Daniels R L, Shelton C, Harnsberger H R
Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA.
Otolaryngol Head Neck Surg. 1998 Oct;119(4):364-9. doi: 10.1016/S0194-5998(98)70080-4.
The financial burden for the evaluation of patients for acoustic neuroma 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 investigation for acoustic neuroma. For these patients, gadolinium-enhanced magnetic resonance imaging is the diagnostic gold standard. Auditory brain stem response testing has been used in the past as a screening test for acoustic neuroma, but its apparent sensitivity has fallen as the ability to image smaller acoustic neuromas has improved. Fast spin echo magnetic resonance imaging techniques without gadolinium have been shown to be as effective in the detection of acoustic neuroma as contrast-enhanced magnetic resonance imaging. Limited nonenhanced fast spin echo magnetic resonance imaging now provides an inexpensive alternative for high-resolution imaging of the internal auditory canal and cerebellopontine angle. Fast spin echo magnetic resonance imaging can now be done at a cost approximating auditory brain stem response testing while providing the anatomic information of contrast-enhanced magnetic resonance 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 echo magnetic resonance imaging with the use of screening protocols based on literature review. The potential cost savings of evaluating patients with sudden sensorineural hearing loss with fast spin echo magnetic resonance imaging for acoustic neuroma was substantial, with a 54% reduction in screening costs. In an era of medical economic scrutiny, fast spin echo magnetic resonance imaging has become the most cost-effective method to screen suspected cases of acoustic tumors at our institution by improving existing technology while reducing the cost of providing that technology and eliminating charges for impedance audiometry, auditory brain stem response testing, and contrast-enhanced magnetic resonance imaging.
在耳鼻喉科诊所，对患者进行听神经瘤评估的经济负担相当大。突发感音神经性听力损失患者是出现单侧、不对称听觉症状且需要排查听神经瘤的人群的一部分。对于这些患者，钆增强磁共振成像（MRI）是诊断的金标准。听觉脑干反应测试过去曾用作听神经瘤的筛查测试，但随着对更小听神经瘤成像能力的提高，其明显的敏感性有所下降。已证明，不使用钆的快速自旋回波MRI技术在检测听神经瘤方面与对比增强MRI一样有效。有限的非增强快速自旋回波MRI现在为内耳道和桥小脑角的高分辨率成像提供了一种廉价的替代方法。现在，快速自旋回波MRI的成本与听觉脑干反应测试相近，同时能提供对比增强MRI的解剖学信息。通过比较常规检查和听神经瘤筛查的成本与使用基于文献综述的筛查方案的快速自旋回波MRI成本，对58例突发感音神经性听力损失患者进行了成本分析。使用快速自旋回波MRI评估突发感音神经性听力损失患者的听神经瘤，潜在的成本节约相当可观，筛查成本降低了54%。在医疗经济审查的时代，快速自旋回波MRI通过改进现有技术、降低提供该技术的成本并消除阻抗测听、听觉脑干反应测试和对比增强MRI的费用，已成为我们机构筛查疑似听神经瘤病例最具成本效益的方法。
