Evaluation of Magnetic Resonance Imaging Diagnostic Approaches for Vestibular Schwannoma Based on Hearing Threshold Differences Between Ears

Metselaar, Mick; Demirtas, Gülnez; Immerzeel, Teun van; Schroeff, Marc van der

doi:10.1097/mao.0000000000000876

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Furthermore, there are similar shortcomings of radiological examinations in AN diagnosis: the low specificity ( Figure 1A ), especially in the early stage ( Figure 1B ), because the smaller tumors are usually asymptomatic, making it complicated for early diagnosis. Some researchers already thought about this misdiagnosis and tried to use a hearing test to help the diagnostic value of MRI ( 19 ). However, adding a new test is a new burden for the economy and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma

et al. 2021

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ObjectivesTo determine the preoperative diagnostic accuracy of MRI and otoneural tests (ONT) for acoustic neuroma (AN) in a cohort of unselected patients with pontocerebellar angle tumors. To find a convenient way to screening out the potential asymptomatic AN patient earlier.DesignThis diagnostic accuracy study was performed in a central hospital and included a consecutive sample of unilateral incipient pontocerebellar angle tumor patients referred for MRI and ONT before surgery. Different AN features of MRI and ONT were collected and concluded into preoperative diagnostic variables or variable combinations. Those of MRI and ONT are analyzed and compared with biopsy results by multivariable receiver operating characteristic (ROC) analysis. The early-stage group, the course of which is 1 year or less, was separately computed and compared.ResultsEighty-three subjects were collected from June 2013 to June 2019; 62 were confirmed AN postoperatively by biopsy, whereas others are not AN. The area under the curve (AUC) of MRI was 0.611, whereas the AUC of ONT was 0.708. In the early-stage group, the AUC of MRI was 0.539, and the AUC of ONT was 0.744.ConclusionsONT was able to identify more subjects affected by unilateral incipient AN than MRI preoperatively. Given that ONT is a functional test for internal auditory canal nerves, it is an optimal screening test for AN patients because it provides more information than MRI for the further clinical plan. It is particularly noteworthy for identifying asymptomatic AN patients and for early stage. Therefore, it may help more patients from unnessesary surgery. Furthermore, an MRI follow-up is suggested if the patient was found alert in ONT.

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Section: Discussionmentioning

confidence: 99%

The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma

et al. 2021

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An international comparison of diagnostic and management strategies for vestibular schwannoma

Hentschel¹,

Rovers²,

Markodimitraki³

et al. 2018

Eur Arch Otorhinolaryngol

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ObjectiveTo compare international diagnostic and management strategies for vestibular schwannoma (VS).MethodsA web-based questionnaire was sent to 130 otolaryngologists, mainly identified through the European Skull Base Society. It contained questions on general information including guideline usage as well as questions on diagnosis (focussing on selection of patients for MRI) and management of VS, including case scenarios. Descriptive statistics were reported.ResultsThirty-six otolaryngologists working in 11 different countries completed the questionnaire (response rate: 28%). Guidelines for diagnosis and management of VS are used by 44% and 42% of respondents, respectively. In the diagnostic strategy for VS, different types and combinations of audiovestibular function tests are used when deciding whether a patient should undergo an MRI. Respondents apply 18 different definitions of asymmetrical hearing loss. Variation was also apparent from reported considerations on management of VS. Most respondents (84%) prefer a wait-and-scan strategy in case of a small intrameatal VS (Koos 1). Variety in management strategies increases for patients with a medium to large sized VS (Koos 2, 3 and 4). The details of each management strategy (wait-and-scan, microsurgery, stereotactic radiosurgery and fractionated radiotherapy) also differ among respondents.ConclusionsA large variation in diagnostic and management strategies for VS was identified between respondents. More evidence and/or consensus seem warranted to reduce uncertainties for patients, and differences in outcome and costs that might result from the variety of strategies currently being applied.Electronic supplementary materialThe online version of this article (10.1007/s00405-018-5199-6) contains supplementary material, which is available to authorized users.

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Asymmetric sensorineural hearing loss and vestibular schwannoma: when to image?

Conley

Diaz

2020

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review We review the literature on the use of audiometric protocols in the guidance of when to obtain MRI for detection of vestibular schwannoma. This discussion will focus on the sensitivity, specificity, and cost-effective analysis of audiometric criteria of asymmetric sensorineural hearing loss (ASNHL) when used to decide when MRI scans should be performed. Recent findings The sensitivity for detecting vestibular schwannomas when invoking published audiometric protocols for triggering MRI acquisition in ASNHL ranged from 50 to 100%. Specificity of these protocols ranged from 23 to 83%. Such audiometric protocols are efficient, achieving sensitivity and specificity at these rates while reducing the screening rate to 18 to 35%. The reduced procurement of MRI while using such audiometric protocols is associated with annual cost savings of between 23 and 82%. While no definitive recommendations can be made from this review, some audiometric protocols offer a better balance of sensitivity and specificity than others. Summary Audiometric protocols for triggering MRI acquisition in ASNHL for evaluation of vestibular schwannoma can be both sensitive and specific. These are competitive measures, and so no protocol is both 100% sensitive and specific. Such protocols become less effective in populations with increased incidence of noise-induced hearing loss. Invocation of such audiometric protocols can considerably reduce the annual cost of MRI evaluation for vestibular schwannomas.

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Evaluation of Magnetic Resonance Imaging Diagnostic Approaches for Vestibular Schwannoma Based on Hearing Threshold Differences Between Ears

Cited by 3 publications

References 19 publications

The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma

The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma

An international comparison of diagnostic and management strategies for vestibular schwannoma

Asymmetric sensorineural hearing loss and vestibular schwannoma: when to image?

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