Murchison Ann P, Gilbert Molly E, Savino Peter J
Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Arch Ophthalmol. 2011 Mar;129(3):301-5. doi: 10.1001/archophthalmol.2011.25.
To evaluate the necessity of neuroimaging in patients with acute, isolated ocular motor mononeuropathies.
A prospective case series evaluating diagnostic technology results in 93 patients older than 50 years with acute isolated mononeuropathies was performed. Patients were included in the study if they had new-onset diplopia with an isolated cranial neuropathy (cranial nerve III, IV, or VI palsy) and no other signs of neurologic dysfunction. All patients had gadolinium-enhanced magnetic resonance imaging (MRI). The number of patients with lesions noted on MRI and the overall cost of imaging the patients were determined. Cost analysis of the MRI was conducted using Current Procedural Terminology codes and Medicare costs in 2010 dollars. Cost utility was estimated using cost data as well as published utility values for adults with diplopia and sex-specific life tables for life expectancy in the United States.
Four of 93 patients had lesions on MRI; however, only 1 of the 93 patients had a lesion related to the cranial mononeuropathy. The total modeled cost of imaging for these 93 patients was $131,688 to determine an underlying cause in 1 patient with no change in treatment. The estimated cost utility for the patient with a causative lesion found by MRI was $90.19 for diagnosis alone.
It may not be medically necessary to perform MRI scanning on every patient with an isolated cranial nerve III, IV, or VI palsy. In adults older than 50 years with an isolated mononeuropathy, physicians should carefully review the patients' history and findings to determine which patients to image at the initial evaluation.
评估急性孤立性动眼神经单神经病患者进行神经影像学检查的必要性。
对93例年龄大于50岁的急性孤立性单神经病患者进行了一项前瞻性病例系列研究，以评估诊断技术结果。如果患者新发复视且伴有孤立性颅神经病变（颅神经III、IV或VI麻痹）且无其他神经功能障碍体征，则纳入本研究。所有患者均接受了钆增强磁共振成像（MRI）检查。确定MRI检查发现有病变的患者数量以及对患者进行影像学检查的总费用。使用现行程序术语编码和2010年美元的医疗保险费用对MRI进行成本分析。利用成本数据以及已发表的成人复视效用值和美国按性别分类的预期寿命生命表来估计成本效用。
93例患者中有4例在MRI上有病变；然而，93例患者中只有1例的病变与颅神经单神经病有关。对这93例患者进行影像学检查以确定潜在病因的总模拟成本为131,688美元，而1例患者的治疗并无改变。仅为诊断目的，MRI检查发现有病因性病变的患者的估计成本效用为90.19美元。
对每例孤立性颅神经III、IV或VI麻痹患者进行MRI扫描在医学上可能并非必要。对于年龄大于50岁的孤立性单神经病成人患者，医生应仔细回顾患者的病史和检查结果，以确定在初始评估时对哪些患者进行影像学检查。
