Setting: Tertiary care academic center: Feinberg School of Medicine, Northwestern University, Chicago.
Synopsis: Of the 122 patients included in the study, 44.3 percent of MRIs were normal, and 55.7 percent were abnormal, of which 25.4 percent were dysosmia-related findings and 40.2 percent were incidental findings. The most common dysosmia-related disagnosis was frontoethmoid sinusitis (18.8 percent) and the most common incidental finding was small vessel disease. Nine patients had intracranial causes of dysosmia and six had intracranial neoplasms. MRI cost per dysosmia etiology diagnosis was $9,445. From 1997 to 2003, median medical malpractice settlements and jury awards ranged from $625,616 and $975,000 for misdiagnosis to between $682,500 and $1,550,000 for delay in treatment. In patients with idiopathic anosmia, MRI identified a possible etiology in one-quarter of the cases.
Bottom line: The consequences of missing an intracranial process or neoplasm in a patient with anosmia justify the expense of an MRI.