title: MRI surveillance of vestibular schwannomas without contrast enhancement: Clinical and economic evaluation.
abstract: To determine if high-resolution T2-weighted (HRT2) magnetic resonance imaging (MRI) is a comparably accurate and economical alternative to the gold standard of contrast-enhanced T1-weighted (T1C) MRI for surveillance of know vestibular schwannomas (VSs).
  
  
  
  Retrospective case-control analysis, systematic review, and economic evaluation.
  
  
  
  Vestibular schwannoma size in anteroposterior, mediolateral, and superoinferior axes were measured by two neuroradiologists, both blinded to previous measurements, for 50 randomized patients with T1C and HRT2 on two separate occasions. Measurements were assessed by Pearson product-moment correlation coefficients, and differences were analyzed by Student t test. Once the data were analyzed, appropriate economic evaluation was performed utilizing institutional-, federal-, and literature-based estimates of cost and incidence/prevalence.
  
  
  
  Pearson correlations (r) between T1C and HRT2 were 0.991 and 0.973 for radiologists 1 and 2, respectively, with no statistically significant differences (P ≤ 0.05) between imaging techniques. Intraobserver and interobserver reliability estimates (κ) were 0.88 to 1 for both T1C and HRT2, indicating very high reliability. Cost-minimization analysis demonstrated cost and charge differences of $148.02 and $1,284 per patient per scan, respectively. This represents an overall cost and charge savings for this 50-patient cohort of $7,401 and $64,200, respectively.
  
  
  
  HRT2 imaging is a highly reliable and lower-cost alternative to T1C for follow-up surveillance scans in patients with VS.
  
  
  
  2C. Laryngoscope, 128:202-209, 2018.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A.
authors.forename: Daniel H
authors.identifier: 0000-0001-6485-2075
authors.initials: DH
authors.lastname: Coelho
authors.affiliation: Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A.
authors.forename: Yang
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A.
authors.forename: Brian
authors.initials: B
authors.lastname: Suddarth
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mamdani
mesh_terms: D016022:Case-Control Studies; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging*; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D019786:Gadolinium DTPA
keywords: MRI; Vestibular schwannoma; contrast; health economics; observation