MAGNETIC-RESONANCE-IMAGING - A COST-EFFECTIVE FIRST LINE INVESTIGATION IN THE DETECTION OF VESTIBULAR SCHWANNOMAS

Magnetic resonance imaging (MRI) is currently the 'gold-standard' inve stigation in patients with a unilateral sensorineural hearing loss. Th e procedure, however, is expensive and of limited availability. Instea d, such patients often undergo a series of audiovestibular tests and c omputed tomography in an attempt to exclude or diagnose a vestibular s chwannoma. We describe seven cases of unilateral vestibular schwannoma in which conventional assessment was either equivocal or failed to de monstrate a tumour subsequently diagnosed by magnetic resonance imagin g. Two patients with neurofibromatosis type 2 are also reported to sho w how magnetic resonance imaging confirmed the presence of a second ve stibular schwannoma despite CT that showed only a unilateral lesion. W e also illustrate how limited protocol MRI of patients is slightly mor e expensive yet much more cost effective than the usual battery of tes ts and propose that it should be the first line investigation for pati ents in whom the clinical picture requires exclusion of a retrocochlea r lesion. Not all of these early diagnosed tumours have been immediate ly removed. In some of the more elderly or infirm patients a 'wait and rescan' policy has been adopted. Nevertheless, the early establishmen t of the correct diagnosis facilitates the subsequent management of th ese patients.