sporadic vestibular schwannoma is generally considered an uncommon phenomenon. However, most data informing this understanding stem from single-slice linear tumor measurements taken in the axial imaging plane. The objective of the current work was to characterize the regression capacity of sporadic vestibular schwannomas using volumetric tumor measurements. STUDY DESIGN Retrospective cohort study using slice-by-slice, three-dimensional volumetric tumor measurements. SETTING Three tertiary referral centers. PATIENTS Patients with sporadic vestibular schwannoma. INTERVENTIONS Wait-and-scan. MAIN OUTCOME MEASURES Regression-free survival rates with regression defined as a decrease of at least 20% of the tumor volume. RESULTS Among 952 patients undergoing a total of 3,505 magnetic resonance imaging studies during observation, 123 experienced volumetric tumor regression after diagnosis at a median of 1.2 years (interquartile range, 0.6-2.9 yr). Volumetric regression-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after diagnosis were 94% (92-95%; 662), 86% (83-89%; 275), and 78% (73-82%; 132), respectively. Among 405 patients who demonstrated an initial period of tumor growth but continued wait-and-scan management, 48 experienced volumetric regression at a median of 1.2 years (interquartile range, 0.8-2.6 yr) after initial growth. Volumetric regression-free survival rates at 1, 3, and 5 years after initial growth were 94% (92-97%; 260), 84% (79-89%; 99), and 75% (67-83%; 43), respectively. Ultimately, only 82 of the 952 patients studied showed exclusively volumetric tumor regression (i.e., without any periods of tumor growth) by the time of last follow-up. CONCLUSION Spontaneous volumetric tumor shrinkage during wait-and-scan management occurs more frequently than suggested by previous studies using linear tumor measurements and can even occur after previous episodes of documented tumor growth. These data further highlight the dynamic nature of vestibular schwannoma growth. To this end, the application of natural history data to patient management requires a nuanced approach that parallels the complex tumor behavior of vestibular schwannoma.
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16
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Neve OM, Chen Y, Tao Q, Romeijn SR, de Boer NP, Grootjans W, Kruit MC, Lelieveldt BPF, Jansen JC, Hensen EF, Verbist BM, Staring M. Fully Automated 3D Vestibular Schwannoma Segmentation with and without Gadolinium-based Contrast Material: A Multicenter, Multivendor Study. Radiol Artif Intell 2022; 4:e210300. [PMID: 35923375 PMCID: PMC9344213 DOI: 10.1148/ryai.210300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE To develop automated vestibular schwannoma measurements on contrast-enhanced T1- and T2-weighted MRI scans. MATERIALS AND METHODS MRI data from 214 patients in 37 different centers were retrospectively analyzed between 2020 and 2021. Patients with hearing loss (134 positive for vestibular schwannoma [mean age ± SD, 54 years ± 12;64 men] and 80 negative for vestibular schwannoma) were randomly assigned to a training and validation set and to an independent test set. A convolutional neural network (CNN) was trained using fivefold cross-validation for two models (T1 and T2). Quantitative analysis, including Dice index, Hausdorff distance, surface-to-surface distance (S2S), and relative volume error, was used to compare the computer and the human delineations. An observer study was performed in which two experienced physicians evaluated both delineations. RESULTS The T1-weighted model showed state-of-the-art performance, with a mean S2S distance of less than 0.6 mm for the whole tumor and the intrameatal and extrameatal tumor parts. The whole tumor Dice index and Hausdorff distance were 0.92 and 2.1 mm in the independent test set, respectively. T2-weighted images had a mean S2S distance less than 0.6 mm for the whole tumor and the intrameatal and extrameatal tumor parts. The whole tumor Dice index and Hausdorff distance were 0.87 and 1.5 mm in the independent test set. The observer study indicated that the tool was similar to human delineations in 85%-92% of cases. CONCLUSION The CNN model detected and delineated vestibular schwannomas accurately on contrast-enhanced T1- and T2-weighted MRI scans and distinguished the clinically relevant difference between intrameatal and extrameatal tumor parts.Keywords: MRI, Ear, Nose, and Throat, Skull Base, Segmentation, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2022.
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17
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Evaluating growth trends of residual sporadic vestibular schwannomas: a systematic review and meta-analysis. J Neurooncol 2022; 159:135-150. [PMID: 35761159 DOI: 10.1007/s11060-022-04051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gross total resection remains the gold-standard approach for vestibular schwannomas (VS) when surgery is indicated. In select cases, incomplete resection (IR) becomes a desired alternative to preserve the facial nerve function and the patient's quality of life. While a lot of earlier studies described incompletely resected sporadic VSs as dormant, more recent studies reported a higher growth rate following IR, therefore an evaluation of the residual VS growth rates could have important implications for the follow-up treatment protocols and provide relevant information for neurosurgeons, neuro-otologists, neuropathologists, and radiologists. Although prognostic factors predicting preoperative VS growth have been previously investigated, these factors have not been investigated following IR. Our review aims to examine the growth rate of residual sporadic VS following IR and to examine variables associated with the regrowth of residual VS. METHODS The review was conducted in accordance with the PRISMA guidelines. Six databases (MEDLINE (Ovid), Embase (Ovid), CINAHL Plus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform and UK Clinical Trials Gateway (WHO ICTRP) were searched. Full-text articles analysing growth rates in at least ten patients who had residual VS after IR were assessed. We conducted a meta-analysis using a random-effects model via RevMan. RESULTS 14 studies totalling 849 patients were included in the analysis. The mean planimetric growth rate was 1.57 mm/year (range 0.16-3.81 mm/year). The mean volumetric growth rate was 281.725 mm3/year (range 17.9-530.0 mm3/year). Age, sex, pre-operative tumour size/volume, cystic tumour sub-type, MIB-1 index, and intracanalicular tumour location were not associated with residual growth. Residual tumour size/volume was statistically significant to growth (OR = 0.65, 95% CI 0.47-0.90, p = 0.01). Radiological re-growth occurred in an average of 26.6% of cases (range 0-54.5%). CONCLUSION From our analysis, only the residual tumour volume/size was associated with residual VS growth. Therefore, close postoperative surveillance for the first year, followed by an annual MRI scan for at least 5 years, and subsequently extended interval surveillance remains of utmost importance to monitor disease progression and provide timely surgical and adjuvant interventions. Our study shows that future work should be aimed at molecular and histological characteristics of residual VSs to aid prognostic understanding of growth.
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Weiner S, Strinitz M, Herfurth J, Hessenauer F, Nauroth-Kreß C, Kampf T, Homola GA, Üçeyler N, Sommer C, Pham M, Schindehütte M. Dorsal Root Ganglion Volumetry by MR Gangliography. AJNR Am J Neuroradiol 2022; 43:769-775. [PMID: 35450855 PMCID: PMC9089252 DOI: 10.3174/ajnr.a7487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/12/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Dorsal root ganglion MR imaging (MR gangliography) is increasingly gaining clinical-scientific relevance. However, dorsal root ganglion morphometry by MR imaging is typically performed under the assumption of ellipsoid geometry, which remains to be validated. MATERIALS AND METHODS Sixty-four healthy volunteers (37 [57.8%] men; mean age, 31.5 [SD, 8.3] years) underwent MR gangliography of the bilateral L4-S2 levels (3D-T2WI TSE spectral attenuated inversion recovery-sampling perfection with application-optimized contrasts by using different flip angle evolution, isotropic voxels = 1.1 mm³, TE = 301 ms). Ground truth dorsal root ganglion volumes were bilaterally determined for 96 dorsal root ganglia (derivation cohort) by expert manual 3D segmentation by 3 independent raters. These ground truth dorsal root ganglion volumes were then compared with geometric ellipsoid dorsal root ganglion approximations as commonly practiced for dorsal root ganglion morphometry. On the basis of the deviations from ellipsoid geometry, improved volume estimation could be derived and was finally applied to a large human validation cohort (510 dorsal root ganglia). RESULTS Commonly used equations of ellipsoid geometry underestimate true dorsal root ganglion volume by large degrees (factor = 0.42-0.63). Ground truth segmentation enabled substantially optimizing dorsal root ganglion geometric approximation using its principal axes lengths by deriving the dorsal root ganglion volume term of [Formula: see text]. Using this optimization, the mean volumes of 510 lumbosacral healthy dorsal root ganglia were as follows: L4: 211.3 (SD, 52.5) mm³, L5: 290.7 (SD, 90.9) mm³, S1: 384.2 (SD, 145.0) mm³, and S2: 192.4 (SD, 52.6) mm³. Dorsal root ganglion volume increased from L4 to S1 and decreased from S1 to S2 (P < .001). Dorsal root ganglion volume correlated with subject height (r = . 22, P < .001) and was higher in men (P < .001). CONCLUSIONS Dorsal root ganglion volumetry by measuring its principal geometric axes on MR gangliography can be substantially optimized. By means of this optimization, dorsal root ganglion volume distribution was estimated in a large healthy cohort for the clinically most relevant lumbosacral levels, L4-S2.
