Schouten Sammy M, Lewis Daniel, Cornelissen Stefan, Li Ka-Loh, Zhu Xiaoping, Maas Marnix C, Pegge Sjoert, Jansen Thijs T G, Mulder Jef J S, Waterval Jérôme J, Postma Alida A, Pathmanaban Omar, Coope David J, Derks Jolanda M M, Langenhuizen Patrick P J H, King Andrew T, Verheul Jeroen B, Kunst Henricus P M
Mental Health & Neuroscience Research Institute, Maastricht University, Maastricht, the Netherlands.
Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Neuro Oncol. 2025 May 15;27(4):1116-1127. doi: 10.1093/neuonc/noae252.
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.
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.
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).
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.
先进的磁共振成像，如扩散加权（DWI）和动态对比增强（DCE）成像，可能提供有关肿瘤内在生物学的有价值的非侵入性信息。本研究旨在评估表观扩散系数（ADC）和DCE-MRI衍生的微血管参数值（Ktrans、ve和vp）作为未来散发性前庭神经鞘瘤（VS）生长的潜在影像学预测指标。
在这项前瞻性队列研究中，2021年1月至2023年1月期间纳入了新诊断为单侧散发性VS且采用初始等待观察策略的患者。患者接受了单一时间点的综合MRI检查方案，包括DWI和DCE-MRI序列。在划定的肿瘤感兴趣区域内，基于体素使用既定流程计算ADC、Ktrans、ve和vp的估计值。在单变量和多变量逻辑回归及生存分析中评估估计参数值与体积生长的相关性。
在110例分析患者中，70例（64%）在随访期间出现生长。主要观察到DCE-MRI衍生参数与VS生长之间存在显著相关性。平均Ktrans（P <.001）和ve（P <.001）肿瘤值的组合提供了一个内部验证模型，生长的AUC为0.85，在优化的临界值时灵敏度为89%，特异性为73%。仅发现缩小肿瘤中的平均ADC值显著更高（P = 0.04）。
VS生长与Ktrans和ve肿瘤值之间观察到的强显著相关性表明，非侵入性DCE-MRI在临床实践中对VS个体化管理具有巨大潜力。需要外部验证来进一步证实这些发现。
