Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma

M C Kleijwegt; A G L van der Mey; F T Wiggers-deBruine; M J A Malessy; M J P van Osch

doi:10.1016/j.ejro.2016.05.005

Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma

Eur J Radiol Open. 2016 Jun 15:3:127-33. doi: 10.1016/j.ejro.2016.05.005. eCollection 2016.

Authors

M C Kleijwegt¹, A G L van der Mey¹, F T Wiggers-deBruine², M J A Malessy³, M J P van Osch⁴

Affiliations

¹ ENT Department, Leiden University Medical Center, Leiden, The Netherlands.
² Radiology Department, Leiden University Medical Center, Leiden, The Netherlands.
³ Neurosurgery Department, Leiden University Medical Center, Leiden, The Netherlands.
⁴ C.J. Gorter Center for High Field MRI, Radiology Department, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Objective: The added value of perfusion MRI for decision-making in vestibular schwannoma (VS) patients is unknown. MRI offers two perfusion methods: the first employing contrast agent (dynamic susceptibility contrast (DSC)-MRI) that provides information on cerebral blood volume (CBV) and cerebral blood flow (CBF), the second by magnetic labeling of blood (arterial spin labeling (ASL)-MRI), providing CBF-images. The goal of the current study is to investigate whether DSC and ASL perfusion MRI provides complimentary information to current anatomical imaging in treatment selection process of VS.

Methods: Nine patients with growing VS with extrameatal diameter >9 mm were included (>2 mm/year and 20% volume expansion/year) and one patient with 23 mm extrameatal VS without growth. DSC and ASL perfusion MRI were obtained on 3 T MRI. Perfusion in VS was scored as hyperintense, hypointense or isointense compared to the contralateral region.

Results: Seven patients showed hyperintense signal on DSC and ASL sequences. Three patients showed iso- or hypointense signal on at least one perfusion map (1 patient hypointense on both DSC-MRI and ASL; 1 patient isointense on DSC-CBF; 1 patient isointense on ASL). All patients showed enhancement on post-contrast T1 anatomical scan.

Conclusion: Perfusion MR provides additional information compared to anatomical imaging for decision-making in VS.

Keywords: AAO-HNS, American Academy of Otolaryngology-Head and Neck Surgery; ASL, arterial spin labeling; CA, contrast agent; CBF, cerebral blood flow; CBV, cerebral blood volume; DSC, dynamic susceptibility contrast; Decision making; Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL); EPI, echo planar imaging; FA, flip angle; FOV, field of view; Gd, gadolinium; MR, magnetic resonance; MRI, magnetic resonance imaging; PCASL, pseudo-continuous arterial spin labeling; Perfusion weighted MR; RF, radiofrequency; SNR, signal to noise ratio; TE, echo time; TR, repetition time; VS, vestibular schwannoma; Vestibular schwannoma; rCBV, relative CBV.