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Morgan J, Manickavel S, Sorace A, Hartman Y, Eli A, Massicano A, Gonzalez ML, Warram JM, Walsh E. Utility of Targeted Positron Emission Tomography Imaging to Predict Schwannoma Growth in a Murine Tumor Model. Laryngoscope 2024; 134:1372-1380. [PMID: 37578272 DOI: 10.1002/lary.30943] [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: 01/24/2023] [Revised: 05/31/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To identify if targeted positron emission tomography (PET) imaging with radiolabeled antibodies can predict tumor growth rate and ultimate tumor size in a murine flank schwannoma model. STUDY DESIGN Animal research study. METHODS Rat schwannoma cells were cultured and implanted into 40 athymic nude mice. Once tumors reached 5 mm in diameter, 30 mice were injected with zirconium-89 labeled antibodies (HER2/Neu, vascular endothelial growth factor receptor 2 (VEGFR2), or IgG isotype). PET/CT was performed, and standardized uptake values (SUV) were recorded. Tumors were serially measured until mice were sacrificed per IACUC protocol. Statistical analysis was performed to measure correlations between SUV values, tumor size, and growth. RESULTS Mean tumor sizes in mm3 on Day 0 were 144 ± 162 for anti-HER2/Neu, 212 ± 247 for anti-VEGFR2, and 172 ± 204 for IgG isotype groups respectively. Mean growth rates in mm3 /day were 531 ± 250 for HER2, 584 ± 188 for VEGFR2, and 416 ± 163 for the IgG isotype group. For both initial tumor size and growth rates, there was no significant difference between groups. There were significant correlations between maximum tumor volume and both the SUV max in the HER2 group (p = 0.0218, R2 = 0.5020), and we observed significant correlations between growth rate, and SUV values (p = 0.0156, R2 = 0.5394). Respectively, in the anti-VEGFR2 group, there were no significant correlations. CONCLUSION In a murine schwannoma model, immunotargeted PET imaging with anti-HER2/Neu antibodies predicted tumor growth rate and final tumor size. Laryngoscope, 134:1372-1380, 2024.
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Affiliation(s)
- Jake Morgan
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sudhir Manickavel
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anna Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yolanda Hartman
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abbigael Eli
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adriana Massicano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Manuel Lora Gonzalez
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erika Walsh
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Nilsen KS, Nordahl SHG, Berge JE, Dhayalan D, Goplen FK. Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma. Otolaryngol Head Neck Surg 2023; 169:1268-1275. [PMID: 37337472 DOI: 10.1002/ohn.399] [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: 02/24/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. STUDY DESIGN National cross-sectional study. SETTING Tertiary university clinic. METHODS Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. RESULTS The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. CONCLUSION The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.
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Affiliation(s)
- Kathrin Skorpa Nilsen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Jan Erik Berge
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Dhanushan Dhayalan
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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Tian L, Chen Z, Wang J, Zhang L, Zhao H, Chi F, Wang J. High frequency hearing loss may act as a screening index evaluating otolith function in vertigo patients with normal semi-circular canal function. Front Neurol 2022; 13:978490. [PMID: 36062007 PMCID: PMC9437537 DOI: 10.3389/fneur.2022.978490] [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] [Received: 06/26/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate whether otolith dysfunction is related to hearing impairment in vertigo patients with normal semicircular canal function, and to clarify the types of hearing impairment that may be related to otolith organ damage.MethodsThe demographic data, pure tone threshold audiometry (PTA) results (air-conduction), data of bithermal and video-head impulse test (vHIT), and vestibular evoked myogenic potential (VEMP) results (reaction threshold, P1–N1 amplitude) of patients with vertigo in outpatient clinic from April 2017 to January 2020 were collected. The clinical records of 51 vertigo patients with normal semicircular canal function were included in this study. Low-frequency, speech-frequency, high-frequency, full-frequency PTA were defined as the average of PTA in different frequency bands, respectively (low: 0.125, 0.25, 0.5 kHz; speech: 0.5, 1, 2 kHz, high: 4, 8 kHz, full 0.125–8 kHz). The correlations between hearing impairment in different frequency bands and otolith function impairment were analyzed.ResultsThe mean thresholds of 51 patients (102 ears) in low-PTA, speech-PTA, high-PTA, full-PTA were 20.95 ± 6.01, 21.92 ± 6.90, 40.12 ± 17.47, 26.97 ± 8.53 dB nHL, respectively. Among 102 ears, 87 ears (85.3%) could elicit c-VEMP waveforms and 65 ears (63.7%) had o-VEMP waveforms. The mean threshold and P1–N1 amplitude of c-VEMP were 83.10 ± 6.96 dB nHL and 176.79 ± 103.10 uV, while those of o-VEMP were 87.92 ± 5.99 dB nHL and 21.45 ± 32.22 uV. The mean threshold in high-PTA was significantly linearly correlated with c-VEMP threshold (P = 0.01) and P1–N1 amplitude (P = 0.028). There were not significant linear correlations between the mean threshold in each frequency band of PTA and o-VEMP threshold (low-PTA: P = 0.266, speech-PTA: P = 0.33, high-PTA: P = 0.311) or P1–N1 amplitude (low-PTA: P = 0.414, speech-PTA: P = 0.069, high-PTA: P = 0.08).ConclusionsThere is a positive linear correlation between saccule dysfunction and high-frequency hearing impairment in vertigo patients with normal semi-circular canal function. High frequency hearing loss can be expected in patients who have saccular damage. It suggests that high frequency hearing loss in PTA may act as a screening index that otolith organ function should be comprehensively evaluated.
