Noncontrast vestibular schwannoma surveillance imaging including an MR cisternographic sequence: is there a need for postcontrast imaging?

Abstract

OBJECTIVE The purpose of this study was to evaluate the use of a noncontrast MRI protocol that includes a cisternographic sequence (CISS/FIESTA/3D DRIVE) compared to a protocol that includes a gadolinium-enhanced sequence in order to determine whether a noncontrast approach could be utilized to follow vestibular schwannomas. METHODS A total of 251 patients with vestibular schwannomas who underwent MRI of the temporal bones that included both cisternographic sequence and postcontrast T1 imaging between January 2000 and January 2016 for surveillance were included in this retrospective study. The size of the vestibular schwannomas was independently assessed on a noncontrast MR cisternographic sequence and compared to size measurements on a postcontrast sequence. The evaluation of intralesional cystic components (identified as T2 signal hyperintensity) and hemorrhagic components (identified with intrinsic T1 hyperintensity) on noncontrast MR sequences was compared to evaluation on postcontrast MR sequences to determine whether additional information could be derived from the postcontrast sequences. Additionally, any potentially clinically significant, incidentally detected findings on the postcontrast T1 sequences were documented and compared with the detection of these findings on the precontrast images. RESULTS No significant difference in vestibular schwannoma size was found when comparing measurements made on the images obtained with the MR cisternographic sequence and those made on images obtained with the postcontrast sequence (p = 0.99). Noncontrast MR images were better (detection rate of 87%) than postcontrast images for detection of cystic components. Noncontrast MR images were also better for identifying hemorrhagic components. No additional clinically relevant information regarding the tumors was identified on the postcontrast sequences. CONCLUSIONS Based on the results of this study, a noncontrast MR protocol that includes a cisternographic sequence would be sufficient for the accurate characterization of size and signal characteristics of vestibular schwannomas, obviating the need for gadolinium contrast administration for the routine surveillance of these lesions.

Intracranial meningioma surveillance using volumetrics from T2‐weighted MRI

“…Accuracy when utilizing T2WI was best within the posterior fossa on our study, as compared to along the convexities, as previously reported 13 . This may be attributed to the ease of measuring a soft tissue mass in the basilar cisterns where abundance of CSF (cerebrospinal fluid) provides excellent imaging contrast, as has been demonstrated in the imaging assessment of intracranial schwannomas 11 …”

“…In 2018, a retrospective case series of 251 patients with vestibular schwannomas demonstrated no significant difference in surveilled size using a noncontrast "cisternographic" technique. 11 A similar study found noncontrast MR surveillance technique performance comparable to contrast MR for detection of subependymal giant cell astrocytomas in tuberous sclerosis complex. 12 In 2020, He et al reported no significant difference in surveilled size of a case series of 18 supratentorial cerebral convexity meningiomas when replacing GBCA-enhanced studies with 2D spin echo T2-weighted images (TWIs) and fluid-attenuated inversion recovery (FLAIR) sequences.…”

“…To minimize these potential risks, and to capitalize on the improving quality of MRI images, noncontrast MRI imaging protocols have been proposed to monitor intracranial neoplasms. In 2018, a retrospective case series of 251 patients with vestibular schwannomas demonstrated no significant difference in surveilled size using a noncontrast “cisternographic” technique 11 . A similar study found noncontrast MR surveillance technique performance comparable to contrast MR for detection of subependymal giant cell astrocytomas in tuberous sclerosis complex 12 .…”

Balanced Steady-State Free Precession Techniques Improve Detection of Residual Germ Cell Tumor for Treatment Planning

“…1,2,[9][10][11][12] Our findings are similar to those in other previous studies that have demonstrated the benefits of adding bSSFP sequences to standard neuroimaging protocols for CNS tumor detection, including high accuracy for vestibular schwannoma detection and spinal drop metastases. 4,[13][14][15][16] Although the inclusion of a bSSFP sequence increased the total scan length by 6 minutes on average, we found that the improved sensitivity and confidence in the interpretation justify the additional imaging time. Furthermore, there is diagnostic synergy between the bSSFP and the standard MR images when interpreted in conjunction.…”

Arachnoid Cysts of the Internal Auditory Canal: Multiplanar Magnetic Resonance Imaging With Audio‐Vestibular Correlates

“…MPR is particularly useful for delineating compressive phenomena, such as mass effects exerted on adjacent neural structures. 15 We previously reported on this approach, demonstrating utility of MPR for characterizing vascular loops features (e.g., position, contact with nerve, and vessel caliber). MPR findings have previously been correlated with auditory and vestibular symptoms 16 and discriminate benign nerve displacement from compressive nerve injury for surgical planning.…”