Intracranial paragangliomas versus schwannomas: Role of dynamic susceptibility contrast perfusion and diffusion MRI

Yoshiaki Ota; Eric Liao; Aristides A Capizzano; Akira Baba; Ryo Kurokawa; Mariko Kurokawa; Ashok Srinivasan

doi:10.1111/jon.13002

Intracranial paragangliomas versus schwannomas: Role of dynamic susceptibility contrast perfusion and diffusion MRI

J Neuroimaging. 2022 Sep;32(5):875-883. doi: 10.1111/jon.13002. Epub 2022 May 12.

Authors

Yoshiaki Ota¹, Eric Liao¹, Aristides A Capizzano¹, Akira Baba¹, Ryo Kurokawa¹, Mariko Kurokawa¹, Ashok Srinivasan¹

Affiliation

¹ Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Background and purpose: Differentiating paragangliomas from schwannomas and distinguishing sporadic from neurofibromatosis type 2 (NF 2)-related schwannomas is challenging but clinically important. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) and diffusion-weighted imaging (DWI) in discriminating infratentorial extra-axial schwannomas from paragangliomas and NF2-related schwannomas.

Methods: This retrospective study included 41 patients diagnosed with paragangliomas, sporadic schwannomas, and NF2-related schwannomas in the infratentorial extra-axial space between April 2013 and August 2021. All cases had pretreatment DSC-MRI and DWI. Normalized mean apparent diffusion coefficient (nADCmean), normalized relative cerebral blood volume (nrCBV), and normalized relative cerebral blood flow (nrCBF) were compared between paragangliomas and schwannomas and between sporadic and NF2-related schwannomas as appropriate.

Results: nrCBV and nrCBF were significantly higher in paragangliomas than in sporadic/NF2-related schwannomas (nrCBV: median 11.5 vs. 1.14/3.74; p < .001 and .004, nrCBF: median 7.43 vs. 1.13/2.85; p < .001 and .007, respectively), while nADCmean were not. The corresponding diagnostic performances were area under the curves (AUCs) of .99/.92 and 1.0/.90 with cutoffs of 2.56/4.22 and 1.94/3.36, respectively. nADCmean were lower, and nrCBV and nrCBF were higher in NF2-related than in sporadic schwannomas (nADCmean: median 1.23 vs. 1.58, nrCBV: median 3.74 vs. 1.14, nrCBF: median 2.85 vs. 1.13; all p < .001), and the corresponding diagnostic performances were AUCs of .93, .91, and .95 with cutoffs of 1.37, 2.63, and 2.48, respectively.

Conclusions: DSC-MRI and DWI both can aid in differentiating paragangliomas from schwannomas and sporadic from NF2-related schwannomas.

Keywords: DSC perfusion MRI; DWI; NF2; paraganglioma; vestibular schwannoma.

MeSH terms

Diffusion Magnetic Resonance Imaging
Humans
Neurilemmoma* / diagnostic imaging
Neurofibromatosis 2*
Paraganglioma* / diagnostic imaging
Perfusion
Retrospective Studies