A cost effective screening protocol for vestibular schwannoma in the late 90s

Abstract

Magnetic resonance imaging (MRI) is the imaging modality of choice in diagnosing vestibular schwannoma (VS). Perceived high costs have prevented clinicians from using it as a screening investigation, although MR scanners are now widely available in the United Kingdon. In a retrospective study, the clinical records of all the patients who presented to the ENT department of Taunton and Someerset NHS Trust with suspected symptoms of VS during the year 1994 were analysed. The cost of confirming or refuting the diagnosis of VS in each patient ranged from £220.72 to £580.31 depending on the number of hospital visits and investigations performed. This study shows that the routine use of MR scanning for detection of VS is cost effective and more effective than the use of conventional tests.

Vestibular schwannoma screening: closing the audit loop

“…1,2 Gadolinium DTPA contrast-enhanced magnetic resonance imaging (MRIg) is currently considered the optimal imaging modality for this tumour and has become the preferred initial screening investigation. [3][4][5][6] Cost containment is achieved by using limited imaging protocols and by examining referred patients in batches. Patient selection for screening can be rationalized by using guidelines and the outcome of this approach has been reported.…”

Vestibular Schwannoma Screening Guidelines: Change in our practise. An audit loop

“…Gadolinium enhanced MRI scans of internal auditory meatus is recognised as the current "gold standard" and cost effective investigation of choice for tumour detection, being able to detect tumours as small as 4mm in diameter [1] [2].…”

“…The falling costs of MRI compared to screening batteries have led to recommendation that it should be used as the sole investigation [2].…”

Identification of predictors and development of a screening protocol for cerebello‐pontine lesions in patients presenting with audio‐vestibular dysfunction

“…The early diagnosis of cerebello‐pontine angle (CPA) lesions allows clinicians and patients to choose between different treatment options, including early surgery or conservative management without high risk of loss of candidacy for low morbidity treatment in terms of facial nerve outcome and hearing preservation 1 . Magnetic resonance imaging (MRI) scanning has become the investigation of choice in patients with suspicious audiovestibular features owing to near 100% sensitivity and specificity for the detection of CPA lesions 2–5 …”

“…1 Magnetic resonance imaging (MRI) scanning has become the investigation of choice in patients with suspicious audiovestibular features owing to near 100% sensitivity and specificity for the detection of CPA lesions. [2][3][4][5] The cost implications of a mass population screening strategy dictates that decisions about requesting an MRI are based solely on the patient's clinical presentation and audiometric characteristics. Whilst the majority of CPA lesions present with asymmetric sensorineural hearing loss, consultations for the evaluation of unilateral or asymmetric audiovestibular symptoms and ⁄ or audiometric thresholds are common.…”