Volumetric growth rates of untreated vestibular schwannomas

2020 ◽  
Vol 133 (3) ◽  
pp. 742-748 ◽  
Author(s):  
Zane Schnurman ◽  
Aya Nakamura ◽  
Michelle W. McQuinn ◽  
John G. Golfinos ◽  
J. Thomas Roland ◽  
...  
Keyword(s):  
Growth Rate ◽  
High Resolution ◽  
Volume Change ◽  
Growth Rates ◽  
Slice Thickness ◽  
Mr Images ◽  
Volumetric Growth ◽  
Volume Increase ◽  
The Mean ◽  
Over Time

OBJECTIVEThere remains a large discrepancy among surgeons in expectations of vestibular schwannoma (VS) growth. The anticipated growth rate of a VS and its potential clinical impact are important factors when deciding whether to observe the lesion over time or to intervene. Previous studies of VS natural growth remain limited, mostly confined to linear measurements, often without high-resolution, thin-sequence imaging. The present study comprehensively assessed natural tumor growth rates using volumetric measurements.METHODSBetween 2012 and 2018, 212 treatment-naïve patients diagnosed with a unilateral VS were evaluated. A total of 699 MR images were assessed, with a range of 2–11 MR images per patient. All MR images preceded any intervention, with patients subsequently being observed through completion of data analysis (36%) or treated with stereotactic radiosurgery (32%) or microsurgical resection (32%). To determine precise tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (99% of scans were ≤ 1-mm slice thickness). A multilevel model with random effects was used to assess the mean volume change over time. Each tumor was categorized as one of the following: growing (volume increase by more than 20% per year), fast growing (volume increase by more than 100% per year), stable (volume change between 20% decrease and 20% increase per year), and shrinking (volume decrease by more than 20% per year).RESULTSThe mean VS volumetric growth rate was 33.5% per year (95% CI 26.9%–40.5%, p < 0.001). When assessing the frequencies of individual tumor annual growth rates, 66% demonstrated growth (30% fast growing), 33% were stable, and 1% exhibited shrinking over an average interval of 25 months. Larger tumors were associated with increased absolute growth, but there was no relationship between tumor size and proportional growth rate. There was also no relationship between patient age and tumor growth rate.CONCLUSIONSThis study comprehensively assessed VS volumetric growth rates using high-resolution images and was conducted in a large and diverse patient sample. The majority of the tumors exhibited growth, with about one-third growing at a rate of 100% per year. These findings may contribute to a consensus understanding of tumor behavior and inform clinical decisions regarding whether to intervene or observe.

scholarly journals How do spinal schwannomas progress? The natural progression of spinal schwannomas on MRI

2016 ◽  
Vol 24 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Kei Ando ◽  
Shiro Imagama ◽  
Zenya Ito ◽  
Kazuyoshi Kobayashi ◽  
Hideki Yagi ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Mr Images ◽  
Relative Growth ◽  
Relative Growth Rates ◽  
Natural Progression ◽  
Rim Enhancement ◽  
Absolute Growth ◽  
The Mean

OBJECT Little is known about the progression of spinal schwannomas. The aim of this study was to determine the natural progression of spinal schwannomas and establish the risk of tumor growth. METHODS This study retrospectively analyzed data from 23 patients (12 men and 11 women, 40–89 years old) with schwannomas detected by MRI. The mean follow-up period was 5 years (range 2–10 years). The absolute and relative growth rates of the tumors were calculated. RESULTS The average tumor size was 1495 mm3 at the initial visit and 2224 mm3 at the final follow-up. The average absolute growth rate was 139 mm3 per year, and the average relative growth rate was 5.3% per year. Tumors were classified into 3 groups based on enhancement patterns: isointense/hyperintense (iso/high; 11 cases), rim enhancement when enhancement was peripheral (high/rim; 5 cases), and heterogeneous/heterogeneous (hetero/hetero; 7 cases) based on Gd-enhanced T2-weighted MRI. The average absolute growth rates of the 3 lesion groups were 588 mm3, 957 mm3, and 3379 mm3, respectively (p < 0.01). CONCLUSIONS Although the tumors classified as iso/high and high/rim on T2-weighted Gd-enhanced MR images were small and grew very little, most tumors with hetero/hetero classification increased in size. Hetero/hetero-type tumors should be followed closely and may require surgery.

