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. 2019 Dec 17;10:5758. doi: 10.1038/s41467-019-13640-1

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — a Images of Gd-enhanced magnetic resonance imaging (MRI) and computed tomography (CT) perfusion in cases 1 and 4. Although the images 24 months before vaccination are T2-weighted images in case 4, the tumors can be clearly seen. White circles indicate targeted tumors for volumetric analysis. CT perfusion revealed reduced tumor blood volume (TBV) in the left meningioma in case 1 and gradually increasing TBV in the falx meningioma in case 4. The range of the color scale is shown. b Changes in tumor volume in the four meningiomas. All meningiomas exhibited increased volume before vaccination. Volumetric meningioma reduction of 10% (MR) was observed in two tumors, a 9% increase (classified as SD in accordance with above-described criteria) was observed in one tumor, and a 31% increase (PD) was observed in one tumor. c Percent change in tumor volume from baseline (pre-vaccination) in all meningiomas. The median baseline target meningioma volume was 3.96 cm³ (range 1.65–6.93 cm³). d Percent change in tumor volume in three patients and the mean values 1 year before and 1 year after the first vaccination. Percent change in tumor volume decreased after vaccination in all meningiomas. P-value was determined by paired t test. e TBV changes in the four meningiomas. The left meningioma in case 1 exhibited a decrease of >30%. However, the other three tumors did not keep decreasing during the course of eight vaccinations. GD gadolinium, MRI magnetic resonance imaging, M months, CT computed tomography, TBV tumor blood volume, Vac vaccine, Pre-Vac the day of the first vaccination, 1 year after 1 year after the first vaccination, 1 year before 1 year before the first vaccination.