Background: The vestibular schwannoma (VS) is the most common cerebellopontine angle tumor in adults, exhibiting a highly variable natural history, from stability to rapid growth. Accurate, the non-invasive prediction of tumor behavior is essential to guide personalized management and avoid overtreatment or delayed intervention.Objective: To systematically review and synthesize the evidence on MRI-based biomarkers for predicting VS growth and treatment responses.Methods: We conducted a PRISMA-compliant search of PubMed, EMBASE, and Cochrane databases for studies published between 1 January 2000 and 1 January 2025, addressing MRI predictors of VS growth. Cohort studies evaluating texture features, signal intensity ratios, perfusion parameters, and apparent diffusion coefficient (ADC) metrics were included. Study quality was assessed using the NOS (Newcastle–Ottawa Scale) score, GRADE (Grading of Recommendations, Assessment, Development and Evaluation), and ROBIS (Risk of Bias in Systematic reviews) tool. Data on diagnostic performance, including the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, andpvalue, were extracted and descriptively analyzed.Results: Ten cohort studies (five retrospective, five prospective, totaln= 525 patients) met the inclusion criteria. Texture analysis metrics, such as kurtosis and gray-level co-occurrence matrix (GLCM) features, yielded AUCs of 0.65–0.99 for predicting volumetric or linear growth thresholds. Signal intensity ratios on gadolinium-enhanced T1-weighted images for tumor/temporalis muscle achieved a 100% sensitivity and 93.75% specificity. Perfusion MRI parameters (Ktrans, ve, ASL, and DSC derived blood-flow metrics) differentiated growing from stable tumors with AUCs up to 0.85. ADC changes post-gamma knife surgery predicted a favorable response, though the baseline ADC had limited value for natural growth prediction. The heterogeneity in growth definitions, MRI protocols, and retrospective designs remains a key limitation.Conclusions: MRI-based biomarkers may provide exploratory signals associated with VS growth and treatment responses. However, substantial heterogeneity in growth definitions and MRI protocols, small single-center cohorts, and the absence of external validation currently limit clinical implementation.
背景：前庭神经鞘瘤（VS）是成人最常见的桥小脑角区肿瘤，其自然病程差异显著，可从稳定状态到快速生长。准确、无创地预测肿瘤行为对于指导个体化治疗、避免过度治疗或延误干预至关重要。目的：系统综述并整合基于MRI的生物标志物预测前庭神经鞘瘤生长及治疗反应的证据。方法：按照PRISMA指南，检索PubMed、EMBASE和Cochrane数据库中2000年1月1日至2025年1月1日发表的研究，探讨前庭神经鞘瘤生长的MRI预测因子。纳入评估纹理特征、信号强度比、灌注参数和表观弥散系数（ADC）指标的队列研究。研究质量采用NOS（纽卡斯尔-渥太华量表）评分、GRADE（推荐分级的评估、制定与评价）和ROBIS（系统评价偏倚风险）工具进行评估。提取诊断性能数据（包括受试者工作特征（ROC）曲线下面积（AUC）、敏感性、特异性和p值）并进行描述性分析。结果：十项队列研究（五项回顾性、五项前瞻性，共525例患者）符合纳入标准。纹理分析指标（如峰度和灰度共生矩阵（GLCM）特征）预测体积或线性生长阈值的AUC为0.65–0.99。钆增强T1加权图像上肿瘤/颞肌的信号强度比实现了100%的敏感性和93.75%的特异性。灌注MRI参数（Ktrans、ve、ASL及DSC衍生的血流指标）可区分生长型与稳定型肿瘤，AUC最高达0.85。伽玛刀术后ADC变化可预测良好治疗反应，但基线ADC对自然生长的预测价值有限。生长定义、MRI方案和回顾性设计的异质性仍是主要局限。结论：基于MRI的生物标志物可为前庭神经鞘瘤生长和治疗反应提供探索性预测信号。然而，生长定义和MRI方案的显著异质性、小型单中心队列研究以及缺乏外部验证，目前限制了其临床转化应用。
MRI-Based Prediction of Vestibular Schwannoma: Systematic Review
肿瘤(癌症)患者之家