Diagnostic performance of an unenhanced MRI exam for tumor follow-up of the optic pathway gliomas in children

Marsault, Pierre; Ducassou, Stéphane; Menut, Fanny; Bessou, P; Havez-Enjolras, M; Chateil, Jean‐François

doi:10.1007/s00234-019-02198-w

Cited by 6 publications

(2 citation statements)

References 48 publications

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“…9,10 In patients with central nervous system tumors, the utility of gadolinium in identifying disease progression has been evaluated in pediatric tuberous sclerosis patients with subependymal giant cell astrocytomas, adults with meningiomas and prolactinomas, and children with optic pathway gliomas. [18][19][20][21][22][23] For all of these tumor types, MRI sequences without gadolinium were reported to be suffi- F I G U R E 2 AUC for an MRI without contrast to diagnose tumor progression (defined from an MRI with contrast) from ROC analysis…”

Section: Discussionmentioning

confidence: 99%

Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic‐hypothalamic low‐grade glioma

Malbari

Chintagumpala

Wood

et al. 2021

Pediatric Blood & Cancer

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Background Patients with chiasmatic‐hypothalamic low‐grade glioma (CHLGG) have frequent MRIs with gadolinium‐based contrast agents (GBCA) for disease monitoring. Cumulative gadolinium deposition in the brains of children is a potential concern. The purpose of this study is to evaluate whether MRI with GBCA is necessary for determining radiographic tumor progression in children with CHLGG. Methods Children who were treated for progressive CHLGG from 2005 to 2019 at Texas Children's Cancer Center were identified. Pre‐ and post‐contrast MRI sequences were separately reviewed by one neuroradiologist who was blinded to the clinical course. Three dimensional measurements and tumor characteristics were evaluated. Radiographic progression was defined as a 25% increase in size (product of two largest dimensions) compared with baseline or best response after initiation of therapy. Results A total of 28 patients with progressive CHLGG were identified with a total of 683 MRIs with GBCA reviewed (mean 24 MRIs/patient; range, 11‐43 MRIs). Radiographic progression was observed 92 times, 91 (99%) on noncontrast and 90 (98%) on contrast imaging. Sixty‐seven progressions necessitating management changes were identified in all (100%) noncontrast sequences and 66 (99%) contrast sequences. Tumor growth > 2 mm in any dimension was identified in 184/187 (98%) noncontrast and 181/187 (97%) with contrast imaging. Metastatic tumors were better visualized on contrast imaging in 4/7 (57%). Conclusion MRI without GBCA effectively identifies patients with progressive disease. When imaging children with CHLGG, eliminating GBCA should be considered unless monitoring patients with metastatic disease.

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Section: Discussionmentioning

confidence: 99%

Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic‐hypothalamic low‐grade glioma

Malbari

Chintagumpala

Wood

et al. 2021

Pediatric Blood & Cancer

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“…Maloney et al report that in their cohort of children with isolated optic pathway gliomas, treatment escalation was only instigated in the context of increased contrast enhancement with concomitant increase in tumour size visible on T2weighted images, and thus propose use of a non-contrast surveillance protocol [11]. An unenhanced surveillance protocol has subsequently been shown by Marsault et al to have satisfactory sensitivity and specificity, based primarily on assessment of tumour volume variation [12]. We believe that the use of GBCAs could be limited in the setting of all low-grade paediatric astrocytomas but this requires further investigation in other tumour locations, as performing repeat MRI surveillance scans for GBCA administration is not ethical when it often involves risk of sedation or anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Surveillance imaging of grade 1 astrocytomas in children: can duration and frequency of follow-up imaging and the use of contrast agents be reduced?

et al. 2020

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Purpose The optimum strategy for the surveillance of low-grade gliomas in children has not been established, and there is concern about the use of gadolinium-based contrast agents (GBCAs), particularly in children, due to their deposition in the brain. The number of surveillance scans and the use of GBCAs in surveillance of low-risk tumours should ideally be limited. We aimed to investigate the consistency and utility of our surveillance imaging and also determine to what extent the use of GBCAs contributed to decisions to escalate treatment in children with grade 1 astrocytomas. Methods This was a retrospective single-centre study at a tertiary paediatric hospital. All children with a new diagnosis of a nonsyndromic World Health Organization (WHO) grade 1 astrocytoma between 2007 and 2013 were included, with surveillance imaging up to December 2018 included in analysis. The intervals of surveillance imaging were recorded, and imaging and electronic health records were examined for decisions related to treatment escalation. Results Eighty-eight patients had 690 surveillance scans in the study period. Thirty-one patients had recurrence or progression leading to treatment escalation, 30 of whom were identified on surveillance imaging. The use of GBCAs did not appear to contribute to multidisciplinary team (MDT) decisions in the majority of cases. Conclusion Surveillance imaging could be reduced in number and duration for completely resected cerebellar tumours. MDT decisions were rarely made on the basis of post-contrast imaging, and GBCA administration could therefore potentially be restricted in the setting of surveillance of grade 1 astrocytomas in children.

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Magnetic resonance imaging diagnosis of subependymal giant cell astrocytomas in follow-up of children with tuberous sclerosis complex: should we always use contrast enhancement?

et al. 2020

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Diagnostic performance of an unenhanced MRI exam for tumor follow-up of the optic pathway gliomas in children

Cited by 6 publications

References 48 publications

Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic‐hypothalamic low‐grade glioma

Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic‐hypothalamic low‐grade glioma

Surveillance imaging of grade 1 astrocytomas in children: can duration and frequency of follow-up imaging and the use of contrast agents be reduced?

Magnetic resonance imaging diagnosis of subependymal giant cell astrocytomas in follow-up of children with tuberous sclerosis complex: should we always use contrast enhancement?

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