Volumetric growth rates of untreated cavernous sinus meningiomas

2021 ◽  
pp. 1-8
Author(s):  
Carolina Gesteira Benjamin ◽  
Zane Schnurman ◽  
Kimberly Ashayeri ◽  
Eman Kazi ◽  
Reed Mullen ◽  
...  
Keyword(s):  
Growth Rate ◽  
Cavernous Sinus ◽  
Growth Rates ◽  
Growth Pattern ◽  
Observation Interval ◽  
Annual Growth ◽  
Patient Treatment ◽  
Annual Growth Rate ◽  
Mr Images ◽  
Volumetric Growth

OBJECTIVE Meningiomas that arise primarily within the cavernous sinus are often believed to be more indolent in their growth pattern. Despite this perceived growth pattern, disabling symptoms can arise even with small tumors. While research has been done on cavernous sinus meningiomas (CSMs) and their treatment, very little is known about their natural growth rates. With a better understanding of the growth rate of CSM, patient treatment and guidance can be can optimized and individualized. The goal of this study was to determine volumetric growth rates of untreated CSMs. METHODS Thirty-seven patients with 166 MR images obtained between May 2004 and September 2019 were reviewed, with a range of 2–13 MR images per patient (average of 4.5 MR images per patient). These scans were obtained over an average follow-up period of 45.9 months (median 33.8, range 2.8–136.9 months). All imaging prior to any intervention was included in this analysis. Volumetric measurements were performed and assessed over time. RESULTS The estimated volumetric growth rate was 23.3% per year (95% CI 10.2%–38.0%, p < 0.001), which is equivalent to an estimated volume doubling time (VDT) of 3.3 years (95% CI 2.1–7.1 years). There was no significant relationship between growth rate and patient age (p = 0.09) or between growth rate and patient sex (p = 0.78). The median absolute growth rate was 41% with a range of −1% to 1793%. With a definition of “growth” as an increase of greater than 20% during the observed period, 65% of tumors demonstrated growth within their observation interval. Growth rates for each tumor were calculated and tumors were segmented based on growth rate. Of 37 patients, 22% (8) demonstrated no growth (< 5% annual growth, equivalent to a VDT > 13.9 years), 32% (12) were designated as slow growth (annual growth rate 5%–20%, VDT 3.5–13.9 years), 38% (14) were found to have medium growth (annual growth rate 20%–100%, VDT 0.7–3.5 years), and 8% were considered fast growing (annual growth rate > 100%, VDT < 0.7 years). CONCLUSIONS This study evaluated CSM volumetric growth rates. A deeper understanding of the natural history of untreated CSMs allows for better counseling and management of patients.

scholarly journals Assessing mPTC Progression during Active Surveillance: Volume or Diameter Increase?

2021 ◽  
Vol 10 (18) ◽  
pp. 4068
Author(s):  
Maria Cristina Campopiano ◽  
Antonio Matrone ◽  
Teresa Rago ◽  
Maria Scutari ◽  
Alessandro Prete ◽  
...  
Keyword(s):  
Growth Rate ◽  
Active Surveillance ◽  
Growth Rates ◽  
Diameter Growth ◽  
Volume Increase ◽  
Node Metastases ◽  
The Mean ◽  
Definition Of ◽  
Immediate Surgery ◽  
Sensitive Marker

Active surveillance (AS) is considered an alternative to immediate surgery in micropapillary thyroid carcinoma (mPTC). However, the definition of clinical mPTC progression during AS is controversial. We evaluated changes in tumor size using both tumor diameters and volume in 109 patients with mPTC followed in an AS protocol for a mean period of 31 ± 18 months. At the time of data lock, 19/109 (17.4%) mPTC reached and maintained a volume increase of ≥50%. However, only 3/19 (15.7%) showed progression, according to the diameter increase. The remaining 16 showed a slight diameter growth without reaching the original protocol progression criteria. The mean mPTC growth rate in stable cases was 0.37 mm3/month, while it was significantly greater in the mPTC, which achieved a volume change ≥50% with respect to the other. The two mPTC that developed a significant diameter increase had a growth rate of 41 and 18 mm3/month. Instead, the growth rates of the three mPTC that developed lymph node metastases were 0, 2.5 and 16 mm3/month. The ≥50% volume increase appears to be a too sensitive marker of disease progression, with a downstream higher surgery rate. The assessment of growth rate could distinguish mPTC with high and low growth rates, which would allow us to tailor the algorithm of the evaluations to a more appropriate timing.