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Affiliation(s)
- S Weiner
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - M Strinitz
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - J Herfurth
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - F Hessenauer
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - C Nauroth-Kreß
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - T Kampf
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - G A Homola
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - N Üçeyler
- Neurology (N.U., C.S.), University Hospital Würzburg, Würzburg, Germany
| | - C Sommer
- Neurology (N.U., C.S.), University Hospital Würzburg, Würzburg, Germany
| | - M Pham
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - M Schindehütte
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
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Brown A, Early S, Vasilijic S, Stankovic KM. Sporadic Vestibular Schwannoma Size and Location Do not Correlate With the Severity of Hearing Loss at Initial Presentation. Front Oncol 2022; 12:836504. [PMID: 35372070 PMCID: PMC8965062 DOI: 10.3389/fonc.2022.836504] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Vestibular schwannoma (VS) is a non-malignant intracranial neoplasm arising from the vestibular branch of the 8th cranial nerve; sensorineural hearing loss (SNHL) is the most common associated symptom. Understanding whether VS imaging characteristics at the time of VS diagnosis can be associated with severity of VS-induced SNHL can impact patient counseling and define promising areas for future research. Patients diagnosed with VS at Massachusetts Eye and Ear (MEE) from 1994 through 2018 were analyzed if magnetic resonance imaging at VS presentation and sequential audiometry were available. Results were compared with original studies available in PubMed, written in English, on VS imaging characteristics and their impact on hearing in patients. A total of 477 patients with unilateral VS from the MEE database demonstrated no significant correlation between any features of tumor imaging at the time of VS diagnosis, such as VS size, impaction or location, and any hearing loss metric. Twenty-three published studies on the impact of VS imaging characteristics on patient hearing met inclusion criteria, with six solely involving NF2 patients and three including both sporadic and NF2-related VS patients. Fifteen studies reported a significant relationship between SNHL and at least one VS imaging characteristic; however, these trends were universally limited to NF2 patients or involved small patient populations, and were not reproduced in larger studies. Taken together, SNHL in sporadic VS patients is not readily associated solely with any tumor imaging characteristics. This finding motivates future studies to define how VS microenvironment and secreted molecules influence VS-induced SNHL.
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Affiliation(s)
- Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States
| | - Samuel Early
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology Head and Neck Surgery, University of California, San Diego, San Diego Medical Center, San Diego, CA, United States
| | - Sasa Vasilijic
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
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20
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Maksoud Z, Schmidt MA, Huang Y, Rutzner S, Mansoorian S, Weissmann T, Bert C, Distel L, Semrau S, Lettmaier S, Eyüpoglu I, Fietkau R, Putz F. Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy. Cancers (Basel) 2022; 14:cancers14061547. [PMID: 35326697 PMCID: PMC8946188 DOI: 10.3390/cancers14061547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Accurate assessment of treatment efficacy is a prerequisite for the improvement in therapeutic outcomes in clinical trials. However, it is very challenging to accurately track the size of meningiomas after radiotherapy, because of their complex shapes and often slow growth. Measuring the whole tumor volume as opposed to simple diameter measurements to assess treatment efficacy, therefore, is very promising but little is known on expected volumetric changes of meningiomas following radiotherapy. Therefore, in this study, we meticulously investigated volumetric changes in meningiomas following radiotherapy incorporating volumetric measurements from 468 MRI studies and evaluated newly proposed RANO volumetric criteria in the context of radiotherapy. We found that temporary tumor enlargement after radiotherapy overall was rare but occurred significantly more frequently after high than after low single doses of radiation, represented an important differential diagnosis to tumor progression and would have skewed results in a clinical trial if not accounted for. Abstract To investigate the occurrence of pseudoprogression/transient enlargement in meningiomas after stereotactic radiotherapy (RT) and to evaluate recently proposed volumetric RANO meningioma criteria for response assessment in the context of RT. Sixty-nine meningiomas (benign: 90%, atypical: 10%) received stereotactic RT from January 2005–May 2018. A total of 468 MRI studies were segmented longitudinally during a median follow-up of 42.3 months. Best response and local control were evaluated according to recently proposed volumetric RANO criteria. Transient enlargement was defined as volumetric increase ≥20% followed by a subsequent regression ≥20%. The mean best volumetric response was −23% change from baseline (range, −86% to +19%). According to RANO, the best volumetric response was SD in 81% (56/69), MR in 13% (9/69) and PR in 6% (4/69). Transient enlargement occurred in only 6% (4/69) post RT but would have represented 60% (3/5) of cases with progressive disease if not accounted for. Transient enlargement was characterized by a mean maximum volumetric increase of +181% (range, +24% to +389 %) with all cases occurring in the first year post-RT (range, 4.1–10.3 months). Transient enlargement was significantly more frequent with SRS or hypofractionation than with conventional fractionation (25% vs. 2%, p = 0.015). Five-year volumetric control was 97.8% if transient enlargement was recognized but 92.9% if not accounted for. Transient enlargement/pseudoprogression in the first year following SRS and hypofractionated RT represents an important differential diagnosis, especially because of the high volumetric control achieved with stereotactic RT. Meningioma enlargement during subsequent post-RT follow-up and after conventional fractionation should raise suspicion for tumor progression.
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Affiliation(s)
- Ziad Maksoud
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Manuel Alexander Schmidt
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
- Department of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Yixing Huang
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Sandra Rutzner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Sina Mansoorian
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Luitpold Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Ilker Eyüpoglu
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, Germany; (Z.M.); (Y.H.); (S.R.); (S.M.); (T.W.); (C.B.); (L.D.); (S.S.); (S.L.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany; (M.A.S.); (I.E.)
- Correspondence: ; Tel.: +49-9131-853-4080
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Wu MJ, Knoll RM, Chen JX, Reinshagen K, Roychowdhury P, McKenna MJ, Kozin ED, Remenschneider AK, Jung DH. A Subset of Intracanalicular Vestibular Schwannomas Demonstrates Minimal Growth Over a 10-Year Period. Otol Neurotol 2022; 43:376-384. [PMID: 35020686 DOI: 10.1097/mao.0000000000003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Vestibular schwannomas (VS) commonly undergo magnetic resonance imaging (MRI) surveillance, but long-term data to support the ideal frequency is limited. Herein, we aim to investigate intracanalicular VS growth predictors and long-term growth rates (GR). STUDY DESIGN Retrospective chart review. SETTING Two tertiary care centers. PATIENTS Sporadic intracanalicular VS with initial conservative management and at least two sequential MRIs. INTERVENTION Serial MRI. MAIN OUTCOME MEASURES VS were categorized by baseline internal auditory canal tertile sublocalization (fundus, midpoint, porus) and size (≤100, 100-200, >200 mm3). Throughout follow-up, volumetric GR (mm3/yr) were determined (baseline-3 yrs, 3-5 yrs, 5-10 yrs) and treatment rates were assessed. RESULTS Ninety-nine intracanalicular VS were identified (mean follow-up of 6.1 ± 4.5 yrs). Mean GR before 5-year follow-up were comparable for baseline tertile involvement and size. After 5-year follow-up, mean GR of VS involving the fundus at baseline were lower than those involving the midpoint and fundus (6.17 ± 21.16 and 119.74 ± 117.57 mm3/yr, respectively; p = 0.034). Mean GR of VS with less than or equal to 100 mm3 at baseline (-7.29 ± 25.44 mm3/yr) were lower than those with 100 to 200 mm3 (86.55 ± 103.99 mm3/yr; p = 0.011) and more than 200 mm3 (45.70 ± 35.71 mm3/yr; p = 0.031). Vestibular schwannomas involving the midpoint and fundus had greater treatment rates compared with VS involving only the fundus (p < 0.001). CONCLUSIONS Baseline tertile involvement and size may predict long-term intracanalicular VS growth where fundal tumors or those less than or equal to 100 mm3 exhibit little long-term growth. Extending surveillance after 5-year follow-up may be reasonable for fundal VS.
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Affiliation(s)
- Matthew J Wu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Renata M Knoll
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Prithwijit Roychowdhury
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Michael J McKenna
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Aaron K Remenschneider
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - David H Jung
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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22
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Aktan SL, Finucane S, Kircher M, Moore D, Bashir M. The Natural History of Small Vestibular Schwannomas. Cureus 2022; 14:e22231. [PMID: 35340467 PMCID: PMC8929235 DOI: 10.7759/cureus.22231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
Objective The incidence of vestibular schwannomas is increasing, and the average tumor size at diagnosis is decreasing. Therefore, understanding the specific growth pattern of small vestibular schwannomas is becoming increasingly important to guide clinical management. The objectives of this study were to evaluate the growth patterns of very small intracanalicular vestibular schwannomas measuring ≤ 4 mm in linear diameter and to assess the likelihood of these lesions ever requiring treatment. Methods A retrospective review was performed. A search of all MRI brain and internal auditory canal studies suggestive of a vestibular schwannoma from 1995 to 2019 was performed at our institution. This resulted in 372 cases, which were then evaluated for the presence of a vestibular schwannoma measuring ≤ 4 mm. All patients had to have at least one follow-up MRI to be included. Images were reviewed by a neuroradiologist. Results Eight ≤ 4 mm vestibular schwannomas were found that met all search criteria. The distribution of tumor sizes was as follows: three 2 mm, one 3 mm and four 4 mm. None of the ≤ 4 mm vestibular schwannomas identified demonstrated any significant growth in the linear dimension defined as greater than 2 mm of growth over observation times of 1-13 years (mean 6.3 years). None of the lesions ever required a treatment intervention per available medical records. Conclusion None of the ≤ 4 mm intracanalicular vestibular schwannomas identified in this study grew significantly or required treatment. Overall, the findings in this study suggest that vestibular schwannomas measuring ≤ 4 mm are unlikely to grow and ever require treatment.
