ULTRA-HIGH-RESOLUTION NONENHANCED FAST SPIN-ECHO MAGNETIC-RESONANCE-IMAGING - COST-EFFECTIVE SCREENING FOR ACOUSTIC NEUROMA IN PATIENTS WITH SUDDEN SENSORINEURAL HEARING-LOSS

The financial burden for the evaluation of patients for acoustic neuro ma 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 investigati on for acoustic neuroma, For these patients, gadolinium-enhanced magne tic resonance imaging is the diagnostic gold standard. Auditory brain stem response testing has been used in the past as a screening test fo r acoustic neuroma, but its apparent sensitivity has fallen as the abi lity to image smaller acoustic neuromas has improved. Fast spin echo m agnetic resonance imaging techniques without gadolinium have been show n to be as effective in the detection of acoustic neuroma as contrast- enhanced magnetic resonance imaging. Limited nonenhanced fast spin ech o magnetic resonance imaging now provides an inexpensive alternative f or high-resolution imaging of the internal auditory canal and cerebell opontine angle. Fast spin echo magnetic resonance imaging can now be d one at a cost approximating auditory brain stem response testing while providing the anatomic information of contrast-enhanced magnetic reso nance 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 ec ho magnetic resonance imaging with the use of screening protocols base d on literature review, The potential cost savings of evaluating patie nts with sudden sensorineural hearing loss with fast spin echo magneti c resonance imaging for acoustic neuroma was substantial, with a 54% r eduction in screening costs. In an era of medical economic scrutiny, f ast spin echo magnetic resonance imaging has become the most cost-effe ctive method to screen suspected cases of acoustic tumors at our insti tution by improving existing technology while reducing the cost of pro viding that technology and eliminating charges for impedance audiometr y, auditory brain stem response testing, and contrast-enhanced magneti c resonance imaging.