Saturday, July 4, 2009

The current standard of care for diagnosing and acoustic neuroma is an MRI of the brain with contrast. And the scan might also include IACs or the internal auditory canals.

Here is a quote from the medical literature that suggests this trend may be changing.

"The pattern and rate of growth of acoustic neuroma are highly variable and currently unpredictable. At least 50% of tumours do not grow, at least for some years after diagnosis. Some studies have found large initial size to be a determinant of later growth, with the opposite also being reported. The mean growth rate for all tumours varies between 1 and 2 mm/year, with a rate of 2-4 mm/year for only those that grow; however, there are cases with significant regression (5%) or exceptional growth (which may exceed 18 mm/year). CONCLUSIONS: The majority of the evidence reviewed was poorly reported and there is therefore an inherent risk of bias. Given the recent improvement in resolution and reduction in cost of MR imaging, ABR can no longer be considered appropriate as the primary test used to screen for acoustic neuroma. T2W or T2*W sequences enable accurate evaluation of the VIIIth and VIIth cranial nerves within the cerebellopontine angle and internal auditory canal as well as evaluation of the cochlea and labyrinth, and inclusion of GdT1W sequences is unlikely to contribute information that would alter patient management in the screening population. The quality of the imaging chain and experience of the reporting radiologist are key factors determining the efficacy of a non-contrast screening strategy. Based on a cost-effectiveness model developed to reflect UK practice it was concluded that a diagnostic algorithm that deploys non-contrast MR imaging as an initial imaging screen in the investigation of acoustic neuroma is less costly than and likely to be as effective as available contrast MR imaging."

From:

The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess. 2009 Mar;13(18):iii-iv, ix-xi, 1-154.
Fortnum H, O'Neill C, Taylor R, Lenthall R, Nikolopoulos T, Lightfoot G, O'Donoghue G, Mason S, Baguley D, Jones H, Mulvaney C.
The NIHR Research Design Service for the East Midlands, Division of Primary Care, 14th Floor, Tower Building, University of Nottingham, UK.
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