Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles

Constanzo, Felipe; Teixeira, Bernardo Corrêa de Almeida; Sens, Patricia; Smaili, Hamzah; Escuissato, Dante Luiz; Ramina, Ricardo

doi:10.1590/0100-3984.2022.0035

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Original Article • Radiol Bras 56 (2) • Mar-Apr 2023 • https://doi.org/10.1590/0100-3984.2022.0035 copy

Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles

Perfusão por ressonância magnética em schwannoma vestibular: influência do tamanho e estádio cístico no perfil da perfusão

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined.

Materials and Methods:

Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)—the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)—as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous).

Results:

Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = –0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037).

Conclusion:

In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.

Keywords:
Neuroma, acoustic; Magnetic resonance imaging/methods; Image enhancement/methods; Skull base neoplasms/ physiopathology

Category	Kep	P	Ve	P	rCBV	P
All VSs
Ktrans	0.03	0.886	0.42	0.062	0.62	0.031
Kep	—	—	–0.51	0.021	0.55	0.062
Ve	—	—	—	—	–0.33	0.296
Small VSs
Ktrans	0.1	0.873	0.8	0.104	—	—
Kep	—	—	0.1	0.873	—	—
Large VSs
Ktrans	0.53	0.041	–0.18	0.513	0.62	0.031
Kep	—	—	–0.38	0.161	0.55	0.062
Ve	—	—	—	—	–0.33	0.296

Size	Ktrans Mean ± SD	P (95% CI)	Kep Mean ± SD	P (95% CI)	Ve Mean ± SD	P (95% CI)
Small	0.13 (0.06)	< 0.001 (–0.24 to –0.08)	0.68 (0.20)	0.037 (0.01 to 0.43)	0.45 (0.15)	< 0.001 (–0.53 to –0.23)
Large	0.29 (0.08)	< 0.001 (–0.24 to –0.08)	0.46 (0.19)	0.037 (0.01 to 0.43)	0.83 (0.14)	< 0.001 (–0.53 to –0.23)
T1	0.08 (0.04)	0.007 (–0.33 to –0.06)	0.62 (0.37)	0.45 (–0.21 to 0.45)	0.37 (0.05)	0.007 (–0.70 to –0.13)
All others	0.27 (0.09)	0.007 (–0.33 to –0.06)	0.50 (0.20)	0.45 (–0.21 to 0.45)	0.78 (0.19)	0.007 (–0.70 to –0.13)
T4	0.30 (0.08)	0.002 (0.06 to 0.22)	0.46 (0.19)	0.09 (–0.38 to 0.03)	0.84 (0.14)	< 0.001 (0.17 to 0.49)
All others	0.16 (0.08)	0.002 (0.06 to 0.22)	0.63 (0.21)	0.09 (–0.38 to 0.03)	0.51 (0.19)	< 0.001 (0.17 to 0.49)

Category	Ktrans Mean ± SD	P (95% CI)	Kep Mean ± SD	P (95% CI)	Ve Mean ± SD	P (95% CI)	rCBV Mean ± SD	P (95% CI)
All VSs
Solid	0.21 (0.10)	0.029 (–0.18 to –0.01)	0.49 (0.23)	0.688 (–0.24 to 0.16)	0.72 (0.25)	0.722 (–0.25 to 0.17)	7.75 (5.57)	0.438 (–7.7 to 3.6)
Cystic	0.30 (0.08)	0.029 (–0.18 to –0.01)	0.53 (0.20)	0.688 (–0.24 to 0.16)	0.76 (0.19)	0.722 (–0.25 to 0.17)	9.8 (2.75)	0.438 (–7.7 to 3.6)
Large VSs
Solid	0.27 (0.08)	0.3 (–0.13 to 0.04)	0.37 (0.15)	0.175 (–0.34 to 0.07)	0.90 (0.06)	0.152 (–0.45 to 0.26)	7.75 (5.57)	0.438 (–7.7 to 3.6)
Cystic	0.31 (0.08)	0.3 (–0.13 to 0.04)	0.51 (0.20)	0.175 (–0.34 to 0.07)	0.79 (0.16)	0.152 (–0.45 to 0.26)	9.8 (2.75)	0.438 (–7.7 to 3.6)
Solid VSs
Small	0.11 (0.05)	0.009 (–0.26 to –0.05)	0.67 (0.23)	0.039 (0.02 to 0.57)	0.46 (0.17)	< 0.001 (–0.61 to –0.27)	—	—
Large	0.27 (0.08)	0.009 (–0.26 to –0.05)	0.37 (0.15)	0.039 (0.02 to 0.57)	0.90 (0.06)	< 0.001 (–0.61 to –0.27)	—	—
Cystic VSs
Solid Part	0.32 (0.08)	< 0.001 (0.11 to 0.25)	0.53 (0.20)	0.927 (–0.39 to 0.36)	0.78 (0.17)	< 0.001 (0.24 to 0.57)	9.8 (2.75)	0.541 (–9.7 to 5.5)
Cystic Part	0.14 (0.04)	< 0.001 (0.11 to 0.25)	0.55 (0.45)	0.927 (–0.39 to 0.36)	0.37 (0.14)	< 0.001 (0.24 to 0.57)	11.87 (7.32)	0.541 (–9.7 to 5.5)

Category	Kep	P	Ve	P	rCBV	P
All solid VSs
Ktrans	–0.21	0.555	0.64	0.048	0.60	0.208
Kep	—	—	–0.52	0.121	0.72	0.103
Ve	—	—	—	—	–0.60	0.208
Large solid VSs
Ktrans	0.67	0.148	–0.66	0.156	0.6	0.208
Kep	—	—	–0.41	0.425	0.72	0.103
Ve	—	—	—	—	–0.6	0.208

Cystic VS portion	Kep	P	Ve	P	rCBV	P
Solid
Ktrans	0.31	0.456	0.10	0.823	0.54	0.266
Kep	—	—	–0.55	0.160	0.71	0.111
Ve	—	—	—	—	–0.14	0.787
Cystic
Ktrans	0.66	0.073	–0.35	0.402	—	—
Kep	—	—	–0.49	0.217	—	—
Ve	—	—	—	—	—	—

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[1] Correspondence: Felipe Constanzo, MD. Department of Skull Base Surgery, Clínica Biobío. Avenida Jorge Alessandri 3515, Talcahuano, Chile. Email: constanzo.md@gmail.com.