Risk-stratified Recommendations for Surveillance MRI Schedule from the
Literature
Author
Risk Assessment
Rosenberg
2000
•6.1% of patients required revision
surgery after initial subtotal resection
•13.5% of tumors can remain dormant for
years before a growth phase
•Subtotal resection increases risk of
recurrence 12-fold compared to gross
total and near total resection
Bloch 2004
Schmerber
2005
•No recurrences were found in 91
patients who had complete resection via
translabyrinthine approach with a mean
follow-up of 11 years
Bennett
2008
•Baseline MRI at 1 year: 285 patients
(95.3%) had no IAC enhancement, 10
(3.3%) had linear enhancement, 3 (1%)
had nodular enhancement
•Repeat MRI at 5 years: no patients who
had linear enhancement demonstrated
increase, 2/3 patients who had nodular
enhancement showed increase
(recurrence)
Fukuda
2011
•Gross total resection had a recurrence
rate of 2.4% (1/41)
•Subtotal resection had a recurrence rate
of 52% (13/25)
•Partial resection had a recurrence rate of
62.5% (5/8)
•Baseline MRI obtained at 2 years after
complete translabyrinthine resection: 8
patients (2.5%) had linear enhancement,
1 (0.3%) with nodular enhancement
•Patients with linear enhancement
showed no progression on repeat MRI at
5, 7, 10, and 15 years
• The patient with nodular enhancement
demonstrated further growth on repeat
MRI at 5 years (recurrence)
•Subtotal resection increased the risk of
regrowth by 9-fold compared to gross
total or near total resection
•Nodular enhancement within the tumor
cavity increased the risk of regrowth by
16-fold compared to linear enhancement
Tysome
2012
Carlson
2012
Recommendation for Postoperative
Surveillance MRI
•Annual MRI for an indefinite period
•Complete removal (gross total and near
total resection): MRI at 1 and 3 years
• Incomplete removal (subtotal
resection): Annual MRI with gradual
lengthening of time between scans if no
evidence of recurrence
•Complete removal: baseline MRI at 5
years
•If surgeon is not confident that
complete removal has been
accomplished: baseline MRI at 2 years
and repeat at 5 years
•Baseline MRI at 1 year
•If no enhancement at baseline, no
further MRIs
•If linear enhancement at baseline,
repeat MRI 2 years later and no further
MRIs if unchanged
•If nodular enhancement at 1 year,
repeat MRI every 2 years through 5
years postoperatively, then space to
every 5 years if no growth
•Study protocol: Baseline MRI at 3-6
months. Repeat MRI at 12 months, then
annually
•Authors do not make recommendations
for surveillance protocol
•Baseline MRI at 2 years
•Linear enhancement should be
reimaged at 5 years to ensure no
progression
•Nodular enhancement should be
considered recurrent disease and
treated without further imaging
•Baseline MRI 3-6 months
• If linear enhancement at baseline:
repeat MRI at 7 and 15 years
• If nodular enhancement following
gross total or near total resection: repeat
MRI at 3, 7, and 15 years
• If nodular enhancement following
subtotal resection: MRI at 2,5,10, and
15 years.