Cost Analysis of Contrast Enhancement in Magnetic Resonance Imaging for Screening Retrocochlear Pathologies in Asymmetric Hearing Loss

Abstract

Objective: Contrast-enhanced temporal magnetic resonance imaging (MRI) is the gold standard for differential diagnosis of retrocochlear pathologies. Nowadays, with the improvement of MRI devices and new imaging modalities, we have very detailed images of the cerebellopontine angle. In this study, we calculated the additional cost of contrast-enhanced MRI and questioned that if contrast-enhanced imaging is still necessary for diagnosis. Methods: Temporal bone MRIs of 1145 patients admitted to our clinic with unilateral asymmetric sensorineural hearing loss were evaluated retrospectively. The factors that affect the cost of the imaging, including serum creatinine test, establishing vascular access, and contrast material were analyzed, both for the cost and the time consumed. Results: Of the 1145 patients, 31 were diagnosed with vestibular schwannoma (VS). Re-examination of the images of the patients with VS revealed that the tumor could be seen on the images with and without contrast in 30 cases. Only one patient had a tiny VS that was difficult to identify on noncontrast imaging. The total additional time and cost for contrast-enhanced imaging were calculated as 18,320 minutes and 37,888 USD. The sensitivity and specificity of the noncontrast 3D FIESTA technique have been determined as 96.8% and 99.9%, respectively. Conclusion: We recommend the noncontrast MRI 3D FIESTA modality for screening because of its high sensitivity and specificity when the cost and time spent for contrast enhancement are taken into account. It will also reduce the expenses of the health system, increase hospital income, and shorten waiting lists of patients.