scholarly journals Ultrasound Surveillance of Ectatic Abdominal Aortas

2008 ◽  
Vol 90 (6) ◽  
pp. 477-482 ◽  
Author(s):  
S Devaraj ◽  
SR Dodds
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Screening Programme ◽  
T Test ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Ultrasound Screening ◽  
The Mean ◽  
Clinically Significant

INTRODUCTION Some studies have considered abdominal aortas of 2.6–2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6–2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients. PATIENTS AND METHODS Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6–2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to ≥ 3.0 cm and ≥ 5.0 cm in diameter were also calculated. RESULTS Out of 999 patients with AAA ≥ 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6–2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56–1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into ≥ 3.0 cm, 45 (13%) expanded to ≥ 5.0 cm and only 8 (2%) expanded to ≥ 5.5 cm over a mean follow-up of 5.4 years (range, 1–14 years). No ectatic aortas expanded to ≥ 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23–1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (≥ 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05–3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001). CONCLUSIONS One-third of patients undergoing AAA screening will have ectatic aortas (2.6–2.9 cm) and at least 13% of these will expand to a size of ≥ 5.0 cm over a follow-up of 4–14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to ≥ 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

Tumor Progression Following Petroclival Meningioma Subtotal Resection: A Volumetric Study

2017 ◽  
Vol 14 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Jacob B Hunter ◽  
Brendan P O’Connell ◽  
Matthew L Carlson ◽  
Lola C Chambless ◽  
Robert J Yawn ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Volumetric Growth ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
The Mean

Abstract BACKGROUND One study has investigated postoperative growth rates following subtotal resection of petroclival meningiomas utilizing linear measurements, which are insensitive to the multidimensional complex growth of meningiomas, to estimate tumor volume. OBJECTIVE To describe petroclival meningioma growth patterns following less-than-complete resection utilizing volumetric analysis and to identify variables associated with tumor progression. METHODS Patients with surgically resected WHO grade I petroclival meningiomas were retrospectively reviewed (1999-2015). Image analysis software was utilized to perform volumetric analyses of tumor size and growth on serial MRI studies. The impact of preoperative and postoperative variables on tumor growth after subtotal resection was analyzed. An increase in tumor volume of at least 20% was defined as “tumor growth.” RESULTS Twenty-three patients had immediate preoperative and serial postoperative MRI studies available for review. The mean preoperative tumor volume was 20.9 cm3 (range 0.4-54.6). The mean extent of resection was 75.5% (range 31.5%-100.0%). At a mean follow-up of 24.8 mo, 12 tumors (66.7%) exhibited radiological tumor growth, while 6 tumors did not change in size. The median annual volumetric growth rate was 2.82 cm3/yr (range –0.34 to 10.1). Extent of resection and immediate postoperative tumor volume were significantly correlated with the annual volumetric growth rate following resection. At last follow-up, 3 (13%) patients required further intervention. CONCLUSION The majority of petroclival meningiomas exhibit growth following subtotal resection. Extent of resection is strongly associated with risk for disease progression following surgery.

scholarly journals Growth Rate Variation and Larval Survival: Inferences from an Individual-Based Size-Dependent Predation Model

1993 ◽  
Vol 50 (1) ◽  
pp. 133-142 ◽  
Author(s):  
James A. Rice ◽  
Thomas J. Miller ◽  
Kenneth A. Rose ◽  
Larry B. Crowder ◽  
Elizabeth A. Marschall ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Individual Variability ◽  
Individual Growth ◽  
Rate Variation ◽  
High Survival ◽  
Initial Growth ◽  
Size Dependent ◽  
The Mean ◽  
Selection For

We used an individual-based Monte Carlo simulation model to explore how changes in the mean and variance of growth rates of individuals in a larval fish cohort interact with size-dependent predation to affect the number and characteristics of individual survivors. Small changes in initial cohort mean growth rate can change survival over the first 60 d of life 10-to 30-fold. But when variance in growth rate among individuals is high, survival can be substantially higher than expected from the initial mean cohort growth rate. Selection for faster-growing individuals becomes stronger with increasing variance and increasing predation rate. In some cases, > 80% of the survivors may come from the upper 25% of the initial growth rate distribution, and the mean growth rate of the survivors may exceed twice the initial mean growth rate. When individual growth rates change from day to day rather than remaining constant, the contribution of atypical individuals is accentuated even further. Counterintuitively, most of the selection for faster-growing individuals happens only after the majority of mortality has already taken place. These results suggest that interactions between individual variability and selective mortality may have important cohort-level implications for survival in fishes.

