Vestibular schwannoma imaging and differential diagnosis

Imaging plays a central role in the modern management of vestibular schwannomas (VS), from the initial diagnosis to treatment planning and subsequent monitoring of treatment response. It is of particular importance in NF2-related schwannomatosis (NF2) and similar genetic tumor predisposition syndromes, where patients require serial monitoring for many years. Magnetic resonance imaging (MRI) is the technique of choice and can reliably detect very small tumors and incremental growth. Modern imaging methods are reviewed, with a focus on MRI. The authors examine the initial evaluation of VS, differential diagnosis, expected posttreatment appearances, imaging after implantation, surveillance imaging, and assessment of complications. They also discuss imaging considerations arising in the context of NF2.