title: Analysis of vestibular schwannoma size in multiple dimensions: a comparative cohort study of different measurement techniques.
abstract: OBJECTIVE
  In this volumetric study of the vestibular schwannoma, we evaluated the accuracy and reliability of several approximation methods that are in use, and determined the minimum volume difference that needs to be measured for it to be attributable to an actual difference rather than a retest error. We also found empirical proportionality coefficients for the different methods. DESIGN/SETTING AND PARTICIPANTS: Methodological study with investigation of three different VS measurement methods compared to a reference method that was based on serial slice volume estimates. These volume estimates were based on: (i) one single diameter, (ii) three orthogonal diameters or (iii) the maximal slice area. Altogether 252 T1-weighted MRI images with gadolinium contrast, from 139 VS patients, were examined.
  
  
  METHODS
  The retest errors, in terms of relative percentages, were determined by undertaking repeated measurements on 63 scans for each method. Intraclass correlation coefficients were used to assess the agreement between each of the approximation methods and the reference method. The tendency for approximation methods to systematically overestimate/underestimate different-sized tumours was also assessed, with the help of Bland-Altman plots.
  
  
  RESULTS
  The most commonly used approximation method, the maximum diameter, was the least reliable measurement method and has inherent weaknesses that need to be considered. This includes greater retest errors than area-based measurements (25% and 15%, respectively), and that it was the only approximation method that could not easily be converted into volumetric units. Area-based measurements can furthermore be more reliable for smaller volume differences than diameter-based measurements.
  
  
  CONCLUSIONS
  All our findings suggest that the maximum diameter should not be used as an approximation method. We propose the use of measurement modalities that take into account growth in multiple dimensions instead.
authors.affiliation: Institute of Surgical Sciences, University of Bergen, Bergen, Norway. jobinv@gmail.com
authors.forename: J K
authors.initials: JK
authors.lastname: Varughese
authors.forename: T
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: F
authors.initials: F
authors.lastname: Vassbotn
authors.forename: G
authors.initials: G
authors.lastname: Moen
authors.forename: M
authors.initials: M
authors.lastname: Lund-Johansen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004428:Ear Neoplasms / Q000473:pathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D015994:Incidence; D007554:Isotopes; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D015588:Observer Variation; D016634:Radiosurgery / Q000295:instrumentation; D015203:Reproducibility of Results; D012107:Research Design
chemical_list: D007554:Isotopes; D005682:Gadolinium