Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Acta Neurochir (Wien). 2024 Apr 5;166(1):168. doi: 10.1007/s00701-024-06059-1.
Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function.
Of 155 patients who underwent resection of vestibular schwannoma (2014-2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications.
Regression tree analysis defined three quantitative ADC groups (× 10 mm/s) as high (> 2248.77; HB 1.7), mid (1468.44-2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003).
Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.
尽管方法有限，但 MRI 中的表观扩散系数 (ADC) 已被证明与前庭神经鞘瘤患者的术后 House-Brackmann (HB) 评分相关。为了纠正单个感兴趣区域 (ROI) 采样的局限性，我们假设全肿瘤 ADC 直方图分析将细化与术后面神经功能相关的这种术前生物标志物的预测价值。
在接受前庭神经鞘瘤切除术的 155 名患者中（2014-2020 年），纳入了 125 名具有必要临床和影像学数据的患者。在进行容积分析和全肿瘤 ADC 直方图后，回归树分析确定了与 HB 分级有显著差异的 ADC 截止值。结果为肿瘤切除程度、面神经功能、住院时间 (LOS) 和并发症。
回归树分析将三个定量 ADC 组（× 10mm/s）定义为高 (>2248.77; HB 1.7)、中 (1468.44-2248.77; HB 3.1) 和低 (<1468.44; HB 2.3) 范围（p<0.04）。中范围 ADC 组术后 HB 评分明显较差，住院时间较长。肿瘤体积大是全切率降低（p<0.0001）、术后 HB 评分升高（p<0.002）、并发症发生率升高（p<0.04）和 LOS 延长（p<0.003）的独立预测因素。
全肿瘤直方图产生了稳健的回归树分析，该分析定义了三个具有显著不同面神经结果的 ADC 组。这可能比实体瘤 ROI 采样更好地反映肿瘤异质性。全肿瘤 ADC 值得进一步研究，作为考虑手术切除的前庭神经鞘瘤患者有用的影像学生物标志物。