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23
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Fouard O, Daisne JF, Wanet M, Regnier M, Gustin T. Long-term volumetric analysis of vestibular schwannomas following stereotactic radiotherapy: Practical implications for follow-up. Clin Transl Radiat Oncol 2022; 33:1-6. [PMID: 34977365 PMCID: PMC8688865 DOI: 10.1016/j.ctro.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
Pseudoprogression may be a late phenomenon after radiosurgery. Loss of central contrast enhancement is not predictive of tumor control. No decision of salvage therapy should be made until the 6th year post-treatment.
Background and purpose Transient tumor swelling is a well-known phenomenon following radiotherapy for vestibular schwannomas (VS). We analyzed the long-term volumetric changes of VS after LINAC radiosurgery, in order to determine a time interval during which a true tumor progression can be distinguished from a pseudoprogression. Methods Among 63 patients with VS treated by one fraction or fractionated radiotherapy, we selected 52 of them who had a minimal follow-up of 5 years. Maximal axial diameter and three-dimensional tumor volume were measured on each MRI scan. Volume changes were interpreted using different error margins ranging from 10 to 20%. Patients were categorized according to the tumor evolution pattern over time. Results Median follow-up was 83 months. One tumor (1.9%) remained stable and 26.9% had continuous shrinkage. Applying an error margin of 13%, a transient tumor enlargement was observed in 63.5% of patients, with a first peak at 6–12 months and a late peak at 3–4 years. A true progression was suspected in 4 (7.7%) patients, tumor regrowth starting after the 3rd or 4th year post-treatment. Only one patient required salvage radiotherapy. Conclusion Transient swelling of VS following radiotherapy is generally an early phenomenon but may occur late. In the first 5 years, a true tumor progression cannot be differentiated from a pseudoprogression. A significant tumor expansion observed on 3 sequential MRI scans after the 3rd year may be suggestive of treatment failure. Long-term follow-up is therefore mandatory and no decision of salvage treatment should be made until the 6th year.
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Affiliation(s)
- O Fouard
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - J F Daisne
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium.,Radiation Oncology Department, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Oncology and Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Wanet
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium
| | - M Regnier
- Scientific Support Unit, CHU UCL Namur, Université catholique de Louvain, Namur, Belgium
| | - T Gustin
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
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24
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Fink KR, Nobles SE, Zeitler DM. Comparing the Precision and Reliability Between Three Radiographic Techniques for Measuring Sporadic Vestibular Schwannomas. Acad Radiol 2022; 29:69-76. [PMID: 33158707 DOI: 10.1016/j.acra.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Several methods exist for measuring vestibular schwannoma (VS) size radiographically. Our aim was to compare the precision and reproducibility of three different radiographic measurement techniques for assessing VS tumor size. MATERIAL AND METHODS Twenty patients with unilateral, sporadic VS previously untreated were identified. All patients had thin-slice T1 weighted, postcontrasted magnetization prepared rapid acquisition gradient echo images. Three measurement techniques were performed using within-subject and between-subject comparison. Experimental comparison of interobserver agreement between techniques was calculated. Interobserver intraclass correlation coefficients, repeatability coefficients, and relative smallest detectable difference were calculated and compared. RESULTS Mean tumor measurements were: 10.3 mm (maximum linear dimension, [MLD]), 495.9 mm3 (orthogonal volumetric analysis, [OVA]), and 572.1 mm3 (segmented volumetric analysis, [SVA]). Interobserver correlation coefficient was excellent for all measurement techniques, but highest for segmented volumetric analysis. Repeatability coefficient was 1.44 mm for MLD, 298.9 mm3 for OVA, and 174.8 mm3 for SVA. The smallest detectable difference was 13.9% for MLD, 60.2% for OVA, and 30.6% for SVA. A subgroup analysis was performed for small tumors (<14 mm) and large tumors (>14 mm) and demonstrated increased precision of segmented volumetric analysis for larger tumors. CONCLUSION Semi-automated segmented volumetric analysis appears more precise than either linear measurement or orthogonal volumetric analysis for reporting VS tumor size, and becomes increasingly precise for larger tumors. Tumor volume and tumor volume change over time using SVA may be more sensitive in surveilling VS than current measurement techniques.
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25
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Marinelli JP, Schnurman Z, Killeen DE, Nassiri AM, Hunter JB, Lees KA, Lohse CM, Roland JT, Golfinos JG, Kondziolka D, Link MJ, Carlson ML. Long-term natural history and patterns of sporadic vestibular schwannoma growth: A multi-institutional volumetric analysis of 952 patients. Neuro Oncol 2021; 24:1298-1306. [PMID: 34964894 PMCID: PMC9340632 DOI: 10.1093/neuonc/noab303] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current study aims to characterize the natural history of sporadic vestibular schwannoma volumetric tumor growth, including long-term growth patterns following initial detection of growth. METHODS Volumetric tumor measurements from 3505 serial MRI studies were analyzed from unselected consecutive patients undergoing wait-and-scan management at three tertiary referral centers between 1998 and 2018. Volumetric tumor growth was defined as a change in volume ≥20%. RESULTS Among 952 patients undergoing observation, 622 experienced tumor growth with initial growth-free survival rates (95% CI) at 1, 3, and 5 years following diagnosis of 66% (63-69), 30% (27-34), and 20% (17-24). Among 405 patients who continued to be observed despite demonstrating initial growth, 210 experienced subsequent tumor growth with subsequent growth-free survival rates at 1, 3, and 5 years following initial growth of 77% (72-81), 37% (31-43), and 24% (18-31). Larger tumor volume at initial growth (HR 1.13, P = .02) and increasing tumor growth rate (HR 1.31; P < .001) were significantly associated with an increased likelihood of subsequent growth, whereas a longer duration of time between diagnosis and detection of initial growth was protective (HR 0.69; P < .001). CONCLUSIONS While most vestibular schwannomas exhibit an overall propensity for volumetric growth following diagnosis, prior tumor growth does not perfectly predict future growth. Tumors can subsequently grow faster, slower, or demonstrate quiescence and stability. Larger tumor size and increasing tumor growth rate portend a higher likelihood of continued growth. These findings can inform timing of intervention: whether upfront at initial diagnosis, after detection of initial growth, or only after continued growth is observed.
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Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zane Schnurman
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Corresponding Author: Matthew L. Carlson, MD, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA ()
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Wach J, Güresir Á, Borger V, Schuss P, Becker A, Coch C, Schmitz MT, Hölzel M, Toma M, Herrlinger U, Vatter H, Güresir E. Elevated baseline C-reactive protein levels predict poor progression-free survival in sporadic vestibular schwannoma. J Neurooncol 2021; 156:365-375. [PMID: 34882287 PMCID: PMC8816751 DOI: 10.1007/s11060-021-03918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Background Recent investigations showed emerging evidence of the role of inflammation in the growth of sporadic vestibular schwannoma (VS). The present retrospective study investigated the impact of systemic inflammation on tumor progression using serum C-reactive protein (CRP) levels in a series of 87 surgically treated sporadic VS patients. Methods The optimal cut-off value for CRP was defined as 3.14 mg/dl according to the receiver operating characteristic curve (AUC: 0.70, 95% CI 0.47–0.92). Patient cohort was dichotomized into normal (n = 66; < 3.14 mg/dl) and high baseline (n = 21; ≥ 3.14 mg/dl) CRP groups. Results No significant differences in age, sex, comorbidities influencing the systemic inflammatory state, Karnofsky performance status (KPS), tumor size, extent of resection, or MIB-1 index were identified between the two groups defined by the baseline CRP levels. Univariable analysis demonstrated that a high CRP level (≥ 3.14 mg/dl) is significantly associated with a shortened progression-free survival (PFS) (hazard ratio (HR): 6.05, 95% CI 1.15–31.95, p = 0.03). Multivariable Cox regression analysis considering age, extent of resection, KPS, tumor size, and baseline CRP confirmed that an elevated CRP level (≥ 3.14 mg/dl) is an independent predictor of shortened PFS (HR: 7.20, 95% CI 1.08–48.14, p = 0.04). Conclusions The baseline CRP level thus serves as an independent predictor of PFS. Further investigations of the role of inflammation and tumor inflammatory microenvironment in the prediction of prognosis in sporadic VS are needed. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03918-0.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany.
