A Systematic Review of Audiological Criteria Used to Determine the Need for MRI Screening in Patients With Suspected Vestibular Schwannoma.
Karim Awad, Gabriela Katz, Simon Freeman et al.
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In 30 seconds
This systematic review evaluated the diagnostic accuracy of non-imaging screening tools for MRI referral in adults with suspected vestibular schwannoma (VS) and asymmetric sensorineural hearing loss. It included 20 studies with 9119 patients. The review found that no screening test consistently achieved high sensitivity and specificity for VS detection, with audiometric protocols being the most effective first-line tools.
Key findings
- Pure tone audiometry showed an inverse relationship between sensitivity and specificity.
- Lower audiometric thresholds achieved sensitivities approaching 100% but reduced specificity.
- ABR demonstrated high sensitivity but reduced detection of tumors ≤10 mm.
- Most studies were retrospective, limiting comparability due to heterogeneity.
Why it matters
Understanding the effectiveness of screening tools for vestibular schwannoma is crucial for clinicians to make informed decisions about MRI referrals, balancing the need for accurate diagnosis with the risks of unnecessary imaging.
What to keep in mind
Most studies included were retrospective, and there was significant heterogeneity in thresholds and risk-of-bias assessments.