Long-term medical imaging use in children with central nervous system tumors

Abstract

Background Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. Procedure We conducted a retrospective cohort study of children aged 0–20 years diagnosed with CNS tumors between 1996–2016 at six U.S. integrated healthcare systems and Ontario, Canada. We collected computed topography (CT), magnetic resonance imaging (MRI), radiography, ultrasound, nuclear medicine examinations from 12 months before through 10 years after CNS diagnosis censoring six months before death or a subsequent cancer diagnosis, disenrollment from the health system, age 21 years, or December 31, 2016. We calculated imaging rates per child per month stratified by modality, country, diagnosis age, calendar year, time since diagnosis, and tumor grade. Results We observed 1,879 children with median four years follow-up post-diagnosis in the U.S. and seven years in Ontario, Canada. During the diagnosis period (±15 days of diagnosis), children averaged 1.10 CTs (95% confidence interval [CI] 1.09–1.13) and 2.14 MRIs (95%CI 2.12–2.16) in the U.S., and 1.67 CTs (95%CI 1.65–1.68) and 1.86 MRIs (95%CI 1.85–1.88) in Ontario. Within one year after diagnosis, 19% of children had ≥5 CTs and 45% had ≥5 MRIs. By nine years after diagnosis, children averaged one MRI and one radiograph per year with little use of other imaging modalities. Conclusions MRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.

Complete patient exposure during paediatric brain cancer treatment for photon and proton therapy techniques including imaging procedures

“…In these cases, the extreme dose spread could be attributed to the fact that, for both CT and X-ray, the dose fall-off is located in the lung region, while for CBCT, it is in the neck area due to its smaller imaging field of view measuring only 17cm along the patient's length, compared to approximately 30cm for the other modalities. Overall, the importance of imaging dose is highlighted in our study (60) and strengthens the necessity to increase awareness on CT procedures (61,62) as well as on-board imaging in this specific application, namely radiotherapy in paediatric populations (63,64). The relative contribution from imaging to the total dose equivalent per organ is more pronounced for proton therapy when compared to photon therapy techniques.…”

Medical imaging utilization and associated radiation exposure in children with down syndrome

“…Children were followed from the start date of their enrollment in the healthcare system until censoring at age 19 years, disenrollment from the healthcare system, death, six months prior to a cancer diagnosis, or end of follow up (December 31, 2016). We conservatively excluded imaging performed within six months prior to a cancer diagnosis to avoid including imaging used to diagnose the cancer [ 17 , 18 ]. Children could contribute additional enrollment periods after a disenrollment.…”

“…Given the large number of observations, Proc Genmod in SAS could not support the full dataset, so we divided the data into two datasets and combined the estimates by calculating the weighted average on the log-scale, weighting inversely by the standard error. 18 We explored effect modification of the association between Down syndrome and imaging utilization by age groups, sex, and calendar year by including interaction terms between Down syndrome status and these factors.…”

Integral neuro-oncological diagnosis As the basis for personalized treatment Of brain tumors (on the example of gliomas In children)

“…Основное различие молекулярных характеристик детских и взрослых LGG заключается в том, что молекулярные характеристики большинства детских опухолей связаны с нарушениями MAPK-пути, связанного с RAS-митоген-активируемой протеинкиназой, в ней выявляется в среднем одна генетическая аберрация. В то же время для взрослых LGG характерна более высокая мутационная нагрузка [14][15][16].…”