Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient

Background 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. Methods 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. Results 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. Conclusion 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.