FINAL COMPARATIVE STUDY FOR VESTIBULAR SCHWANNOMA @ ACOUSTIC NEUROMA BASED ON ARTICLES REVIEW
MRI IS THE GOLD STANDARD MODALITIES IN DETECTION OF VESTIBULAR SCHWANNOMAS
Prepared by Aasiah Yassin and Anisah Kamil
Introduction
As increasing number of new technology in this era, like cordless phone and mobile phone. Increasing case of cerebellopontine angle tumor including the vestibular schwannoma become the main interest among researches. Therefore, Hardell et al (2013) done a pooled analysis of this technology effects on the function of hearing and cerebellopontine angle system. The results show that the hypothesis is significant with increasing number of cases collected in Sweden. Based on other study made by International Agency for Research on Cancer (IARC) on March 2011 reported a positive carcinogenic effect of high RF-EMF including glioma and acoustic neuroma.
Early detection of Vestibular schwannoma
Rosahl et al (2017) stated on their paper interdisplinary challenge in diagnose and treating vestibular schwannoma, the tumor can be diagnose based on the stages of tumor using grading scale of facial nerve and hearing system. They also had mentioned that MRI scan and audiometry and vestibular diagnosis as the base for early observation for vestibular schwannoma. Besides, Kunwarpal Singh et al (2014) mentioned that features of meningioma in MRI scan can be easily interchange with vestibular schwannoma. However, Farid (2014) said that cerebellopontine angle meningioma is more valuable when using CT scan, which the calcification and hyperostosis as the common findings. As compared to MRI images, the meningioma will appear like board based dural lesions that attached to petrous dura mater or inferior aspects of tentorium.
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Figure 1: Stages of Acoustic Neuroma.
T1: Intracanalicular; T2: intra-/extrameatal; T3: tumor reaches the brainstem; T4: tumor compresses the brainstem |
Diagnostic accuracy of MRI
According to Strasila and Sychra (2016), MRI is the gold standard for diagnosing vestibular schwannoma as its sensitivity and specificity are almost 100%.
Ahmad et al (2014) mentioned in their research on diagnostic accuracy of MRI scan of acoustic neuroma as safely non-invasive procedure, however, the authors argues the capability of the histopathology is far more accurate as compared to MRI Scan. Since the results shows 96.4% diagnostic accuracy of MRI scan out of 55 of respondents.
Basic features of MRI scan to diagnose acoustic neuroma
According Forgues et al (2018), the non-contrast T2-weighted sequence is fairly more accurate as compared to contrast enhanced T1-weighted sequence. The non-contrast T2-weighted sequence specificity is 88.2% and sentivity 77.7% which provide a more precise in terms of size, tumor growth, tumor characteristics and location. In addition, the measurement of tumor in T2-weighted images are much smaller than post enhanced T1-weighted images by 47% evaluation.
Conversely, Kunwarpal Singh et al (2014) reported that the sensitivity of post contrast T1 is 100% detection specifically for small voxel size of tumor. In this study, all cases of vestibular schwannomas were moderately enhanced with a consistent homogeneity, with specificity accuracy is 92.86%, positive predictive value of 94.12% and accuracy of 96.67%. Meanwhile, Rosahl et al (2017) also stated that the high resolution contrast media may visualised very small tumor and post-operative evaluation to assist feature recurrent scars or residual tumor tissue. He also highlighted the important of FLAIR sequence is mainly to exclude any interfering pathologies. Strasila and Sychra (2016) and Farid (2014) also claimed high resolution sequence and gadolinium based contrast media is crucial.
Both articles confirmed the basic features for MRI machine is 1.5 Tesla, T2-weighted and T1-weighted 3D, turbo-spin echo sequence as the basic protocol in detecting acoustic neuroma. This statement is also supported by Rosahl et al (2017) and Strasila and Sychra (2016), where the protocol used in MRI as the same but also include FLAIR, spin echo, 3D gradient echo or 3D-turbo spin echo as additional sequence.
Based on Farid (2014), FLAIR sequence is best for hearing loss case as it shows a better elevation of intra-labyrinthine protein and accumulation or obstruction at cochlear aperture. He also had discussed the appearance of the lesions usually iso-intense in T1 and hyper-intense on T2, however in appear a hypo-intense filling defect when using 3D heavily T2-weighted sequence. After using contrast, the VS usually show an intense enhancement whether homogeneous or non-homogeneous appearance
CT scan VS MRI scan
Strasila and Sychra (2016) is the strongest literature that mentioned MRI scan is far better in detection of vestibular schwannoma as compare to CT scan. As MRI become the routine method for post resection and radiosurgery of vestibular schwannoma, has ability to detect extension of infection if exist. They also argue that CT scan is best for visualizing bony structure and limited to preoperative planning and post-operative care. Lin and Crane (2017) claimed that MRI is the first option to evaluate the vestibular schwannoma. Both articles recommended contrast enhanced CT of temporal bone is an alternative or those MRI contraindicated. Curtin and Hirsch (2008) also supported that CT scan examination is still a reliable imaging to demonstrate bony part including petrous bone and labyrinth that might useful for pre-operative planning of lesion removal. Farid N. (2014), claimed that CT has ability to provide important details of temporal bone and osseous labyrinth but still MRI scan become the best in evaluating cerebellopontine angle pathology due to high contrast enhancement in soft tissue.
All the literature agreed that both CT and MRI can detect moderate-large size of vestibular schwannoma but MRI is better for small-moderate size due to superior contrast resolution, including MacKeith, Kerr and Milford (2013). In other perspective, MRI was greatly assist in reducing mortality and morbidity rate today. (Philip et al, 2009).
Other literature like Newton et al (2010), due to limiting factor which is cost to implement contrast enhanced MRI for early detection, there other diagnostic tool and method exist to detect acoustic neuroma such as audiometry tool. Another method like histopathology also can be used instead of MRI scan as mentioned by Ahmad et al (2014).
Conclusion
In brief, MRI scan is the gold standard modality in detection of small sized vestibular schwannoma as it used for pre-operative planning and post-operative management. However, the CT scan also can be the alternative modalities in case for trauma patient and MRI contraindicated.
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