Longitudinal quantitative analysis of the tuber-to-brain proportion in patients with tuberous sclerosis

2013 ◽  
Vol 12 (1) ◽  
pp. 71-76 ◽  
Author(s):  
David S. Hersh ◽  
Jonathan Chun ◽  
Howard L. Weiner ◽  
Steven Pulitzer ◽  
Henry Rusinek ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Mr Images ◽  
Proliferation Markers ◽  
Cerebellar Lesions ◽  
The Mean ◽  
Minimum Interval ◽  
Changes Over Time ◽  
Single Time Point ◽  
Study Inclusion ◽  
Over Time

Object In patients with tuberous sclerosis complex (TSC), the tuber-to-brain proportion (TBP) is a marker of seizure severity and cognitive function. However, few studies have quantified the TBP. Furthermore, authors of these studies have measured the TBP at only a single time point, despite the fact that tuber cells were found to express proliferation markers, suggesting that they may be dynamic lesions. Authors of the present study used a semi-automated tuber segmentation program to determine whether the TBP changes over time. Methods Axial FLAIR MR images were retrospectively identified for patients with TSC who had undergone imaging at the authors' institution between February 1998 and June 2009. Using FireVoxel software, the TBP was measured for each patient at a minimum interval of 2 years. Results Twelve patients meeting the study inclusion criteria were identified. The mean TBP was 1.88% (range 0.38%–3.70%). Eight patients demonstrated minimal changes and 3 patients demonstrated small increases in TBP. The remaining patient exhibited a decrease of 1.00%, which correlated with a visible decrease in the size of 2 cerebellar lesions. Conclusions Semi-automated brain segmentation is a valuable tool in the longitudinal study of tubers. A subset of patients with TSC, particularly those with cerebellar lesions, may exhibit changes in the TBP over time.

Osteonecrosis diagnosed on MR images of the knee: Relationship to reduced bone mineral density determined by high resolution peripheral quantitative CT

2003 ◽  
Vol 44 (5) ◽  
pp. 525-531 ◽  
Author(s):  
M. Zanetti ◽  
J. Romero ◽  
M. A. Dambacher ◽  
J. Hodler
Keyword(s):  
Bone Mineral Density ◽  
High Resolution ◽  
Distal Radius ◽  
Bone Mineral ◽  
Insufficiency Fracture ◽  
Mr Images ◽  
Mineral Density ◽  
Quantitative Ct ◽  
Tibial Condyle ◽  
The Mean

Purpose: To evaluate if osteonecrosis diagnosed on MR images of the knee relates to reduced bone mineral density (BMD) and may be caused by an insufficiency fracture. Material and Methods: Thirty-two consecutive patients (8 men, 24 women; age range 27–82 years, mean 62 years) with MR findings of osteonecrosis of the femoral or tibial condyle were prospectively included. Trabecular and cortical BMD were measured with high resolution peripheral quantitative CT in the non-dominant distal radius and the tibia of the involved extremity. One tibia was not measured due to posttraumatic deformity. Results: The mean trabecular BMD of the radius was 81% of the young-adult average peak BMD (range 19–160%). The mean cortical BMD in the radius was 86% (range 63–108%). The mean trabecular BMD in the tibia was 92% (range 28–160%). The mean cortical BMD in the tibia was 86% (range 49–132%). The values of the trabecular bone of the distal radius (tibia) were normal in 11 (15) patients, osteopenic in 12 (4), and osteoporotic in 9 (12), respectively. The cortical bone values of the distal radius (tibia) were normal in 12 (13) patients, osteopenic in 12 (12), and osteoporotic in 8 (6), respectively. Conclusion: Osteoporosis and osteopenia are commonly found in patients with osteonecrosis of the knee as diagnosed on MR images. This indicates that for some patients an insufficiency mechanism may be responsible for the MR findings. However, in the patients with normal bone density other reasons for osteonecrosis may be present.

scholarly journals The Growth Rate Of Verruca Stroemia (O. Müller)