| | - Ági Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
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Tufts Medical Center Experience With Long-Term Follow-Up of Vestibular Schwannoma Treated With Gamma Knife Stereotactic Radiosurgery: Novel Finding of Delayed Pseudoprogression. Adv Radiat Oncol 2021; 6:100687. [PMID: 34409200 PMCID: PMC8360957 DOI: 10.1016/j.adro.2021.100687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Our purpose was to evaluate the long-term outcomes of patients with vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (GKSRS) with modern techniques, with attention to posttreatment tumor growth dynamics, dosimetric predictors, and late toxicities. Methods and Materials One hundred twelve patients with VS were treated with GKSRS with a median dose of 12.5 Gy to the 50% isodose line treated between 2004 and 2015, with patients followed up to 15 years. Target and organ-at-risk doses were recorded, and tumor diameter/volume, audiologic decline, and trigeminal/facial nerve preservation were tracked from treatment onward. Results GKSRS yielded local control of 5, 10, and 15 years at 96.9%, 90.0%, and 87.1% respectively. Pseudoprogression was found in 45%, with a novel pattern detected with peak swelling at 31 months. Pseudoprogression was associated with smaller tumor diameter at treatment and fewer treatment isocenters, but not with the development of any toxicity, nor was it predicted by any dosimetric factor. Median time to hearing loss was 3.4 years with actuarial hearing preservation at 2, 5, and 10 years of 66.5%, 43.1%, and 37.6%, with rate of hearing loss correlating with maximum cochlea and modiolus doses. Trigeminal and facial nerve preservation rates were 92.7% and 97.6%, respectively. Increasing maximum tumor dose was associated with facial paresthesia. Conclusions Modern GKSRS is a safe and effective treatment for VS on long-term follow-up, with high levels of facial and trigeminal nerve preservation. A novel pattern of pseudoprogression has been identified suggesting longer imaging follow-up may be needed before initiating salvage in those without symptomatic progression. Several tumor and dosimetric predictors have been suggested for the development of different toxicities, requiring further evaluation.
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Gurewitz J, Schnurman Z, Nakamura A, Navarro RE, Patel DN, McMenomey SO, Roland JT, Golfinos JG, Kondziolka D. Hearing loss and volumetric growth rate in untreated vestibular schwannoma. J Neurosurg 2021; 136:768-775. [PMID: 34416729 DOI: 10.3171/2021.2.jns203609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS). METHODS Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5-48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios. RESULTS Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss. CONCLUSIONS Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.
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Affiliation(s)
| | | | | | | | | | - Sean O McMenomey
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
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Association of Metformin With Volumetric Tumor Growth of Sporadic Vestibular Schwannomas. Otol Neurotol 2021; 42:1081-1085. [PMID: 34260511 DOI: 10.1097/mao.0000000000003149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Recent research demonstrates a potential association between metformin use and reduced sporadic vestibular schwannoma (VS) growth in patients undergoing conservative observation. The current study was designed to elucidate the effect of metformin on tumor growth in sporadic VS using volumetric analyses. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Patients with sporadic VS who elected initial conservative treatment with at least two serial magnetic resonance imaging (MRI) scans were included. INTERVENTIONS Metformin use among patients with observed sporadic VS. MAIN OUTCOME MEASURES Tumor growth, defined as an increase in volume of at least 20% from the initial MRI. RESULTS A total of 361 patients were evaluated. Thirty-four patients (9%) had a diagnosis of diabetes at baseline. Nineteen patients (5%) were taking metformin at the time of the initial MRI. Metformin use was not significantly associated with a reduced risk of volumetric tumor growth in a univariable analysis in all patients undergoing observation for VS (hazard ratio [HR] 0.75; 95% confidence intervals [CI] 0.40-1.42; p = 0.38) or within the diabetic subset (HR 0.79; 95% CI 0.34-1.83; p = 0.58). Additionally, diabetes status, insulin dependence, hemoglobin A1c value, and metformin dose were not significantly associated with volumetric tumor growth. CONCLUSION Despite promising initial results in several previous studies, our data suggest that metformin use does not significantly reduce the risk of volumetric tumor growth in sporadic VS.
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Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging? Neurosurg Rev 2021; 45:751-761. [PMID: 34269934 DOI: 10.1007/s10143-021-01604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/19/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
In order to verify whether a previous gamma knife surgery (GKS) treatment could influence the oncological and functional outcome in large vestibular schwannoma (VS) surgery, we have compared group of patients operated on for large VS after failed GKS to a group of genuine VS that underwent the same functional nerve-sparing resection technique regimen in the same period. Single center retrospective cohort study of 23 consecutive GKS failure and 170 genuine VS patients operated on between April 2003 and March 2019. After resection, patients were allocated to a Wait-&-rescan or an upfront GKS policy. At last follow-up examination, the facial nerve function was good (House-Brackmann grades I or II) in 95% of the GKS failure and 84% of the genuine VS patients (p = .25). The median volume of tumor residue was .56 cc in the GKS failure group and .62 cc in the genuine VS group (p = .70). Tumor control was achieved in 91% and 83% of cases with a mean follow-up of 74 and 63 months in the GKS failure and the genuine VS populations, respectively. The 1-, 5-, and 7-year progression-free survival were 100%, 95%, and 85% respectively in the GKS failure group and 97%, 80%, and 81% in the genuine VS group (p = .27). Despite significant modifications of the microsurgical environment associated to salvage surgery after GKS failure, a functional nerve-sparing resection is an effective strategy to optimize the results on facial nerve function, with similar long-term tumor control to those observed in the genuine VS population.
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Abstract
OBJECTIVE 1) To compare vestibular schwannoma maximum linear dimensions and calculated volume with measured volume in accurately determining tumor volume and growth. 2) To determine natural growth history of vestibular schwannomas utilizing volumetric measurements in an observed patient population. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic referral. PATIENTS One hundred fifty two adults with a vestibular schwannoma who underwent observational management with sequential magnetic resonance imaging (MRI) scans (496 scans). INTERVENTION MRI scans. MAIN OUTCOME MEASURES Tumor volume calculated from linear dimensions compared with measured volume. The percentage change in tumor size (linear or volume) between consecutive MRI scans. RESULTS The percentage change in tumor size between consecutive MRIs is significantly different between maximum linear dimension (MLD) and measured tumor volume (p = 0.03), but no difference exists in the percentage change between measured and calculated tumor volume (p = 0.882 for three linear measurements, p = 0.637 for two linear measurements). The overall number of growing tumors is 57.2% (n = 87) with an average growth rate of 62.6%. If a criterion for growth of 20% change is used, 32.2% of tumors monitored by linear volume would have demonstrated growth while 57.2% of tumors with measured volume demonstrated growth. CONCLUSION Maximum linear dimensions are a significantly less sensitive measure of tumor growth compared with measured volumes. Calculated tumor volume utilizing three linear measurements is an accurate predictor of both measured tumor volume and tumor growth.
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Strauss C, Rampp S, Scheller C, Prell J, Strauss C, Doerfler A, Engelhorn T. Volumetry and Surgical Grading Systems for Vestibular Schwannoma Size Assessment and their Relationship to Postoperative Facial Nerve Function. J Neurol Surg A Cent Eur Neurosurg 2021; 83:39-45. [PMID: 34100269 DOI: 10.1055/s-0041-1725951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Treatment modalities in vestibular schwannoma (VS) are difficult to compare since different techniques for size measurements are used. The purpose of this study was to evaluate the relation between different tumor size grading systems regarding their compatibility as well as the relationship to facial nerve outcome facilitating comparisons of different studies. MATERIAL AND METHODS In this retrospective study, preoperative magnetic resonance imaging of 100 patients with surgically treated VS was evaluated regarding total tumor volume and anatomical extension based on the Koos and Samii classification, as well as volumetric and maximal diameter measures. Three-dimensional constructive interference in steady state (3D-CISS) and T1 postcontrast volumetric interpolated breath-hold examination (VIBE) sequences were used. Facial nerve function was evaluated according to the House-Brackmann (HB) scale 6 months following complete tumor removal via the retrosigmoid approach. RESULTS Tumor size showed a moderate influence on postsurgical facial nerve function with correlations not exceeding 0.4. Severe palsy was observed mainly in patients with large tumors with Koos grade 4, Samii grade 4b, respectively a volume of at least 6 cm3 or a maximum diameter of 2.4 cm for HB ≥ 3 and a volume of 7.5 cm3 and maximum diameter of 3.2 cm for HB ≥ 4. In regard to volumetry, the Koos and Samii grading systems were highly comparable, whereas the maximal diameter showed consistently lower correlation values. CONCLUSIONS The results of our study allow direct comparison of studies on surgery versus radiotherapy of VS. The data allow for translation of tumor sizes based on different grading systems. Comparison of microsurgical, radiotherapeutic and radiosurgical approaches should concentrate on patients with large tumors. Whereas smaller tumors were rarely associated with severe facial palsy, large tumors did not exclude the possibility of weak or no palsy 6 months after surgery.
