Currie Stuart, Saunders David, Macmullen-Price Jeremy, Verma Sanjay, Ayres Philip, Tait Caroline, Harwood Ceryl, Scarsbrook Andrew, Craven Ian J
1 Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust , Leeds , UK.
2 Department of Ear Nose and Throat Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK.
Br J Radiol. 2019 Apr;92(1096):20180833. doi: 10.1259/bjr.20180833. Epub 2019 Jan 23.
: To examine whether the model of Getting It Right First Time (GIRFT) could be relevant to the surveillance of non-operated vestibular schwannomas (vs) by testing the following hypotheses: (1) in the UK there is a great variation in the imaging protocol for the follow-up of vs; (2) high-resolution, T weighted MRI (HRT W-MRI) has an equivalent accuracy to gadolinium-enhanced T weighted MRI (Gd-MRI) in the assessment of vs size and; (3) imaging with HRT W-MRI rather than Gd-MRI could offer financial savings.
: Two neuroradiologists independently performed measurements of 50 vs imaged with HRT W-MRI and Gd-MRI. Differences in mean tumour measurements between HRT W-MRI and Gd-MRI were determined, as were intra- and interobserver concordance. Level of agreement was measured using Bland-Altman plots. Consultant neuroradiologists within 30 adult neurosurgical units in the UK were contacted via email and asked to provide the MRI protocol used for the surveillance of non-operated vs in their institution. The financial difference between scanning with HRT W-MRI and Gd-MRI was determined within Leeds Teaching Hospitals NHS Trust.
: There was no statistically significant difference in the mean diameter of vs size, measured on HRT W-MRI and Gd-MRI (p = 0.28 & p = 0.74 for observers 1 and 2 respectively). Inter- and intraobserver concordance were excellent (Interclass correlation coefficient = 0.99, Interclass correlation coefficient ≥ 0.98 respectively). Differences between the two sequences were within limits of agreement. 26 of 30 UK neuroscience centres (87 % response rate) provided imaging protocols. 16 of the 26 (62%) centres use Gd-MRI for the surveillance of vs. HRT -MRI is £36.91 cheaper per patient than Gd-MRI.
: Variation exits across UK centres in the imaging surveillance of non-operated vs. HRT W-MRI and Gd-MRI have equivalent accuracy when measuring vs. Imaging with HRT W-MRI rather than Gd-MRI offers potential financial savings.
: This study highlights the potential health and economic benefits of a national standardized imaging protocol for the surveillance of non-operated vs.
通过检验以下假设，探讨首次正确诊疗（GIRFT）模式是否与非手术治疗的前庭神经鞘瘤（VS）监测相关：（1）在英国，VS随访的成像方案存在很大差异；（2）在评估VS大小时，高分辨率T加权MRI（HRT W-MRI）与钆增强T加权MRI（Gd-MRI）具有同等准确性；（3）使用HRT W-MRI而非Gd-MRI成像可节省费用。
两名神经放射科医生独立对50例用HRT W-MRI和Gd-MRI成像的VS进行测量。确定HRT W-MRI和Gd-MRI之间平均肿瘤测量值的差异，以及观察者内和观察者间的一致性。使用Bland-Altman图测量一致性水平。通过电子邮件联系了英国30个成人神经外科单位的顾问神经放射科医生，要求他们提供所在机构用于非手术VS监测的MRI方案。在利兹教学医院国民保健服务信托基金内确定了使用HRT W-MRI和Gd-MRI扫描的费用差异。
在HRT W-MRI和Gd-MRI上测量的VS平均直径无统计学显著差异（观察者1和观察者2的p值分别为0.28和0.74）。观察者间和观察者内的一致性都很好（组内相关系数分别为0.99和≥0.98）。两个序列之间的差异在一致性范围内。30个英国神经科学中心中的26个（回复率87%）提供了成像方案。26个中心中的16个（62%）使用Gd-MRI进行VS监测。HRT -MRI每位患者比Gd-MRI便宜36.91英镑。
英国各中心在非手术VS的成像监测方面存在差异。在测量VS时，HRT W-MRI和Gd-MRI具有同等准确性。使用HRT W-MRI而非Gd-MRI成像可节省潜在费用。
本研究强调了全国标准化成像方案在非手术VS监测方面的潜在健康和经济效益。
