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MORE CONFUSED THAN EVER!

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Tobeycat1134:
More confused than ever
On December 29, 2016 my ENT diagnosed me with a 9mm x 4mm x 4mm AN.  He sent me to a neurotologist; my appointment was yesterday, January 23.  He said that yes, there is an “enhancement” on my MRI, however it could be a number of things, viral inflammation, acoustic neuroma, or fatty tissue.  I had a MRI done November 7, 2014 that did not show a tumor.  Therefore, I was concerned that is was growing rapidly.  The neuotologist could not open the disc for the 2014 MRI for some reason (I had no problem opening it up on my computer at home) therefore he couldn’t tell if there it was a tumor there and it had only been missed when it was read.  I opened it and although I am not a radiologist, I did not see anything on the 2014 MRI.  He wants to do another MRI in 4 months to check for growth.  Symptoms include moderate severe hearing loss in left ear, chronic headaches, tinnitus, and an occasional slight tingling in my lower lip and chin.   How do they know before surgery if what is showing on the MRI is a tumor or something else?  I would love for it to be something else, but I do not want to a chance of losing more hearing and worsening my symptoms. Advise is appreciated.

ANSydney:
Hi Tobeycat,

Suggestions are that vestibular schwannoma growths are not linear with time and slows down with time ( http://acusticusneurinom.dk/wp-content/uploads/2015/10/natural-history-of-vs.pdf ). Let's assume that the MRI in November 2014 is correct in showing no tumor. If so, then sometime in the past two years growth started and it's now up to 9 x 4 x 4 mm.

Your tumor is small so you have time on your side. A followup MRI is a good idea so that growth rate can be established. Another one 6 months later will determined the rate of change in the rate of change. In your case these delays are probably appropriate since you would probably be put on the observation path until continued growth could be established and the tumor got larger than 15 mm. In any case, some authors suggest observation until 20 mm and I've even seem more.

Willbur:
How old are you? Time maybe on your side.

Tobeycat1134:
52

PaulW:
Do you have your radiologists report? What does it say?
Radiologists are normally way better at reading and diagnosing things than the doctors that read the reports afterwards.
As I understand it, there are lots of different bumps you could have that could be an AN.
Depending on how your MRI was done will help determine if it is or isn't, or if they need to do further MRI. Many MRI's are done without Gadolinium these days for safety and cost. They can detect a very small growth or AN without the dye.
What the Gadolinium does help with is determining what sort of growth it is.
Anything with blood vessels will light up so tumors often do, while fat doesn't..

From what your neurotologist is saying it sounds like your MRI was done without Gadolinium which makes it impossible to say if you have an AN or not.
If you did have Gadolinium and the thing lights up like a light bulb on T1 weighted images, and appears as a grey blob on T2 weighted images without Gadolinium then I believe they should be leaning towards an AN.

Disclaimer
Please note I am not a medical professional and all of the above is my personal opinion, anything above could be wildly inaccurate

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