The Real-World Impact of Vestibular Schwannoma Fully Automated Volume Measures on the Evaluation of Size Change and Clinical Management Outcomes in a Multidisciplinary Meeting Setting.

Background: Vestibular schwannoma (VS) management decisions are made within multidisciplinary meetings (MDMs). The improved accuracy of volumetric compared to linear tumor measurements is well-recognized, but current volumetric evaluation methods are too time-intensive. The aim was to determine if the availability of fully automated volumetric tumor measures during MDM preparation resulted in different radiological outcomes compared to a standard approach with linear dimensions, and whether this impacted the clinical management decisions.

Methods: A prospective cohort study evaluated 50 adult patients (mean age 64.6, SD 12.8; 24 male, 26 female) with unilateral sporadic VS. Two simulated MDMs were convened using different methods to measure tumor size during radiology preparation: MDM-mlm used linear tumor dimensions, while MDM-avm was provided with fully automated deep learning-based volume measurements. Interval changes in VS size from the index to final and penultimate to final magnetic resonance imaging (MRI) studies defined the radiological outcomes. The subsequent clinical MDM outcomes were classified. Wilcoxon signed rank tests compared the radiological classification of VS size change and the management outcomes between the MDM-mlm and the MDM-avm.

Results: The 57 interval MRI comparisons in 33 patients showed a significant difference in the classification of VS size change between the MDM-mlm and MDM-avm for all intervals (z=2.49, P=.01). However, there was no significant difference in the resulting management decisions between the 2 MDMs (z=0.30, P= .76).

Conclusion: Provision of fully automated VS volume measurements to "real-world" MDM preparation significantly impacted the radiological classification of VS size change but did not influence management decisions.