Objective:1) To compare vestibular schwannoma maximum linear dimensions and calculated volume with measured volume in accurately determining tumor volume and growth. 2) To determine natural growth history of vestibular schwannomas utilizing volumetric measurements in an observed patient population.Study Design:Retrospective chart review.Setting:Tertiary academic referral.Patients:One hundred fifty two adults with a vestibular schwannoma who underwent observational management with sequential magnetic resonance imaging (MRI) scans (496 scans).Intervention:MRI scans.Main Outcome Measures:Tumor volume calculated from linear dimensions compared with measured volume. The percentage change in tumor size (linear or volume) between consecutive MRI scans.Results:The percentage change in tumor size between consecutive MRIs is significantly different between maximum linear dimension (MLD) and measured tumor volume (p = 0.03), but no difference exists in the percentage change between measured and calculated tumor volume (p = 0.882 for three linear measurements, p = 0.637 for two linear measurements). The overall number of growing tumors is 57.2% (n = 87) with an average growth rate of 62.6%. If a criterion for growth of 20% change is used, 32.2% of tumors monitored by linear volume would have demonstrated growth while 57.2% of tumors with measured volume demonstrated growth.Conclusion:Maximum linear dimensions are a significantly less sensitive measure of tumor growth compared with measured volumes. Calculated tumor volume utilizing three linear measurements is an accurate predictor of both measured tumor volume and tumor growth.

Objective: Management of small vestibular schwannomas has evolved to where observation with interval imaging is an accepted treatment strategy. Loss of residual hearing is a known complication of observation. Magnetic resonance imaging (MRI) may provide critical information to assist in determining which tumors are at highest risk of hearing loss. We wished to determine what effect fundal cap size and cochlear fluid-attenuated inversion recovery (FLAIR) signal had on the progression of hearing loss in a large cohort of observed subjects. Study Design: Retrospective chart review. Setting: Tertiary academic referral center. Patients: Three hundred ninety-three adults with a vestibular schwannoma who underwent expectant management with serial audiograms and MRI. Interventions: Audiogram and MRI. Main Outcome Measures: Hearing outcomes included pure-tone average and word discrimination score (WRS). Cochlear FLAIR signal was measured as a ratio between the affected and nonaffected cochlea. Cerebrospinal fluid fundal cap was measured from the most lateral aspect of the tumor to the fundus of the internal auditory canal. Results: An increased cochlear FLAIR ratio was associated with a worse initial WRS (p = 0.0001, β=−0.25). A multivariate regression analysis demonstrated the variables fundal cap and initial WRS to significantly predict change in WRS over time. The larger the fundal cap size, the smaller the change in the WRS (p = 0.047, β=−0.35). Conclusions: Cerebrospinal fluid fundal cap size predicts the natural history of hearing in vestibular schwannoma patients. The presence of a smaller fundal cap is correlated with a greater risk of progression of hearing loss and should be a variable considered in the management of small vestibular schwannomas.

No abstract

No abstract

Objective To document the outcome of radioiodine therapy (RIT) in differentiated thyroid cancer (DTC) patients with recent contrasted computed tomography (CCT). Methods Eighteen patients with DTC and recent thyroidectomy who underwent RIT within 90 days after a CCT were included. Disease status following RIT and whether the expected response to RIT was achieved were documented. Disease status was classified into one of three categories based on the patient’s thyroglobuline level, radioiodine scan (RIS), and other imaging modalities: no evidence of disease (NED), microscopic residual disease (MRD), or gross residual disease (GRD). Expected response to RIT was based on the overall interpretation of the referring physicians of follow up thyroglobuline values, RIS findings and clinical assessment as reflected in progress notes. Follow-up stimulated thyroglobuline and (or) RIS was performed on average 10.8 months after RIT (median 12 months). The last progress note reviewed was on average 33.3 months after RIT (median 31 months). Results There were 12 patients with NED, two with MRD and four with GRD. Expected response to RIT was achieved in 17 patients. In one patient, the effectiveness of RIT could not be determined. Conclusion RIT in postthyroidectomy setting can be successfully performed within 90 days after CCT. Further research is needed to confirm our findings.