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. 2009 Aug;51(8):517-24.
doi: 10.1007/s00234-009-0529-4. Epub 2009 May 6.

Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements

Rick van de Langenberg  1 , Bert Jan de Bondt, Patty J Nelemans, Brigitta G Baumert, Robert J Stokroos
Affiliations

Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements

Rick van de Langenberg et al. Neuroradiology. 2009 Aug.

Abstract

Introduction: A conservative treatment strategy is often proposed as a primary treatment option in the management of vestibular schwannomas (VS). In this "wait and scan" policy, audiovestibular symptoms are monitored regularly, and VS growth is measured on consecutive magnetic resonance images (MRI). The aim of this study is validation of two-dimensional versus volume MRI assessment in the longitudinal follow-up of VS and to define tumor growth beyond measurement error.

Methods: MRI scans of 68 consecutive patients with VS were analyzed retrospectively. Two-dimensional and volume measurements on contrast enhanced (CE) T1- and T2-weighted images were performed independently by two readers. Smallest detectable differences (SDD) were calculated, and intraclass correlation coefficients (ICCs) were determined for both assessment methods.

Results: Two-dimensional and volume measurements both showed best reproducibility on CE T1-weighted images. SDD for differences relative to baseline MRI [SDD (%)] for two-dimensional measurements had a higher interobserver error compared to volume measurements (40% versus 19.7%), which decreases when tumor size increases. The ICC for two-dimensional measurements in three directions was 0.947, 0.974, and 0.978 and for volume measurements 0.999.

Conclusion: Volume measurements are more accurate compared to two-dimensional measurements for the evaluation of VS growth. These measurements are assessed preferably on CE T1-weighted images. SDD (%) strongly depends on VS size. SDD between consecutive scans exceeds the common clinical applied criterion of 1 or 2 mm growth to define growth.

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Figures

Fig 1
Fig 1
a, b Contrast-enhanced T1-weighted image with a vestibular schwannoma in the cerebellopontine angle (CPA) on the right side. a Measurements in the axial plane: X is the maximum mediolateral, and Y the maximum anteroposterior dimension; b in the coronal plane, the Z demonstrates the maximum craniocaudal dimension
Fig. 2
Fig. 2
a: Example of area tracing with volume software. Axial contrast-enhanced T1-weighted image shows a right-sided vestibular schwannoma (asterisk) with a large cerebellopontine angle component. The red line is the result of the autotracer which lines the vestibular schwannoma. b Three dimensional representation of a vestibular schwannoma (VS), integrating the surface of all slice intervals. The small intracanalicular (A) and large extracanalicular (B) portion of the VS can easily be identified
Fig. 3
Fig. 3
Bland and Altman plot of baseline two-dimensional maximum craniocaudal (CC) dimension measurements on contrast-enhanced T1-weighted images (CE T1-WI). The values on the Y-axis represent the measurement differences between the two readers and their mean difference (thin line). The values on the X-axis represent the mean of both measurements. The thick black lines represent the 95% limits of agreement. Interobserver differences are larger in smaller vestibular schwannomas
Fig. 4
Fig. 4
Bland and Altman plot of baseline volume measurements on contrast-enhanced T1-weighted images (CE T1-WI). The values on the Y-axis represent the measurement differences between the two readers and their mean difference (thin line). The values on the X-axis represent the mean of both measurements. The thick black lines represent the 95% limits of agreement. Interobserver differences are larger in smaller vestibular schwannomas
See this image and copyright information in PMC

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