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

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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.

Article Information

Correspondence Karen Buch: Massachusetts General Hospital, Boston, MA. karen.buch@gmail.com; kbuch@partners.org.

INCLUDE WHEN CITING Published online August 10, 2018; DOI: 10.3171/2018.3.JNS1866.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Example of the long-axis measurement of a vestibular schwannoma on an MR cisternographic sequence (left) and a T1 postcontrast image (right) obtained in a 38-year-old woman with a right vestibular schwannoma.

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    Axial cisternographic image (left) and precontrast T1-weighted image (right) obtained in a 58-year-old woman with a right vestibular schwannoma. A focus of intrinsic T1 hyperintensity (black arrow) corresponding to presumed hemorrhage is not well identified on the cisternographic image. A cystic component (white arrow) is well visualized on the cisternographic image.

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    Example of an incidental finding that was given a clinical significance score of 3. A 64-year-old woman was found to have an acute pontine infarct (white arrow) on the diffusion-weighted sequence (left), adjacent to a remote lacunar infarct (white arrowhead), as shown on the MR cisternographic image (right).

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