Potential conflict of interest: None provided.
Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient†
Version of Record online: 11 JUL 2012
Copyright © 2013 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 1, pages 56–61, January 2013
How to Cite
Decker, J. R., Meen, E. K., Kern, R. C. and Chandra, R. K. (2013), Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient. International Forum of Allergy & Rhinology, 3: 56–61. doi: 10.1002/alr.21066
- Issue online: 10 JAN 2013
- Version of Record online: 11 JUL 2012
- Manuscript Accepted: 27 MAY 2012
- Manuscript Revised: 7 MAY 2012
- Manuscript Received: 15 MAR 2012
- olfactory disorders;
Intracranial causes of dysosmia are uncommon. Nonetheless, a missed intracranial disorder or neoplasm is worrisome. Magnetic resonance imaging (MRI) may be used in diagnosis; however, the cost effectiveness of this practice is unclear. We hypothesize that MRI scans for idiopathic dysosmia will demonstrate sufficient significant findings to be a cost-effective screening tool.
Tertiary-care otolaryngology clinic records were queried for smell and taste disturbance. The patients underwent anosmia-protocol MRI of the brain for idiopathic dysosmia in 122 cases. Each MRI report was reviewed for dysosmia findings, intracranial neoplasms, and incidental findings.
MRI was normal in 44.3%, there were dysosmia-related findings in 25.4%, and incidental findings in 40.2%. The most common related diagnosis was occult frontoethmoid sinusitis (18.8%). The most common incidental diagnosis was small vessel disease (21.1%). Intracranial neoplasms were observed in 6 patients (4.9%). Nine patients had intracranial causes of dysosmia including olfactory meningiomas, infarct, trauma, and atrophy. MRI cost per dysosmia etiology diagnosis was $9445. Costs increased to $32,355 and $48,880 per intracranial cause or neoplasm, respectively. Cost to diagnose 1 causal intracranial neoplasm was $146,400. From 1997 to 2003, median medical malpractice settlements ranged from $625,616 for misdiagnosis to $682,500 for delay in treatment to $1,750,000 for brain injury. The median jury award was $975,000 for misdiagnosis, $1,550,000 for delayed treatment, and $6,000,000 for brain injury.
MRI in idiopathic dysosmia yielded information regarding the diagnosis in one-quarter of cases. The implications of missing an intracranial neoplasm alone justify the cost of screening MRI for idiopathic dysosmia. © 2013 ARS–AAOA, LLC.