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. 2025 May 15;27(4):1116-1127.
doi: 10.1093/neuonc/noae252.

Dynamic contrast-enhanced and diffusion-weighted MR imaging for predicting tumor growth of sporadic vestibular schwannomas: A prospective study

Sammy M Schouten  1   2   3   4   5 , Daniel Lewis  6   7 , Stefan Cornelissen  8   2 , Ka-Loh Li  6 , Xiaoping Zhu  6 , Marnix C Maas  5 , Sjoert Pegge  5 , Thijs T G Jansen  3   5 , Jef J S Mulder  3   5 , Jérôme J Waterval  1   3   4 , Alida A Postma  1   3   4 , Omar Pathmanaban  6 , David J Coope  6 , Jolanda M M Derks, Patrick P J H Langenhuizen  8   2 , Andrew T King  6 , Jeroen B Verheul  2 , Henricus P M Kunst  1   3   4   5
Affiliations

Dynamic contrast-enhanced and diffusion-weighted MR imaging for predicting tumor growth of sporadic vestibular schwannomas: A prospective study

Sammy M Schouten et al. Neuro Oncol. .

Abstract

Background: Advanced MR imaging, such as diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) imaging, may provide valuable noninvasive information on intrinsic tumor biology. This study aims to evaluate apparent diffusion coefficient (ADC) and DCE-MRI-derived microvascular parameter values (Ktrans, ve, and vp) as potential imaging predictors for future sporadic vestibular schwannoma (VS) growth.

Methods: In this prospective cohort study, patients with newly diagnosed unilateral sporadic VS and an initial wait-and-scan strategy were enrolled between January 2021 and January 2023. Patients underwent a single timepoint comprehensive MRI protocol, including DWI and DCE-MRI sequences. The estimated values of ADC, Ktrans, ve, and vp were calculated using established pipelines on a voxelwise basis within the delineated tumor region of interest. Associations of the estimated parameter values with volumetric growth were evaluated in uni- and multivariable logistic regression and survival analyses.

Results: Of the 110 analyzed patients, 70 (64%) exhibited growth during follow-up. A significant correlation was primarily observed between the DCE-MRI-derived parameters and VS growth. The combination of mean Ktrans (P < .001) and ve (P < .001) tumor values provided an internally validated model with an AUC of 0.85 for growth, yielding a sensitivity of 89% and specificity of 73% at the optimized cutoff value. Only the mean ADC values were found to be significantly higher in shrinking tumors (P = .04).

Conclusions: The strongly significant correlation observed between VS growth and Ktrans and ve tumor values indicate the great potential of the noninvasive DCE-MRI for individualized VS management in clinical practice. External validation is needed to further substantiate these findings.

Keywords: advanced MRI; apparent diffusion coefficient; dynamic contrast-enhanced; vestibular schwannoma; volumetric growth.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Flow diagram of the study population.
Figure 2.
Figure 2.
Summarizing boxplots with 5–95 percentile whiskers of mean (A) Ktrans, (B) ve, (C) vp, and (D) ADC tumor values of growing (N = 70), stable (N = 25) and regressing (N = 15) tumors. Comparison of growing, stable and regressing tumors using one-way ANOVA analysis. *Log-transformed due to right skewness.
Figure 3.
Figure 3.
Kaplan–Meier survival curves of (A) growth-free survival rates of the total cohort; (B) growth-free survival rates stratified in mean Ktrans value quartiles; (C) growth-free survival rates stratified in mean ve value quartiles.
Figure 4.
Figure 4.
Case examples with size at diagnosis and at follow-up (volume in cm3 and maximum extrameatal diameter in mm) with corresponding Ktrans and ve (sfe50) maps: (A) growing tumor; (B) growing tumor with cystic components; (C) tumor with stable solid component, but growing cystic components; (D) regressing tumor; (E) regressing tumor.
See this image and copyright information in PMC

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