Should we be moving to a national standardized non-gadolinium MR imaging protocol for the surveillance of vestibular schwannomas?

Abstract

Getting It Right First Time (GIRFT) is a UK national programme designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. 1 Imaging performed for the surveillance of patients with non-operated brain tumours such as vestibular schwannomas is a practice that may benefit from the GIRFT model. Vestibular schwannomas (vs), also known as acoustic neuromas, are benign tumours that originate from the Schwann cells of the vestibular nerve sheath and typically occur in the cerebellopontine angle and internal auditory canal. 2 They account for 10% of all brain neoplasms and studies have approximated their incidence to 10-20 cases per million people per year, although this is likely an

High-Resolution T2-Weighted Imaging for Surveillance in Postoperative Vestibular Schwannoma: Equivalence with Contrast-Enhanced T1WI for Measurement and Surveillance of Residual Tumor

“…Studies also shown noncontrast T2WI to be accurate in the detection of interval growth in patients with known, surgically-naïve vestibular schwannoma. 17,18 To our knowledge, no studies exist examining the use of noncontrast T2WI for postoperative surveillance.…”

Can I Diagnose a Vestibular Schwannoma Using Non-Contrast Imaging?

“…2 These steady-state imaging sequences currently include various manufacturer-specific sequences such as CISS (Constructive Interference into Steady State, Siemens), FIESTA-C (Fast Imaging Employing Steady-state Acquisition Cycled Phases, GE), DRIVE (Driven Equilibrium Radiofrequency Reset Pulse, Philips), bFFE (Balanced Fast Field Echo, Philips) and SPACE (Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions, Siemens). 3 The submillimeter-resolution images from these sequences can be manipulated on computer-based DICOM imaging software to provide reformatted images in non-orthogonal planes that allow visualization of the entire 8 th cranial nerve, from the brainstem to the fundus of the internal auditory canal. In these sequences, cerebrospinal fluid (CSF) displays a high signal intensity that provides an excellent contrasting background to the inherent low signal intensity of the 7 th and 8 th cranial nerves.…”