Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss

Abstract

The financial burden for the evaluation of patients for acoustic neuroma in an otolaryngology practice is substantial. Patients with sudden sensorineural hearing loss represent a portion of that population seen with unilateral, asymmetric auditory symptoms who require investigation for acoustic neuroma. For these patients, gadolinium-enhanced magnetic resonance imaging is the diagnostic gold standard. Auditory brain stem response testing has been used in the past as a screening test for acoustic neuroma, but its apparent sensitivity has fallen as the ability to image smaller acoustic neuromas has improved. Fast spin echo magnetic resonance imaging techniques without gadolinium have been shown to be as effective in the detection of acoustic neuroma as contrast-enhanced magnetic resonance imaging. Limited nonenhanced fast spin echo magnetic resonance imaging now provides an inexpensive alternative for high-resolution imaging of the internal auditory canal and cerebellopontine angle. Fast spin echo magnetic resonance imaging can now be done at a cost approximating auditory brain stem response testing while providing the anatomic information of contrast-enhanced magnetic resonance imaging. Cost analysis was done in the cases of 58 patients with sudden sensorineural hearing loss by comparing the costs for routine workup and screening of acoustic neuroma with the cost of fast spin echo magnetic resonance imaging with the use of screening protocols based on literature review. The potential cost savings of evaluating patients with sudden sensorineural hearing loss with fast spin echo magnetic resonance imaging for acoustic neuroma was substantial, with a 54% reduction in screening costs. In an era of medical economic scrutiny, fast spin echo magnetic resonance imaging has become the most cost-effective method to screen suspected cases of acoustic tumors at our institution by improving existing technology while reducing the cost of providing that technology and eliminating charges for impedance audiometry, auditory brain stem response testing, and contrast-enhanced magnetic resonance imaging.