Volumetric Analysis Outperforms Linear Measurements in Assessing Growth Patterns of Vestibular Schwannomas

Saturday, October 17, 2026

2:36 PM - 2:42 PM PT

Location: 515B

Presenting Author(s)

Andre Joseph Burnham, MD

Resident Physician
Washington University School of Medicine
Saint Louis, MO, United States

Co-Author(s)

AW

Amit Walia, MD

Neurotology Fellow
Washington University/B-JH/SLCH Consortium
St. Louis, MO, United States
Matthew A. Shew, MD

Assistant Professor
Washington University School of Medicine
St. Louis, MO, United States
PJ

Pawina Jiramongkolchai, MD

Assistant Professor
Washington University in St. Louis, United States
JH

Jacques A. Herzog, MD

Professor of Otolaryngology—Head & Neck Surgery
Washington University School of Medicine
Creve Couer, MO, United States

Senior Author(s)

ND

Nedim Durakovic, MD

Associate Professor
Washington University School of Medicine
Saint Louis, MO, United States

Disclosure(s):

Andre Joseph Burnham, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nedim Durakovic, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Accurate assessment of tumor growth is central to the management of vestibular schwannomas (VS); however, conventional MRI reporting often relies on linear measurements in axial or two-dimensional planes, which may inadequately capture true tumor growth. Here, we utilized the Sectra manual volumetric tool to measure growth in vestibular schwannomas.

Methods: We performed a retrospective longitudinal analysis of patients with VS undergoing serial MRI imaging for tumor surveillance between 2013 and 2025 at a single institution. Tumor growth (defined as greater than a 10% change) was assessed using volumetric measurements obtained via the Sectra IDS7 manual volume measurement tool or contemporaneous radiology reports describing two-dimensional growth between initial diagnosis and the most recent imaging.

Results: A total of 54 patients with vestibular schwannomas met inclusion criteria, with a median imaging follow-up of 31.8 months. Volumetric analysis identified tumor growth in 79.6% of cases, compared with 59.3% using axial/linear MRI reports (p = 0.0198). In the volumetric group, 12.9% of tumors showed no growth, whereas in the axial/linear group, 33.3% of tumors showed no growth. Four patients (7.4%) in each group demonstrated negative growth. Using linear regression analysis, volumetric measurements were significantly associated with tumor growth over time (p < 0.0014), whereas the growth curve for axial/linear measurements was not statistically different from a slope of zero. Moreover, the mean overall percent growth was higher with volumetric analysis in both paired and unpaired analyses (p < 0.0001).

Conclusions: Volumetric tumor measurement using the Sectra manual volumetric analysis tool identifies growth patterns in vestibular schwannomas that may not be captured by changes in conventional two-dimensional or axial MRI reporting. These findings suggest that volumetric analysis may provide a more sensitive, efficient, and clinically meaningful evaluation of tumor progression, with potential implications for surveillance strategies and treatment decision-making.