Umut Percem ORHAN SOYLEMEZ, Başak ATALAY, Nesrin GÜNDÜZ

Vestibüler Şıvannomlarda Koos Sınıflaması ile ADC- Post Kontrast Sinyal İntensite Değerlerinin İlişkisi

Amaç: Vestibüler şıvannomların evrelemesinde kullanılan Koos sınıflamasının gözlemciler arası güvenilirliğini belirlemek, bu sınıflamanın Görünür Difüzyon Katsayısı (ADC) ve kontrast sonrası sinyal intensite değerleri ile korelasyonunu değerlendirmek. Yöntemler: Hastane veri tabanından 4 yıllık süre içerisinde radyolojik raporlamada vestibuler şıvannom tanısı yer almış olan MR görüntüleri retrospektif olarak tarandı. Lezyonların Koos sınıflamasına göre derecesi, klinik ve patolojik verilere kör olan iki bağımsız radyolog tarafından değerlendirildi. Koos sınıflamasının gözlemciler arası uyumunu analiz etmek için Cohen's Kappa; ADC, sinyal intensite ölçümleri ve Koos tümör derecesi arasındaki korelasyonu saptamada Kendall's tau b korelasyon katsayısı kullanıldı. Bulgular: 34 vestibüler şıvannom, 33 hasta (21 kadın, ortalama yaş 52.6±16.6 yıl) çalışmaya dahil edildi. Güvenilirlik analizleri, ADC (ICC: 0.93, %95 GA: 0.87-0.97, p

Anahtar Kelimeler:

Vestibular Şıvannoma, Manyetik Rezonans Görüntüleme, Koos sınıflaması, Görünür Difüzyon Katsayısı

The Relationship Between Koos Classification and ADC-Post-Contrast Signal Intensity Values of Vestibular Schwannomas

Aim: To determine the interobserver reliability of the Koos classification which is used for grading vestibular schwannomas and to evaluate its correlation with Apperent Diffusion Coefficiency (ADC) and post contrast signal intensity values. Methods: Vestibular schwannomas were retrospectively scanned from picture archiving and communication system over a 4-year period. Koos grade of tumor was assessed by two radiologists blinded to the clinical and pathological data. Cohen’s Kappa was used to analyse interobserver agreement of Koos grade. The correlation between ADC, signal intensity measurements and Koos grade of tumors was analysed with Kendall’s tau b correlation coefficient. Results: 33 patients (21 females, mean age 52.6±16.6 years) with 34 vestibular schwannomas were included the study. The reliability analyses revealed excellent inter-observer agreement for ADC (ICC: 0.93, 95% CI: 0.87-0.97, p

Keywords:

Vestibular Schwannoma, Magnetic Resonance Imaging, Koos classification, Apperent Diffusion Coefficiency,

PDF

___

1. Lin D, Hegarty JL, Fischbein NJ, Jackler RK. The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 2005 Mar; 131(3):241-4.
2. Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 20. Jan 11;22(1):31-45.
3. Evans DG, Moran A, King A, Saeed S, Gurusinghe N, Ramsden R. Incidence of vestibular schwannoma and neurofibromatosis 2 in the North West of England over a 10-year period: higher incidence than previously thought. Otol Neurotol. 2005 Jan;26(1):93-7.
4. Singh K, Singh MP, Thukral C, Rao K, Singh K, Singh A. Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas. Indian J Otolaryngol Head Neck Surg. 2015 Mar;67(1):21-7.
5. De Foer B, Kenis C, Van Melkebeke D, Vercruysse JP, Somers T, Pouillon M. et al. Pathology of the vestibulocochlear nerve. Eur J Radiol. 2010 May;74(2):349-58. doi: 10.1016/j.ejrad.2009.06.033. Epub 2010 Mar 27. PMID: 20347243.
6. Leon J, Lehrer EJ, Peterson J, Vallow L, Ruiz-Garcia H, Hadley A. et al. Observation or stereotactic radiosurgery for newly diagnosed vestibular schwannomas: A systematic review and meta-analysis. J Radiosurg SBRT. 2019;6(2):91-100.
7. Koos WT, Day JD, Matula C, Levy DI. Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg. 1998 Mar;88(3):506-12. doi: 10.3171/jns.1998.88.3.0506. PMID: 9488305.
8. Erickson NJ, Schmalz PGR, Agee BS, Fort M, Walters BC, McGrew BM. et al. Koos Classification of Vestibular Schwannomas: A Reliability Study. Neurosurgery. 2019 Sep 1;85(3):409-414.
9. Rueß D, Pöhlmann L, Grau S, Hamisch C, Hoevels M, Treuer H. et al. Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system. Sci Rep. 2020 Jun 9;10(1):930
10. Régis J, Carron R, Moucharrafien S, Delsantin C, Porcheron D, Thomassin JM. et al. Radiochirurgie et radiothérapie stéréotaxique des schwannomes vestibulaires [Role of radiosurgery and stereotactic radiotherapy in the management of vestibular schwannomas]. Cancer Radiother. 2012 Jun;16 Suppl:S70-8.
11. Morton RP, Ackerman PD, Pisansky MT, Krezalek M, Leonetti JP, Raffin MJ. et al. Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection. J Neurosurg. 2011 Feb;114(2):375-80
12. Copeland W, Hoover J, Morris J, Driscoll C, Link M Use of preoperative MRI to predict vestibular schwannoma intraoperative consistency and facial nerve outcome. J Neurol Surg B Skull Base; 2013; 74:347–350.
13. Kunigelis KE, Hosokawa P, Arnone G, Raban D, Starr A, Gurau A. et al. The predictive value of preoperative apparent diffusion coefficient (ADC) for facial nerve outcomes after vestibular schwannoma resection: clinical study. Acta Neurochir (Wien). 2020 Aug;162(8):1995-2005.
14. Lin EP, Crane BT. The Management and Imaging of Vestibular Schwannomas. AJNR Am J Neuroradiol. 2017 Nov;38(11):2034-2043. 15. Xu XQ, Li Y, Hong XN, Wu FY, Shi HB. Radiological indeterminate vestibular schwannoma and meningioma in cerebellopontine angle area: differentiating using whole-tumor histogram analysis of apparent diffusion coefficient. Int J Neurosci. 2017 Feb;127(2):183-190
16. Huang CF, Chiou SY, Wu MF, Tu HT, Liu WS, Chuang JC. Apparent diffusion coefficients for evaluation of the response of brain tumors treated by Gamma Knife surgery. J Neurosurg. 2010 Dec;113 Suppl:97-104.