Screening for vestibular schwannoma: magnetic resonance imaging findings and management

Abstract

We report the contrast-enhanced magnetic resonance imaging (MRIg) findings from a series of 1139 patients who underwent screening to exclude a diagnosis of vestibular schwannoma. An acoustico-facial nerve bundle tumour was found in 3.1 per cent of patients imaged and vestibular schwannoma incidence is estimated at 1.4 per 100,000 population per annum. MRIg showed an abnormality in 14 per cent of patients; about one third of the findings may have accounted for the presenting symptom(s). A small number of patients had unexpected pathology revealed that required onward referral for further active management.

Potential savings in the diagnosis of vestibular schwannoma

“…The overall probability to have pathology was 14.1%, from which we distinguished the probability to have VS (3.0%). Of the remaining 11.1% with other pathology, 20.5% was considered to be important …”

“…To assess the potential annual savings of these strategies, we performed a budget impact analysis for the Netherlands and the United Kingdom (UK). We based our budget impact analysis on population estimates of the Netherlands and the UK, an incidence of VS of 19.4 per million in the general population and an incidence of VS of 3% in the screening population …”

“…T1‐weighted MRI of the CPA with contrast is considered the gold standard for detecting VS and is often used in combination with high‐resolution T2 of the CPA and T2‐weighted MRI of the whole brain to screen for other pathology . As the incidence of VS is only 3% in the screening population, MRI has a very low yield . Taking into account other pathologies (eg meningioma, demyelinating disease) that can be found through MRI in this population, approximately 14% of all MRI scans will show abnormalities .…”

“…As the incidence of VS is only 3% in the screening population, MRI has a very low yield . Taking into account other pathologies (eg meningioma, demyelinating disease) that can be found through MRI in this population, approximately 14% of all MRI scans will show abnormalities . The other 86% of MRIs are negative and can be considered an inefficient use of resources and may cause unnecessary uncertainty for the patient …”

“…approximately 14% of all MRI scans will show abnormalities. 7 The other 86% of MRIs are negative and can be considered an inefficient use of resources and may cause unnecessary uncertainty for the patient. 8,9 More efficient strategies could potentially avoid unnecessary MRIs in the diagnosis of VS and thus potentially increase cost-effectiveness.…”