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Affiliation(s)
- Liang Tian
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Zhongchun Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinyu Wang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Lei Zhang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Hao Zhao
- Department Nuclear Medicine, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
| | - Fanglu Chi
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Jing Wang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
- *Correspondence: Jing Wang
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Evaluation of Vestibular Function in Diagnosis of Vestibular Schwannomas. Curr Med Sci 2021; 41:661-666. [PMID: 34403089 DOI: 10.1007/s11596-021-2407-1] [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: 04/22/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Vestibular schwannomas (VS) are benign tumors of the vestibular nerve. The common first symptoms are hearing loss and tinnitus, followed by imbalance, vertigo, and facial nerve involvement. The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests, which often interfere with clinicians' diagnoses. Thus, the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging (MRI), ignoring the evaluation of vestibular function at the source of pathological lesions. With the development and improvement of vestibular evaluation technology and its wide application in the clinic, modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives, providing an objective basis for the diagnosis and treatment of vestibular diseases. In this report, we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.
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Kiyofuji S, Neff BA, Carlson ML, Driscoll CLW, Link MJ. Large and small vestibular schwannomas: same, yet different tumors. Acta Neurochir (Wien) 2021; 163:2199-2207. [PMID: 33471207 DOI: 10.1007/s00701-021-04705-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vestibular schwannomas (VS) present at variable size with heterogeneous symptomatology. Modern treatment paradigms for large VS include gross total resection, subtotal resection (STR) in combination with observation, and/or radiation to achieve optimal function preservation, whereas treatment is felt to be both easier and safer for small VS. The objective is to better characterize the presentation and surgical outcomes of large and small VS. METHODS We collected data of patients who had surgically treated VS with a posterior fossa diameter of 4.0 cm or larger (large tumor group, LTG) and smaller than 1.0 cm in cisternal diameter (small tumor group, STG). Statistical significance was defined as p < 0.05. RESULTS LTG included 48 patients (average tumor size: 44.9 mm) and STG 38 (7.9 mm). Patients in STG presented more frequently with tinnitus and sudden hearing loss. Patients in LTG underwent more STR than STG (50.0% vs. 2.6%, p < 0.0001). LTG had more complications (31.3% vs. 13.2%, p = 0.049). Postoperative facial nerve function in STG was significantly better than LTG. STG had better hearing preoperatively (p < 0.0001) and postoperatively than LTG (p = 0.0002). Postoperative headache was more common in STG (13.2% vs. 2.1%, p = 0.045). The rate of recurrence/progression needing treatment was not statistically different between the groups (12.5% in LTG vs. 7.9% in STG, p = 0.49). Those patients who required periprocedural cerebrospinal fluid diversion had higher risk of infection (20.8% vs 4.8%, p = 0.022). CONCLUSION Large and small VS present differently. LTG showed more unsatisfactory outcomes in facial nerve function and postoperative hearing despite maximal efforts undertaken toward function-preservation strategy; however, similar tumor control was achieved.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 154-0023, Japan.
