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Response prediction of vestibular schwannoma after gamma-knife radiosurgery using pretreatment dynamic contrast-enhanced MRI: a prospective study

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Abstract

Objectives

There are few known predictive factors for response to gamma-knife radiosurgery (GKRS) in vestibular schwannoma (VS). We investigated the predictive role of pretreatment dynamic contrast-enhanced (DCE)-MRI parameters regarding the tumor response after GKRS in sporadic VS.

Methods

This single-center prospective study enrolled participants between April 2017 and February 2019. We performed a volumetric measurement of DCE-MRI-derived parameters before GKRS. The tumor volume was measured in a follow-up MRI. The pharmacokinetic parameters were compared between responders and nonresponders according to 20% or more tumor volume reduction. Stepwise multivariable logistic regression analyses were performed, and the diagnostic performance of DCE-MRI parameters for the prediction of tumor response was evaluated by receiver operating characteristic curve analysis.

Results

Ultimately, 35 participants (21 women, 52 ± 12 years) were included. There were 22 (62.9%) responders with a mean follow-up interval of 30.2 ± 5.7 months. Ktrans (0.036 min−1 vs. 0.057 min−1, p = .008) and initial area under the time-concentration curve within 90 s (IAUC90) (84.4 vs. 143.6, p = .003) showed significant differences between responders and nonresponders. Ktrans (OR = 0.96, p = .021) and IAUC90 (OR = 0.97, p = .004) were significant differentiating variables in each multivariable model with clinical variables for tumor response prediction. Ktrans showed a sensitivity of 81.8% and a specificity of 69.2%, and IAUC90 showed a sensitivity of 100% and a specificity of 53.8% for tumor response prediction.

Conclusion

DCE-MRI (particularly Ktrans and IAUC90) has the potential to be a predictive factor for tumor response in VS after GKRS.

Key Points

•Pretreatment prediction of gamma-knife radiosurgery response in vestibular schwannoma is still challenging.

•Dynamic contrast-enhanced MRI could have predictive value for the response of vestibular schwannoma after gamma-knife radiosurgery.

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Abbreviations

DCE:

Dynamic contrast-enhanced

GKRS:

Gamma-knife radiosurgery

K trans :

Volume transfer constant

v e :

Volume of extravascular extracellular space

v p :

Blood plasma volume

VS:

Vestibular schwannoma

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Funding

This study was supported by a grant from Bracco Imaging, a grant from the Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs (HI16C1111), by the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2016M3C7A1914002), by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C2008949 and NRF-2020R1A4A1018714), by Creative-Pioneering Researchers Program through Seoul National University (SNU), and by the Institute for Basic Science (IBS-R006-A1). Bracco Imaging, Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs, HI16C1111, Seung Hong Choi, the Brain Research Program through the National Research Foundation of Korea, NRF-2016M3C7A1914002, Seung Hong Choi, Basic Science Research Program through the National Research Foundation of Korea, NRF-2020R1A2C2008949, Seung Hong Choi, NRF-2020R1A4A1018714, Seung Hong Choi, Creative-Pioneering Researchers Program through Seoul National University, and by the Institute for Basic Science, IBS-R006-A1, Seung Hong Choi.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Inpyeong Hwang, Seung Hong Choi, Eung Koo Yeon, Ji Ye Lee, Roh-Eul Yoo, Koung Mi Kang, Tae Jin Yun, Ji-hoon Kim & Chul-ho Sohn

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Seung Hong Choi, Roh-Eul Yoo, Koung Mi Kang, Tae Jin Yun, Ji-hoon Kim & Chul-ho Sohn

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Seung Hong Choi, Roh-Eul Yoo & Chul-ho Sohn

  4. Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul, 08826, Republic of Korea

    Seung Hong Choi

  5. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jin Wook Kim

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  1. Inpyeong Hwang
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Corresponding author

Correspondence to Seung Hong Choi.

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Hwang, I., Choi, S.H., Kim, J.W. et al. Response prediction of vestibular schwannoma after gamma-knife radiosurgery using pretreatment dynamic contrast-enhanced MRI: a prospective study. Eur Radiol 32, 3734–3743 (2022). https://doi.org/10.1007/s00330-021-08517-1

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