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Affiliation(s)
- Catharina Strauss
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
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Reznitsky M, Petersen MMBS, West N, Stangerup SE, Cayé-Thomasen P. The natural history of vestibular schwannoma growth-prospective 40-year data from an unselected national cohort. Neuro Oncol 2021; 23:827-836. [PMID: 33068429 DOI: 10.1093/neuonc/noaa230] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Optimal management of vestibular schwannoma (VS) is still debated and thus international consensus has not been achieved. Treatment options are observation, radiotherapy, and surgery. Knowledge on the natural history of tumor growth is essential for choice of treatment modality. The aim is to present intra-/extrameatal tumor growth and management data from a prospective, unselected national cohort of patients diagnosed with VS during the period 1976-2015. METHODS Since 1976, all data from patients diagnosed with sporadic VS in Denmark have been referred to our national treatment center, where they have been entered prospectively into the national database. Data on tumor localization, growth, and treatment were retrieved. Growth definition: >2 mm by linear measurement, in accordance with the Tokyo 2001 consensus-meeting recommendations. RESULTS 3637 cases of VS were diagnosed, in which 1304 patients had surgery and 21 received radiotherapy post diagnosis. 2312 patients were observed with mean follow-up of 7.33 years. Of these, 434(19%; 102 intra-and 332 extrameatal tumors) changed to active treatment during the observation period due to tumor growth. 5 years after diagnosis, 21% of the intrameatal tumors exhibited growth during observation, whereas 37% of extrameatal tumors had grown, increasing to 25% intrameatal and 42% extrameatal after 10 years. Following growth, the intrameatal tumors were mostly observed further and the extrameatal mostly underwent surgery. Tumor growth occurred mainly within the first 5 years post diagnosis. CONCLUSION This natural history study documents the growth occurrence of both intra-and extrameatal VS during the first 12 years after diagnosis and should be used in patient counseling, management, and treatment decision making.
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Affiliation(s)
- Martin Reznitsky
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels West
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sven-Eric Stangerup
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lee WJ, Lee JI, Choi JW, Kong DS, Nam DH, Cho YS, Shin HJ, Seol HJ. Optimal Volume of the Residual Tumor to Predict Long-term Tumor Control Using Stereotactic Radiosurgery after Facial Nerve-preserving Surgery for Vestibular Schwannomas. J Korean Med Sci 2021; 36:e102. [PMID: 33904259 PMCID: PMC8076845 DOI: 10.3346/jkms.2021.36.e102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Intended subtotal resection (STR) followed by adjuvant gamma knife radiosurgery (GKRS) has emerged as an effective treatment option for facial nerve (FN) preservation in vestibular schwannomas (VSs). This study aimed to identify the optimal cut-off volume of residual VS to predict favorable outcomes in terms of both tumor control and FN preservation. METHODS This retrospective study assessed the patients who underwent adjuvant GKRS for residual VS after microsurgery. A total of 68 patients who had been followed up for ≥ 24 months after GKRS were included. Tumor progression was defined as an increase in tumor volume (TV) of ≥ 20%. House-Brackmann grades I and II were considered to indicate good FN function. RESULTS The median residual TV was 2.5 cm³ (range: 0.3-27.4). The median follow-up period after the first adjuvant GKRS was 64 months (range: 25.7-152.4). Eight (12%) patients showed tumor progression. In multivariate analyses, residual TV was associated with tumor progression (P = 0.003; hazard ratio [HR], 1.229; 95% confidence interval [CI], 1.075-1.405). A residual TV of 6.4 cm³ was identified as the cut-off volume for showing the greatest difference in progression-free survival (PFS). The 5-year PFS rates in the group with residual TVs of < 6.4 cm³ (54 patients) and that with residual TVs of ≥ 6.4 cm³ (14 patients) were 93.3% and 69.3%, respectively (P = 0.014). A good FN outcome was achieved in 57 (84%) patients. Residual TV was not associated with good FN function during the immediate postoperative period (P = 0.695; odds ratio [OR], 1.024; 95% CI, 0.908-1.156) or at the last follow-up (P = 0.755; OR, 0.980; 95% CI, 0.866-1.110). CONCLUSION In this study, residual TV was associated with tumor progression in VS after adjuvant GKRS following STR. As preservation of FN function is not correlated with the extent of resection, optimal volume reduction is imperative to achieve long-term tumor control. Our findings will help surgeons predict the prognosis of residual VS after FN-preserving surgery.
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Affiliation(s)
- Won Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Sun Cho
- Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Postural Sway Predicts Growth in Untreated Vestibular Schwannoma: A Retrospective Volumetric Study. Otol Neurotol 2021; 42:e495-e502. [PMID: 33443976 DOI: 10.1097/mao.0000000000003032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One in three vestibular schwannomas (VS) will grow within 3 years after diagnosis, but no reliable baseline parameter has been found to predict such growth. OBJECTIVE To determine if postural sway is associated with growth of untreated VS. METHODS Patients with newly diagnosed sporadic VS assigned to a wait-and-scan protocol were identified from a prospectively maintained database. Postural sway was measured by posturography at baseline and patients were classified as steady or unsteady. Observer-blinded volumetric tumor measurements were performed on the diagnostic MRI and a 3-year control MRI. Tumor growth quantified as relative growth (%) and volume-doubling time (VDT and VDT-1) were investigated as dependent variables against baseline parameters. RESULTS Out of 204 VS patients, 53 (26%) were classified as unsteady on the platform at baseline. Median tumor volume was 0.32 cm3 (range 0.02-4.79), and 51% demonstrated significant growth within 3 years. Unsteady patients had significantly faster-growing tumors, with a mean relative growth of 172.5% compared to 79.5% in steady patients (p < 0.006). Seventy-seven percent of unsteady patients had >20% volume increase, compared to 42% in steady patients (p < 0.001). Mean VDT-1 was 0.65 doublings per year for unsteady patients, and 0.22 for steady patients (p < 0.001). Multivariate regression analysis including demographic and clinical parameters showed an OR of 5.6 (95% CI 2.6, 11.8) for growth in unsteady patients. CONCLUSIONS This is the first demonstrated association between a measurable parameter and future growth in untreated VS. Our findings may help clinicians identify patients with a higher risk for tumor growth and provide closer monitoring or early treatment.
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Park HH, Park SH, Oh HC, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK. The behavior of residual tumors following incomplete surgical resection for vestibular schwannomas. Sci Rep 2021; 11:4665. [PMID: 33633337 PMCID: PMC7907355 DOI: 10.1038/s41598-021-84319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/15/2021] [Indexed: 11/09/2022] Open
Abstract
The management of vestibular schwannoma (VS) with residual tumor following incomplete resection remains controversial and little is known regarding postoperative tumor volume changes. The behavior of residual tumors was analyzed for 111 patients who underwent surgery for newly diagnosed VS between September 2006 and July 2017. The postoperative tumor volume changes were assessed during a mean follow-up of 69 months (range 36–147 months). Fifty-three patients underwent imaging surveillance following incomplete resection. There was no residual tumor growth in 44 patients (83%). A significant regression of residual tumor volume was noted in the no growth group at postoperative 1 year (p = 0.028), 2 years (p = 0.012), but not from 3 years onwards. Significant predictors of regrowth were immediate postoperative tumor volume ≥ 0.7 cm3 (HR 10.5, p = 0.020) and residual tumor location other than the internal auditory canal (IAC) (HR 6.2, p = 0.026). The mean time to regrowth was 33 months (range 5–127 months). The 2-, 5-, and 10-year regrowth-free survival rates were 90.6%, 86.8%, and 83%, respectively. In conclusion, significant residual tumor regression could occur within 2 years for a VS with an immediate postoperative tumor volume less than 0.7 cm3 or residual tumor in IAC.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyun-Ho Jung
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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Teyateeti A, Graffeo CS, Perry A, Tryggestad EJ, Brown PD, Pollock BE, Link MJ. The Effect of Prescription Isodose Variation on Tumor Control and Toxicities in Stereotactic Radiosurgery for Sporadic Vestibular Schwannoma: Propensity Score-Matched Case–Control Study. Skull Base Surg 2021; 83:193-202. [DOI: 10.1055/s-0040-1718908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/03/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objective Vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (SRS) was typically performed at 50% isodose line (IDL50); however, the impact of IDL variation on outcomes is poorly understood. This study aimed to compare tumor control (TC) and toxicities between treatment at 40% (IDL40) and 50% (IDL50).
Methods Sporadic/unilateral VS patients treated with SRS dose 12 to 14 Gy and prescription isodose volume ≤10cm3 were included. Propensity score matching was applied to IDL40 cohort to generate an IDL50 companion cohort, adjusting for age and prescription isodose volume. After exclusion of patients with follow-up <24 months, there were 30 and 28 patients in IDL40 and IDL50 cohorts, respectively.
Results Median follow-up time was 96 months (24–225 months). Actuarial and radiographic TC rates were 91.8% and clinical TC was 96.2% both at 5 and 10 years. TC was higher in IDL40 cohort but not significant (96.4 vs. 86.7%; p = 0.243). Hearing preservation (HP) rates were 71.9 and 39.2% at 5- and 10-year intervals, with significantly higher rates of HP noted in IDL40 cohort (83.3 vs. 57.1% at 5-year interval; 62.5 vs. 11.4% at 10-year interval; p = 0.017). Permanent facial neuropathy occurred in two patients, both from the IDL50 cohort (3.5%). Rates of post-SRS steroid treatment or shunt placement for hydrocephalus were slightly higher in IDL50 patients (6.9 vs. 17.9%; p = 0.208 and 3.3 vs. 7.1%; p = 0.532).
Conclusion For treatment of VS with SRS, dose prescription at IDL40 or IDL50 provides excellent long-term TC and toxicity profiles. IDL40 may be associated with improved long-term HP.