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Brian A Neff
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Morrison DR, Sorace AG, Hamilton E, Moore LS, Houson HA, Udayakumar N, Ovaitt A, Warram JM, Walsh EM. Predicting Schwannoma Growth in a Tumor Model Using Targeted Imaging. Otol Neurotol 2021; 42:e615-e623. [PMID: 33661237 PMCID: PMC9762121 DOI: 10.1097/mao.0000000000003063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Vestibular schwannoma (VS) is a common pathology encountered in neurotology clinics. Many patients are observed with a "wait and scan" approach. Previous efforts to determine radiographic indicators of future growth have been unsuccessful. Using a mouse subcutaneous tumor model, we seek to determine if fluorescent imaging with directed immunotargets could be used to predict schwannoma growth rate. METHODS Anti-VEGFR2 and anti-Her2/Neu monoclonal antibodies were covalently linked to a near-infrared probe (IRDye800). Immunodeficient mice underwent subcutaneous injections with a rat-derived schwann (R3) cell line. When tumor growth was evident, either Anti-VEGFR2-IRDye800, anti-Her2/Neu-IRDye800, or Immunoglobulin G (IgG) Isotype-IRDye800 (control) were injected via tail vein. The mice were serially imaged in a closed field near-IR device. Fluorescent data were analyzed for tumor signal and correlated with tumor sie and growth rate. Heterogeneity of fluorescent tumor signal was also assessed. RESULTS In both anti-VEGFR2 and anti-Her2/Neu groups, there were strong correlations between day 1 mean tumor fluorescence and eventual maximum tumor volume (p = 0.002, 0.001; r2 = 0.92, 0.86). There was also strong correlation with maximum tumor signal on day 1 and maximum tumor volume (p = 0.003, 0.008; r2 = 0.90, 0.91). There was no such correlation in the control group (p = 0.99, 0.75; r2 = 0.0002, 0.028). CONCLUSION Given the potential morbidity in VS intervention, observation is an appropriate approach for patients with slow-growing or stagnant tumors. We seek to identify immunotargets in a murine model that show promise in predicting schwannoma growth with advanced imaging techniques. Both Her2/Neu and VEGFR2 correlated strongly wth tumor size and growth rates and are promising targets that merit further investigation.
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Affiliation(s)
- Daniel R. Morrison
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anna G. Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ellis Hamilton
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay S. Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hailey A. Houson
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alyssa Ovaitt
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason M. Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erika M. Walsh
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
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Predictive Value of Preoperative and Intraoperative Neurophysiology in Evaluating Long-term Facial Function Outcome in Acoustic Neuroma Surgery. Otol Neurotol 2020; 41:530-536. [DOI: 10.1097/mao.0000000000002553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhou YJ, Li QZ, Gao YQ, Gao LX, Zhao ZX, Wu YZ, Wang J. Are Meniere's disease patients with otolith organ impairment more likely to have balance dysfunction? Acta Otolaryngol 2019; 139:977-981. [PMID: 31536431 DOI: 10.1080/00016489.2019.1663923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Patients with Meniere's disease (MD) may present with peripheral vestibular end organ dysfunction and balance dysfunction. Objective: This study aimed to compare the results of vestibular evoked myogenic potential (VEMP) tests with those of the sensory organization test (SOT) in patients with MD to determine whether they are correlated. Material and methods: In total, 132 patients with unilateral MD were evaluated using an audiometric test, the SOT, a caloric test and VEMP tests. Results: Cervical VEMP and ocular VEMP tests were conducted in 132 patients with MD, and the response rates of the affected side were lower than those of the unaffected side. The composite score, C5ES, and C6ES of the SOT were significantly decreased in patients with no VEMP responses compared to those with VEMP responses. Conclusions and significance: MD patients with no VEMP responses are more likely to develop balance impairment than those with VEMP responses. MD patients with otolith organ impairment may therefore have balance disorders, and should exercise caution to prevent falls and subsequent injuries.
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Affiliation(s)
- Yu-Juan Zhou
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Qing-Zhong Li
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Ying-Qi Gao
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Lin-Xi Gao
- Department of Otolaryngology Head & Neck Surgery, Xijing Hospital, Xi’an, China
| | - Zhi-Xiang Zhao
- Department of Otolaryngology Head & Neck Surgery, Zhejiang Hospital, Zhejiang, China
| | - Yong-Zhen Wu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Jing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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