Evaluating the effect of voxel size on the accuracy of 3D volumetric analysis measurements of brain tumors.

Introduction: Neurofibromatosis type 2 related Schwannomatosis (NF2-SWN) is a genetic disorder characterized by the growth of vestibular schwannomas (VS), which often leads to progressive hearing loss and vestibular dysfunction. Accurate volumetric assessment of VS tumors is crucial for effective monitoring and treatment planning. Since tumor growth dynamics are often subtle, the resolution of MRI scans plays a critical role in detecting small volumetric changes that inform clinical decisions. This study evaluates the impact of MRI voxel resolution on the accuracy of manual and AI-driven volumetric segmentation of VS in NF2-SWN patients. Methods: Ten patients with NF2-SWN, totaling 17 tumors, underwent high-resolution MRI scans with varying voxel sizes on different MRI machines at Yale New Haven Hospital. Tumors were segmented using both manual and AI-based methods, and the effect of voxel size on segmentation precision was quantified through volume measurements, Dice similarity coefficients, and Hausdorff distances. Results: Results indicate that larger voxel sizes (1.2 × 0.9 × 4.0 mm) significantly reduced segmentation accuracy when compared to smaller voxel sizes (0.5 × 0.5 × 0.8 mm). In addition, AI-based segmentation outperformed manual methods, particularly at larger voxel sizes. Discussion: These findings highlight the importance of optimizing voxel resolution for accurate tumor monitoring and suggest that AI-driven segmentation may improve consistency and precision in NF2-SWN tumor surveillance.