title: Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma.
abstract: OBJECTIVE
  The added value of perfusion MRI for decision-making in vestibular schwannoma (VS) patients is unknown. MRI offers two perfusion methods: the first employing contrast agent (dynamic susceptibility contrast (DSC)-MRI) that provides information on cerebral blood volume (CBV) and cerebral blood flow (CBF), the second by magnetic labeling of blood (arterial spin labeling (ASL)-MRI), providing CBF-images. The goal of the current study is to investigate whether DSC and ASL perfusion MRI provides complimentary information to current anatomical imaging in treatment selection process of VS.
  
  
  METHODS
  Nine patients with growing VS with extrameatal diameter >9 mm were included (>2 mm/year and 20% volume expansion/year) and one patient with 23 mm extrameatal VS without growth. DSC and ASL perfusion MRI were obtained on 3 T MRI. Perfusion in VS was scored as hyperintense, hypointense or isointense compared to the contralateral region.
  
  
  RESULTS
  Seven patients showed hyperintense signal on DSC and ASL sequences. Three patients showed iso- or hypointense signal on at least one perfusion map (1 patient hypointense on both DSC-MRI and ASL; 1 patient isointense on DSC-CBF; 1 patient isointense on ASL). All patients showed enhancement on post-contrast T1 anatomical scan.
  
  
  CONCLUSIONS
  Perfusion MR provides additional information compared to anatomical imaging for decision-making in VS.
authors.affiliation: ENT Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Kleijwegt
authors.affiliation: ENT Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A G L
authors.initials: AG
authors.lastname: van der Mey
authors.affiliation: Radiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F T
authors.initials: FT
authors.lastname: Wiggers-deBruine
authors.affiliation: Neurosurgery Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M J A
authors.initials: MJ
authors.lastname: Malessy
authors.affiliation: C.J. Gorter Center for High Field MRI, Radiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M J P
authors.initials: MJ
authors.lastname: van Osch
keywords: AAO-HNS, American Academy of Otolaryngology-Head and Neck Surgery; ASL, arterial spin labeling; CA, contrast agent; CBF, cerebral blood flow; CBV, cerebral blood volume; DSC, dynamic susceptibility contrast; Decision making; Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL); EPI, echo planar imaging; FA, flip angle; FOV, field of view; Gd, gadolinium; MR, magnetic resonance; MRI, magnetic resonance imaging; PCASL, pseudo-continuous arterial spin labeling; Perfusion weighted MR; RF, radiofrequency; SNR, signal to noise ratio; TE, echo time; TR, repetition time; VS, vestibular schwannoma; Vestibular schwannoma; rCBV, relative CBV