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Affiliation(s)
- Achiraya Teyateeti
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States
- Department of Radiology, Division of Radiation Oncology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Eric J. Tryggestad
- Department of Radiation Physics, Mayo Clinic, Rochester, Minnesota, United States
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States
| | - Bruce E. Pollock
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Oft D, Schmidt MA, Weissmann T, Roesch J, Mengling V, Masitho S, Bert C, Lettmaier S, Frey B, Distel LV, Fietkau R, Putz F. Volumetric Regression in Brain Metastases After Stereotactic Radiotherapy: Time Course, Predictors, and Significance. Front Oncol 2021; 10:590980. [PMID: 33489888 PMCID: PMC7820888 DOI: 10.3389/fonc.2020.590980] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background There is insufficient understanding of the natural course of volumetric regression in brain metastases after stereotactic radiotherapy (SRT) and optimal volumetric criteria for the assessment of response and progression in radiotherapy clinical trials for brain metastases are currently unknown. Methods Volumetric analysis via whole-tumor segmentation in contrast-enhanced 1 mm³-isotropic T1-Mprage sequences before SRT and during follow-up. A total of 3,145 MRI studies of 419 brain metastases from 189 patients were segmented. Progression was defined using a volumetric extension of the RANO-BM criteria. A subset of 205 metastases without progression/radionecrosis during their entire follow-up of at least 3 months was used to study the natural course of volumetric regression after SRT. Predictors for volumetric regression were investigated. A second subset of 179 metastases was used to investigate the prognostic significance of volumetric response at 3 months (defined as ≥20% and ≥65% volume reduction, respectively) for subsequent local control. Results Median relative metastasis volume post-SRT was 66.9% at 6 weeks, 38.6% at 3 months, 17.7% at 6 months, 2.7% at 12 months and 0.0% at 24 months. Radioresistant histology and FSRT vs. SRS were associated with reduced tumor regression for all time points. In multivariate linear regression, radiosensitive histology (p=0.006) was the only significant predictor for metastasis regression at 3 months. Volumetric regression ≥20% at 3 months post-SRT was the only significant prognostic factor for subsequent control in multivariate analysis (HR 0.63, p=0.023), whereas regression ≥65% was no significant predictor. Conclusions Volumetric regression post-SRT does not occur at a constant rate but is most pronounced in the first 6 weeks to 3 months. Despite decreasing over time, volumetric regression continues beyond 6 months post-radiotherapy and may lead to complete resolution of controlled lesions by 24 months. Radioresistant histology is associated with slower regression. We found that a cutoff of ≥20% regression for the volumetric definition of response at 3 months post-SRT was predictive for subsequent control whereas the currently proposed definition of ≥65% was not. These results have implications for standardized volumetric criteria in future radiotherapy trials for brain metastases.
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Affiliation(s)
- Dominik Oft
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manuel Alexander Schmidt
- Department of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Roesch
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Veit Mengling
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Siti Masitho
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Luitpold Valentin Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Trau G, Venkatasamy A, Charpiot A. Vestibular schwannomas with spontaneous shrinkage: about 35 cases. Eur Arch Otorhinolaryngol 2021; 278:4235-4241. [PMID: 33388984 DOI: 10.1007/s00405-020-06530-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
PURPOSES The first aim is to describe the epidemiological, clinical, and radiological characteristics of regressive vestibular schwannomas (VS), based on volumetric measurements on MRI to define which regressions are significant. The secondary aim is to look for a correlation between a shrinkage of the tumor and the medical history, and the presence of clinical symptoms. METHODS We first selected all patients presenting with a VS who underwent two or more MRI of the internal auditory canal on the same 3 T MRI machine retrospectively between January 2013 and June 2018. All MRI images were evaluated independently by two radiologists. The volumetric analysis was performed contrast-enhanced 2D spin-echo T1-weighted sequence and expressed in cubic centimeters. RESULTS Thirty-five patients presented with a regressive VS on MRI (14%). The annual mean shrinkage rate was 0.08 cm3/year. Eighty percent of the patients present both a shrinkage by more than 0.01 cm3/year and a decrease of the initial tumor volume by more than 20%. The majority of patients are asymptomatic or presented moderate balance disorders, which remained stable or improved over time. Tinnitus was observed in 47% and was stable or improved in the majority of cases and the mean annual mean hearing loss was by < or = 4 dB/year. CONCLUSION Out of 247 VS, 14% decreased using follow-up (by > or = 2 MRI), and a spontaneous shrinkage greater than 0.01 cm3/year and greater than 20% could be considered significant.
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Affiliation(s)
- Guillaume Trau
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, 1 Avenue Molière, Strasbourg, France.
| | - Aïna Venkatasamy
- Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Anne Charpiot
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, 1 Avenue Molière, Strasbourg, France
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Shapey J, Wang G, Dorent R, Dimitriadis A, Li W, Paddick I, Kitchen N, Bisdas S, Saeed SR, Ourselin S, Bradford R, Vercauteren T. An artificial intelligence framework for automatic segmentation and volumetry of vestibular schwannomas from contrast-enhanced T1-weighted and high-resolution T2-weighted MRI. J Neurosurg 2021; 134:171-179. [PMID: 31812137 DOI: 10.3171/2019.9.jns191949] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Automatic segmentation of vestibular schwannomas (VSs) from MRI could significantly improve clinical workflow and assist in patient management. Accurate tumor segmentation and volumetric measurements provide the best indicators to detect subtle VS growth, but current techniques are labor intensive and dedicated software is not readily available within the clinical setting. The authors aim to develop a novel artificial intelligence (AI) framework to be embedded in the clinical routine for automatic delineation and volumetry of VS. METHODS Imaging data (contrast-enhanced T1-weighted [ceT1] and high-resolution T2-weighted [hrT2] MR images) from all patients meeting the study's inclusion/exclusion criteria who had a single sporadic VS treated with Gamma Knife stereotactic radiosurgery were used to create a model. The authors developed a novel AI framework based on a 2.5D convolutional neural network (CNN) to exploit the different in-plane and through-plane resolutions encountered in standard clinical imaging protocols. They used a computational attention module to enable the CNN to focus on the small VS target and propose a supervision on the attention map for more accurate segmentation. The manually segmented target tumor volume (also tested for interobserver variability) was used as the ground truth for training and evaluation of the CNN. We quantitatively measured the Dice score, average symmetric surface distance (ASSD), and relative volume error (RVE) of the automatic segmentation results in comparison to manual segmentations to assess the model's accuracy. RESULTS Imaging data from all eligible patients (n = 243) were randomly split into 3 nonoverlapping groups for training (n = 177), hyperparameter tuning (n = 20), and testing (n = 46). Dice, ASSD, and RVE scores were measured on the testing set for the respective input data types as follows: ceT1 93.43%, 0.203 mm, 6.96%; hrT2 88.25%, 0.416 mm, 9.77%; combined ceT1/hrT2 93.68%, 0.199 mm, 7.03%. Given a margin of 5% for the Dice score, the automated method was shown to achieve statistically equivalent performance in comparison to an annotator using ceT1 images alone (p = 4e-13) and combined ceT1/hrT2 images (p = 7e-18) as inputs. CONCLUSIONS The authors developed a robust AI framework for automatically delineating and calculating VS tumor volume and have achieved excellent results, equivalent to those achieved by an independent human annotator. This promising AI technology has the potential to improve the management of patients with VS and potentially other brain tumors.
