Retrospective study of vestibular schwannoma in patients referred to MRI: prevalence and referral criteria

BACKGROUND: Vestibular schwannoma (VS) is a rare, benign tumor of the vestibulocochlear nerve. Diagnosis relies on MRI, but nonspecific clinical symptoms make early identification challenging. OBJECTIVE: To evaluate the prevalence of VS among MRI referrals and assess the clinical symptoms and referral criteria leading to imaging. MATERIAL AND METHODS: This retrospective observational study was conducted at a tertiary university hospital from July 2023 to August 2024. Data were extracted from institutional radiological imaging archive system. The total number of MRI referrals, confirmed VS cases, and associated clinical symptoms were recorded. Referral patterns were analysed using the European Academy of Otology and Neuro-Otology (EAONO) criteria. RESULTS: Of 600 MRI scans analyzed, 11 cases (1.8%) confirmed VS. Referrals were primarily made by private ENT specialists (68.5%). Tumor sizes ranged from 6-23 mm, with two tumors exceeding 20 mm, requiring consideration for surgery. Asymmetrical hearing loss was the most frequently mentioned symptom (80.8%), but no single symptom or combination reliably predicted VS. CONCLUSION: VS was an uncommon finding among MRI referrals. Asymmetric hearing loss was the predominant symptom but did not reliably predict tumor presence. The findings highlight the need to refine referral criteria to improve diagnostic efficiency and reduce unnecessary imaging.