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__NOTOC__
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{{Acoustic neuroma}}
{{Acoustic neuroma}}
{{CMG}}; {{AE}}
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== Overview ==
== Overview ==
[[Gadolinium]]-enhanced [[Magnetic resonance imaging|MRI scan]] is the definitive [[diagnostic test]] for acoustic neuroma and can identify [[tumors]] as small as 1-2 millimeter in [[diameter]]. On [[brain]] [[Magnetic resonance imaging|MRI]], acoustic neuroma characterized by hypointense mass on T1-weighted [[Magnetic resonance imaging|MRI]], and hyperintense mass on T2-weighted [[Magnetic resonance imaging|MRI]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
*[[Gadolinium]]-enhanced [[magnetic resonance imaging|magnetic resonance imaging (MRI)]]  is the preferred [[diagnostic test]] for identifying acoustic neuroma and can identify [[tumors]] as small as 1-2 millimeter in [[diameter]].<ref>{{Cite journal
| author = [[E. P. Lin]] & [[B. T. Crane]]
| title = The Management and Imaging of Vestibular Schwannomas
| journal = [[AJNR. American journal of neuroradiology]]
| volume = 38
| issue = 11
| pages = 2034–2043
| year = 2017
| month = November
| doi = 10.3174/ajnr.A5213
| pmid = 28546250
}}</ref><ref>{{Cite journal
| author = [[D. F. Wilson]], [[R. S. Hodgson]], [[M. F. Gustafson]], [[S. Hogue]] & [[L. Mills]]
| title = The sensitivity of auditory brainstem response testing in small acoustic neuromas
| journal = [[The Laryngoscope]]
| volume = 102
| issue = 9
| pages = 961–964
| year = 1992
| month = September
| doi = 10.1288/00005537-199209000-00001
| pmid = 1518359
}}</ref>


=== Study of choice ===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
| valign="top" |
 
|+
OR
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|MRI component}}
 
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
The following result of [gold standard test] is confirmatory of [disease name]:
|-
* [Result 1]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* [Result 2]
:T1
 
| style="padding: 5px 5px; background: #F5F5F5;" |
OR
*Slightly hypointense to the adjacent [[brain]] (63%)
 
*Isointense to the adjacent [[brain]] (37%)
[Name of the investigation] must be performed when:
*May contain hypointense [[Cyst|cystic]] areas
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
|-
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
 
:T2
OR
| style="padding: 5px 5px; background: #F5F5F5;" |
 
*[[Heterogeneous|Heterogeneously]] hyperintense to the adjacent [[brain]]
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*[[Cyst|Cystic]] areas [[fluid]] intensity
 
*May have associated peritumoral [[Arachnoid mater|arachnoid]] [[Cyst|cysts]]
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
:T1 C+ (Gd)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Contrast medium|Contrast]] enhancement is vivid
*But [[heterogeneous]] in larger [[Tumor|tumors]]
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''


There are no established criteria for the diagnosis of [disease name].
Post-op [[Magnetic resonance imaging|MRI]]: Linear enhancement may not indicate [[tumor]]. But if there is [[Nodule (medicine)|nodular]] enhancement, suspect [[tumor]] recurrence which will necessitate follow-up [[Magnetic resonance imaging|MRI]].<ref name="radio">Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref>


===Staging===
[[File:Intracanalicular_acoustic_schwannoma.jpg|thumb|none|200px|[[Magnetic resonance imaging|MRI]] showing Intracanalicular acoustic neuroma<ref>Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/intracanalicular-acoustic-schwannoma here]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>]]
[[File:Intrameatal vestibularis schwannoma.jpg|thumb|none|200px|[[Magnetic resonance imaging|MRI]] showing [[Internal auditory meatus|Intrameatal]] vestibular schwannoma<ref>Image courtesy of  Dr. Roberto Schubert [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/intrameatal-vestibularis-schwannoma here]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>]]


==References==
==References==

Latest revision as of 18:05, 26 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohsen Basiri M.D.

Overview

Gadolinium-enhanced MRI scan is the definitive diagnostic test for acoustic neuroma and can identify tumors as small as 1-2 millimeter in diameter. On brain MRI, acoustic neuroma characterized by hypointense mass on T1-weighted MRI, and hyperintense mass on T2-weighted MRI.

Diagnostic Study of Choice
MRI component Features
T1
  • Slightly hypointense to the adjacent brain (63%)
  • Isointense to the adjacent brain (37%)
  • May contain hypointense cystic areas
T2
T1 C+ (Gd)

Post-op MRI: Linear enhancement may not indicate tumor. But if there is nodular enhancement, suspect tumor recurrence which will necessitate follow-up MRI.[3]

MRI showing Intracanalicular acoustic neuroma[4]
MRI showing Intrameatal vestibular schwannoma[5]

References

  1. ↑ E. P. Lin & B. T. Crane (2017). "The Management and Imaging of Vestibular Schwannomas". AJNR. American journal of neuroradiology. 38 (11): 2034–2043. doi:10.3174/ajnr.A5213. PMID 28546250. Unknown parameter |month= ignored (help)
  2. ↑ D. F. Wilson, R. S. Hodgson, M. F. Gustafson, S. Hogue & L. Mills (1992). "The sensitivity of auditory brainstem response testing in small acoustic neuromas". The Laryngoscope. 102 (9): 961–964. doi:10.1288/00005537-199209000-00001. PMID 1518359. Unknown parameter |month= ignored (help)
  3. ↑ Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
  4. ↑ Image courtesy of Dr Frank Gaillard. Radiopaedia (original file here).[http://radiopaedia.org/licence Creative Commons BY-SA-NC
  5. ↑ Image courtesy of Dr. Roberto Schubert Radiopaedia (original file here).[http://radiopaedia.org/licence Creative Commons BY-SA-NC

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