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Affiliation(s)
- Jonathan Shapey
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Guotai Wang
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
- 4School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Reuben Dorent
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Alexis Dimitriadis
- 6Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London
| | - Wenqi Li
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Ian Paddick
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Neil Kitchen
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Sotirios Bisdas
- 6Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London
| | - Shakeel R Saeed
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 7The Ear Institute, University College London; and
- 8The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Sebastien Ourselin
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Robert Bradford
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Tom Vercauteren
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
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Patel EJ, Deep NL, Schecht M, Hagiwara M, Roland JT. Tracking Spontaneous Vestibular Schwannoma Regression with Volumetric Measurements. Laryngoscope 2020; 131:E1647-E1652. [PMID: 33103767 DOI: 10.1002/lary.29201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To characterize a series of patients with MRI evidence of spontaneous vestibular schwannoma (VS) regression. STUDY DESIGN Retrospective case series. METHODS Retrospective review between 2012 and 2020 from a single, tertiary-care center of all patients with an untreated, sporadic VS and spontaneous regression in volumetric tumor size over the course of observation. The main outcome measures included VS size and location, presenting symptoms, medication use, changes in pure-tone averages and word recognition scores. RESULTS The 13 treatment-naïve patients (62% female, mean age 67.1 years) with spontaneous VS regression represented 3.9% of all patients undergoing observation with serial imaging during the study period. Median tumor size from initial MRI was 529.0 mm3 (range: 108 mm3 -13,180 mm3 ). The mean interval between MRI measurements was 5.5 years (SD 4.4 years). The average percent decrease in tumor size was 36.1% (SD 21.9%) and the average rate of volume decrease was 15.8 mm3 /yr (SD 25.4 mm3 /yr). Five patients were classified as having major regression, defined by a relative decrease in volume of >40%, while eight patients had minor regression (<40% relative volume reduction). No significant differences in initial tumor size, rate of regression, or audiometric changes were observed between the major and minor regression cohorts. CONCLUSIONS Patients with evidence of a spontaneously shrinking VS have a heterogeneous presentation. Due to the scarcity of this phenomenon, predicting which tumors will eventually undergo regression remains unclear. Employing volumetric measurements to compare serial MRI scans may improve the accuracy of detecting shrinking tumors. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1647-E1652, 2021.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Michael Schecht
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - Mari Hagiwara
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - John T Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
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Schnurman Z, Nakamura A, McQuinn MW, Golfinos JG, Roland JT, Kondziolka D. Volumetric growth rates of untreated vestibular schwannomas. J Neurosurg 2020; 133:742-748. [PMID: 31374553 DOI: 10.3171/2019.5.jns1923] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There remains a large discrepancy among surgeons in expectations of vestibular schwannoma (VS) growth. The anticipated growth rate of a VS and its potential clinical impact are important factors when deciding whether to observe the lesion over time or to intervene. Previous studies of VS natural growth remain limited, mostly confined to linear measurements, often without high-resolution, thin-sequence imaging. The present study comprehensively assessed natural tumor growth rates using volumetric measurements. METHODS Between 2012 and 2018, 212 treatment-naïve patients diagnosed with a unilateral VS were evaluated. A total of 699 MR images were assessed, with a range of 2-11 MR images per patient. All MR images preceded any intervention, with patients subsequently being observed through completion of data analysis (36%) or treated with stereotactic radiosurgery (32%) or microsurgical resection (32%). To determine precise tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (99% of scans were ≤ 1-mm slice thickness). A multilevel model with random effects was used to assess the mean volume change over time. Each tumor was categorized as one of the following: growing (volume increase by more than 20% per year), fast growing (volume increase by more than 100% per year), stable (volume change between 20% decrease and 20% increase per year), and shrinking (volume decrease by more than 20% per year). RESULTS The mean VS volumetric growth rate was 33.5% per year (95% CI 26.9%-40.5%, p < 0.001). When assessing the frequencies of individual tumor annual growth rates, 66% demonstrated growth (30% fast growing), 33% were stable, and 1% exhibited shrinking over an average interval of 25 months. Larger tumors were associated with increased absolute growth, but there was no relationship between tumor size and proportional growth rate. There was also no relationship between patient age and tumor growth rate. CONCLUSIONS This study comprehensively assessed VS volumetric growth rates using high-resolution images and was conducted in a large and diverse patient sample. The majority of the tumors exhibited growth, with about one-third growing at a rate of 100% per year. These findings may contribute to a consensus understanding of tumor behavior and inform clinical decisions regarding whether to intervene or observe.
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Affiliation(s)
| | | | | | | | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
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McGrath H, Li P, Dorent R, Bradford R, Saeed S, Bisdas S, Ourselin S, Shapey J, Vercauteren T. Manual segmentation versus semi-automated segmentation for quantifying vestibular schwannoma volume on MRI. Int J Comput Assist Radiol Surg 2020; 15:1445-1455. [PMID: 32676869 PMCID: PMC7419453 DOI: 10.1007/s11548-020-02222-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022]
Abstract
Purpose Management of vestibular schwannoma (VS) is based on tumour size as observed on T1 MRI scans with contrast agent injection. The current clinical practice is to measure the diameter of the tumour in its largest dimension. It has been shown that volumetric measurement is more accurate and more reliable as a measure of VS size. The reference approach to achieve such volumetry is to manually segment the tumour, which is a time intensive task. We suggest that semi-automated segmentation may be a clinically applicable solution to this problem and that it could replace linear measurements as the clinical standard. Methods Using high-quality software available for academic purposes, we ran a comparative study of manual versus semi-automated segmentation of VS on MRI with 5 clinicians and scientists. We gathered both quantitative and qualitative data to compare the two approaches; including segmentation time, segmentation effort and segmentation accuracy. Results We found that the selected semi-automated segmentation approach is significantly faster (167 s vs 479 s, \documentclass[12pt]{minimal}
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\begin{document}$$p<0.001$$\end{document}p<0.001), less temporally and physically demanding and has approximately equal performance when compared with manual segmentation, with some improvements in accuracy. There were some limitations, including algorithmic unpredictability and error, which produced more frustration and increased mental effort in comparison with manual segmentation. Conclusion We suggest that semi-automated segmentation could be applied clinically for volumetric measurement of VS on MRI. In future, the generic software could be refined for use specifically for VS segmentation, thereby improving accuracy. Electronic supplementary material The online version of this article (10.1007/s11548-020-02222-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hari McGrath
- GKT School of Medical Education, King's College London, London, UK.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Peichao Li
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reuben Dorent
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Robert Bradford
- Queen Square Radiosurgery Centre (Gamma Knife), National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Shakeel Saeed
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- The Ear Institute, UCL, London, UK
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - Sotirios Bisdas
- Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, UCL, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Tran S, Killeen DE, Qazi S, Balachandra S, Hunter JB. Association of Metformin With the Growth of Vestibular Schwannomas. Otolaryngol Head Neck Surg 2020; 164:182-187. [DOI: 10.1177/0194599820937970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess whether medication use, specifically statin, metformin, and aspirin, affects the growth of vestibular schwannomas (VSs). Study Design Retrospective case series. Setting Single tertiary care academic hospital. Subjects and Methods Patients were enrolled if they were diagnosed with sporadic VS and had at least 2 magnetic resonance imaging (MRI) studies at a minimum of 6 months apart prior to any intervention. Electronic medical records were reviewed for demographic and medication data. Tumor volumes on MRI studies were assessed via BrainLab iPlan. The primary endpoint was VS tumor growth, defined as a 20% increase in tumor volume, between consecutive MRI studies or between the first and last available MRI study. Predictors of volumetric growth, specifically statin, aspirin, or metformin use, were analyzed with t tests, chi-square test, univariate logistic regression, and multivariate logistic regression. Results A total of 387 patients met inclusion criteria, 53.5% of whom were women. For all patients, the mean age was 60.6 years (range, 18.2-89.2 years); the mean axial tumor diameter, 11.9 mm (range, 1.7-32.0 mm); and the mean tumor volume, 0.85 cm3 (range, 0.01-13.1 cm3). In review of the electronic medical record, 46 patients (11.9%) were taking metformin; 145 (37.5%), a statin; and 117 (30.2%), aspirin. Among patients taking metformin, 39.1% (18/46) exhibited volumetric growth, as opposed to 58.2% (198/340) of nonusers ( P = .014). Metformin (odds ratio, 0.497; P = .036) is significantly associated with reduced VS growth when controlling for aspirin, statin, and tumor size on multivariate logistic regression. Conclusion Metformin use is associated with reduced volumetric VS growth.
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Affiliation(s)
- Sophia Tran
- University of Texas System, Austin, Texas, USA
| | - Daniel E. Killeen
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Jacob B. Hunter
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Anton-Rodriguez JM, Lewis D, Djoukhadar I, Russell D, Julyan P, Coope D, King AT, Lloyd SKL, Evans DG, Jackson A, Matthews JC. [18F]fluorothymidine and [18F]fluorodeoxyglucose PET Imaging Demonstrates Uptake and Differentiates Growth in Neurofibromatosis 2 Related Vestibular Schwannoma. Otol Neurotol 2020; 40:826-835. [PMID: 31033921 PMCID: PMC6594723 DOI: 10.1097/mao.0000000000002272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text Objective: To investigate whether [18F]fluorothymidine (FLT) and/or [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate growth in neurofibromatosis 2 (NF2) related vestibular schwannomas (VS) and to evaluate the importance of PET scanner spatial resolution on measured tumor uptake. Methods: Six NF2 patients with 11 VS (4 rapidly growing, 7 indolent), were scanned with FLT and FDG using a high-resolution research tomograph (HRRT, Siemens) and a Siemens Biograph TrueV PET-CT, with and without resolution modeling image reconstruction. Mean, maximum, and peak standardised uptake values (SUV) for each tumor were derived and the intertumor correlation between FDG and FLT uptake was compared. The ability of FDG and FLT SUV values to discriminate between rapidly growing and slow growing (indolent) tumors was assessed using receiver operator characteristic (ROC) analysis. Results: Tumor uptake was seen with both tracers, using both scanners, with and without resolution modeling. FDG and FLT uptake was correlated (R2 = 0.67–0.86, p < 0.01) and rapidly growing tumors displayed significantly higher uptake (SUVmean and SUVpeak) of both tracers (p < 0.05, one tailed t test). All of the PET analyses performed demonstrated better discriminatory power (AUCROC range = 0.71–0.86) than tumor size alone (AUCROC = 0.61). The use of standard resolution scanner with standard reconstruction did not result in a notable deterioration of discrimination accuracy. Conclusion: NF2 related VS demonstrate uptake of both FLT and FDG, which is significantly increased in rapidly growing tumors. A short static FDG PET scan with standard clinical resolution and reconstruction can provide relevant information on tumor growth to aid clinical decision making.