1958 ◽  
Vol 37 (2) ◽  
pp. 427-433 ◽  
Author(s):  
H. Barnes
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Specific Growth ◽  
Maximum Size ◽  
Rhythmic Pattern ◽  
The Mean ◽  
Rhythmic Growth ◽  
Specific Growth Rates ◽  
High Level ◽  
Balanus Balanoides

Data are presented on the growth rate of Verruca stroemia under natural conditions and when exposed continuously and cleaned repeatedly. Several series exposed at different times of the year were followed.Rapid growth takes place (under raft conditions) following settlement; the maximum size is virtually reached in one season's growth between spring and early winter. There is little growth in midwinter.Differences between the mean specific growth rates of the various series can be ascribed to differences in the availability of food.The question is discussed as to whether there is any seasonal rhythm; the evidence indicates that no marked rhythmic pattern of growth exists.Observations on deep-water populations would be of value for comparison and to unmask any relatively weak rhythmic growth.The mean specific growth rates at half their maximum size are compared for several species—Balanus balanoides, B. crenatus, B. balanus, Chthamalus stellatus and Verruca stroemia; it is similar for all species except Chthamalus stellatus. The high level barnacle may require stimulation such as is provided by wave action to elicit full metabolic activity.

P14.02 The Natural History of a Residual Intracranial Meningioma- Volumetric Growth and Predictors of Progression

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii38-ii38
Author(s):  
C S Gillespie ◽  
G E Richardson ◽  
M A Mustafa ◽  
A I Islim ◽  
S M Keshwara ◽  
...  
Keyword(s):  
Growth Rate ◽  
Prognostic Factors ◽  
Skull Base ◽  
Growth Rates ◽  
Multivariable Analysis ◽  
Volumetric Growth ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Base Location

Abstract BACKGROUND Resection of meningioma leaves residual solid tumour in ~25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and associated prognostic factors. MATERIAL AND METHODS Growth rates were assessed using a linear mixed effects model, in a retrospective adult cohort that underwent subtotal resection of meningioma (2004–2018). Endpoints were re-treatment, end of follow-up or death. Cox regression analysis was used to identify prognostic factors for progression, defined using the Response Assessment in Neuro-Oncology (RANO) volumetric criteria. RESULTS 236 patients were included. Mean age at surgery was 56.3 years (SD=13.7) and 73.7% were female. WHO grades were 1 (n=195, 82.6%), 2 (n=40, 16.9%) and 3 (n=1, 0.5%). Adjuvant fractionated radiotherapy (fRT) was administered to 34 patients (14.4%), with no propensity towards higher WHO grade or residual volume. Median pre-operative meningioma and post-operative residual volumes were 34.0cm3 (IQR 16.0–63.0) and 2.0cm3 (IQR 0.8–5.2), respectively. Median follow-up was 64 months (IQR 42–104). Median absolute growth rate (AGR) and relative growth rate (RGR) were 0.1cm3/year and 4.3%/year, respectively. According to RANO criteria, 132 (55.9%) patients progressed, of which 13 (9.8%) developed symptoms. Median progression-free survival was 56 months (95% CI 43.1–69.0). Multivariable analysis identified adjuvant fRT (HR 1.7, [95% CI 1.0–2.8], P=0.046), skull base location (HR 1.5, [95% CI 1.0–2.4], P=0.047) and Ki-67 index (HR 3.7 [95% CI 1.3–10.8], P=0.017) as prognostic factors for volumetric progression. WHO grade was not significant (HR 1.0, [95% CI 0.5–1.7], P=0.905). Forty-nine patients who progressed (37.1%) underwent further treatment: fRT (n=19), re-operation (n=15), Stereotactic radiosurgery (SRS) (n=10) and surgery+adjuvant fRT (n=5). Of those, 8 (16.3%) progressed further (after re-operation [n=6] and SRS [n=2]). Seven were treated with a 2nd re-operation (n=3), fRT (n=3), and SRS (n=1). One patient progressed after a 2nd reoperation and was treated with SRS, after which they remained stable. Median survival was not reached. 5- and 10-year overall survival (OS) was 96% and 86% respectively. CONCLUSION Growth rates of a residual meningioma vary with a dichotomy observed in progression rates. Half of patients with a residual meningioma showed radiological progression requiring multiple treatment to control the tumour. The other half demonstrate a more indolent course. Skull base location and higher Ki67 are important prognostic factors for progression and therefore, should be considered to stratify patients for adjuvant radiotherapy.

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