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Affiliation(s)
- Jose M Anton-Rodriguez
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester
| | - Daniel Lewis
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Manchester Skull Base Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust
| | - Ibrahim Djoukhadar
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - David Russell
- Department of Radiology, Manchester University NHS Foundation Trust
| | - Peter Julyan
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester
| | - David Coope
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Manchester Skull Base Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust
| | - Andrew T King
- Manchester Skull Base Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust
| | - Simon K L Lloyd
- Manchester Skull Base Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals National Health Service Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Alan Jackson
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester
| | - Julian C Matthews
- Division of Informatics, Imaging and Data Sciences, MAHSC, University of Manchester.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester
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George-Jones NA, Wang K, Wang J, Hunter JB. Automated Detection of Vestibular Schwannoma Growth Using a Two-Dimensional U-Net Convolutional Neural Network. Laryngoscope 2020; 131:E619-E624. [PMID: 32304338 DOI: 10.1002/lary.28695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if an automated vestibular schwannoma (VS) segmentation model has comparable performance to using the greatest linear dimension to detect growth. STUDY DESIGN Case-control Study. METHODS Patients were selected from an internal database who had an initial gadolinium-enhanced T1-weighted magnetic resonance imaging scan and a follow-up scan captured at least 5 months later. Two observers manually segmented the VS to compute volumes, and one observer's segmentations were used to train a convolutional neural network model to automatically segment the VS and determine the volume. The results of automatic segmentation were compared to the observer whose measurements were not used in model development to measure agreement. We then examined the sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) to compare automated volumetric growth detection versus using the greatest linear dimension. Growth detection determined by the external observer's measurements served as the gold standard. RESULTS A total of 65 patients and 130 scans were studied. The automated method of segmentation demonstrated excellent agreement with the observer whose measurements were not used for model development for the initial scan (interclass correlational coefficient [ICC] = 0.995; 95% confidence interval [CI]: 0.991-0.997) and follow-up scan (ICC = 0.960; 95% CI: 0.935-0.975). The automated method of segmentation demonstrated increased sensitivity (72.2% vs. 63.9%), specificity (79.3% vs. 69.0%), and AUC (0.822 vs. 0.701) compared to using the greatest linear dimension for growth detection. CONCLUSIONS In detecting VS growth, a convolutional neural network model outperformed using the greatest linear dimension, demonstrating a potential application of artificial intelligence methods to VS surveillance. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E619-E624, 2021.
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Affiliation(s)
- Nicholas A George-Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kai Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Paragangliomas of the Head and Neck: Local Control and Functional Outcome Following Fractionated Stereotactic Radiotherapy. Am J Clin Oncol 2020; 42:818-823. [PMID: 31592806 DOI: 10.1097/coc.0000000000000614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate local control and functional outcome following state-of-the-art fractionated stereotactic radiotherapy (FSRT) for paragangliomas of the head and neck. METHODS In total, 40 consecutive patients with paragangliomas of the head and neck received conventionally FSRT from 2003 to 2016 at the Department of Radiation Oncology of the University Hospital Erlangen. Local control, toxicities, and functional outcome were examined during follow-up. In total, 148 magnetic resonance imaging studies were subjected to longitudinal volumetric analysis using whole tumor segmentation in a subset of 22 patients. RESULTS A total of 80.0% (32/40) of patients received radiotherapy as part of their primary treatment. In 20.0% (8/40) of patients, radiation was used as salvage treatment after tumor recurrence in patients initially treated with surgery alone. The median dose applied was 54.0 Gy (interdecile range, 50.4 to 56.0 Gy) in single doses of 1.8 or 2 Gy. Local control was 100% after a median imaging follow-up of 52.2 months (range, 0.8 to 152.9 mo). The volumetric analysis confirmed sustained tumor control in a subset of 22 patients and showed transient enlargement (range, 129.6% to 151.2%) in 13.6% of cases (3/22). After a median volumetric follow-up of 24.6 months mean tumor volume had diminished to 86.1% compared with initial volume. In total, 52.5% (21/40) of patients reported improved symptoms after radiotherapy, 40% (16/40) observed no subjective change with only 7.5% (3/40) reporting significant worsening. CONCLUSIONS State-of-the-art FSRT provides excellent control and favorable functional outcome in patients with paragangliomas of the head and neck. The volumetric analysis provides improved evidence for sustained tumor control.
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Patel NS, Huang AE, Dowling EM, Lees KA, Tombers NM, Lohse CM, Marinelli JP, Van Gompel JJ, Neff BA, Driscoll CLW, Link MJ, Carlson ML. The Influence of Vestibular Schwannoma Tumor Volume and Growth on Hearing Loss. Otolaryngol Head Neck Surg 2020; 162:530-537. [PMID: 31986971 DOI: 10.1177/0194599819900396] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To ascertain the relationship among vestibular schwannoma (VS) tumor volume, growth, and hearing loss. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary center. SUBJECTS AND METHODS Adults with observed VS and serviceable hearing at diagnosis were included. The primary outcome was the development of nonserviceable hearing as estimated using the Kaplan-Meier method. Associations of tumor volume with baseline hearing were assessed using Spearman rank correlation coefficients. Associations of volume and growth with the development of nonserviceable hearing over time were assessed using Cox proportional hazards models and summarized with hazard ratios (HRs). RESULTS Of 230 patients with VS and serviceable hearing at diagnosis, 213 had serial volumetric tumor data for analysis. Larger tumor volume at diagnosis was associated with increased pure-tone average (PTA) (P < .001) and decreased word recognition score (WRS) (P = .014). Estimated rates of maintaining serviceable hearing at 6 and 10 years following diagnosis were 67% and 49%, respectively. Larger initial tumor volume was associated with development of nonserviceable hearing in a univariable setting (HR for 1-cm3 increase: 1.36, P = .040) but not after adjusting for PTA and WRS. Tumor growth was not significantly associated with time to nonserviceable hearing (HR, 1.57; P = .14), although estimated rates of maintaining serviceable hearing during observation were poorer in the group that experienced growth. CONCLUSION Larger initial VS tumor volume was associated with poorer hearing at baseline. Larger initial tumor volume was also associated with the development of nonserviceable hearing during observation in a univariable setting; however, this association was not statistically significant after adjusting for baseline hearing status.
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Affiliation(s)
- Neil S Patel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice E Huang
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Langenhuizen PPJH, Zinger S, Hanssens PEJ, Kunst HPM, Mulder JJS, Leenstra S, de With PHN, Verheul JB. Influence of pretreatment growth rate on Gamma Knife treatment response for vestibular schwannoma: a volumetric analysis. J Neurosurg 2019; 131:1405-1412. [PMID: 30497177 DOI: 10.3171/2018.6.jns18516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to gain insight into the influence of the pretreatment growth rate on the volumetric tumor response and tumor control rates after Gamma Knife radiosurgery (GKRS) for incidental vestibular schwannoma (VS). METHODS All patients treated with GKRS at the Gamma Knife Center, ETZ Hospital, who exhibited a confirmed radiological progression of their VS after an initial observation period were included. Pre- and posttreatment MRI scans were volumetrically evaluated, and the volume doubling times (VDTs) prior to treatment were calculated. Posttreatment volumes were used to create an objective mathematical failure definition: 2 consecutive significant increases in tumor volume among 3 consecutive follow-up MRI scans. Spearman correlation, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis were used to determine the influence of the VDT on the volumetric treatment response. RESULTS The resulting patient cohort contained 311 patients in whom the VDT was calculated. This cohort had a median follow-up time of 60 months after GKRS. Of these 311 patients, 35 experienced loss of tumor control after GKRS. The pretreatment growth rate and the relative volume changes, calculated at 6 months and 1, 2, and 3 years following treatment, showed no statistically significant correlation. Kaplan-Meier analysis revealed that slow-growing tumors, with a VDT equal to or longer than the median VDT of 15 months, had calculated 5- and 10-year control rates of 97.3% and 86.0%, respectively, whereas fast-growing tumors, with a VDT less than the median growth rate, had control rates of 85.5% and 67.6%, respectively (log-rank, p = 0.001). The influence of the VDT on tumor control was also determined by employing the Cox regression analysis. The resulting model presented a significant (p = 0.045) effect of the VDT on the hazard rates of loss of tumor control. CONCLUSIONS By employing a unique, large database with long follow-up times, the authors were able to accurately investigate the influence of the pretreatment VS growth rate on the volumetric GKRS treatment response. The authors have found a predictive model that illustrates the negative influence of the pretreatment VS growth rate on the efficacy of radiosurgery treatment. The resulting tumor control rates confirm the high efficacy of GKRS for slow-growing VS. However, fast-growing tumors showed significantly lower control rates. For these cases, different treatment strategies may be considered.
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Affiliation(s)
- Patrick P J H Langenhuizen
- 1Gamma Knife Center Tilburg, Department of Neurosurgery, ETZ Hospital, Tilburg
- 2Eindhoven University of Technology, Eindhoven
| | | | | | - Henricus P M Kunst
- 3Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen; and
| | - Jef J S Mulder
- 3Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen; and
| | - Sieger Leenstra
- 4Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jeroen B Verheul
- 1Gamma Knife Center Tilburg, Department of Neurosurgery, ETZ Hospital, Tilburg
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