Role of MRI in the management of children with diffuse pontine tumors: a study of 15 patients and review of the literature

Kornreich, Liora; Schwarz, Michael; Karmazyn, Boaz; Cohen, Ian J.; Shuper, Avinoam; Michovitz, Shalom; Yaniv, I.; Fenig, Eyal; Horev, Gadi

doi:10.1007/s00247-005-1502-y

Cited by 30 publications

(28 citation statements)

References 26 publications

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“…The infiltrative nature and location of DIPG precludes surgical intervention. Patients are diagnosed and followed using conventional magnetic resonance imaging (MRI), though imaging characteristics including tumor size, tumor extent, necrosis and encapsulation of the basilar artery are not prognostic and have limited utility in evaluating response to treatment [7–9]. Radiation therapy is the standard treatment, providing transient palliation of neurological symptoms in 75 – 85% of patients [6, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma

et al. 2011

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Patients with diffuse intrinsic pontine glioma (DIPG) face a grim prognosis with limited treatment options. Many patients will enroll on investigational trials though the role of chemotherapy or immunotherapy is unclear. Radiographic changes on conventional MRI are used to evaluate tumor response and progression, but are not predictive of outcome in these patients. More sensitive measures of tumor biology are needed to improve patient management. We evaluated changes in magnetic resonance spectroscopy (MRS) biomarkers in patients with DIPG. Thirty-eight patients were enrolled prospectively on an IRB-approved protocol, which included standard MRI, single voxel spectroscopy (SVS) and multi-slice multi-voxel spectroscopy (MRSI). Scans were performed at multiple time points during each patient’s clinical course, with a total of 142 scans. The prognostic values of Choline:N-acetylaspartate (Cho:NAA), Cho:Creatine (Cho:Cr) and the presence of lactate and lipids (+Lac/Lip) were evaluated. Cho:NAA and variance in Cho:NAA values among different voxels within a tumor were each predictive of shorter survival. This prospective study shows that MRS can be used to identify high-risk patients and monitor changes in tumor metabolism, which may reflect changes in tumor behavior.

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Section: Introductionmentioning

confidence: 99%

Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma

et al. 2011

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“…The terms “recurrence” and “progression” were defined in all three studies, although only two reported recurrences as “symptomatic” and “asymptomatic” and defined these terms . All three studies reported OS, although only Kornreich defined the term (see Supporting Information Table S5). This was also the only study to report PFS.…”

Section: Resultsmentioning

confidence: 99%

“…Kornreich was a retrospective case series study looking at the role of surveillance MRI in the management of 15 pediatric patients with DIPG. Although the frequency of imaging was not reported, the mean number of MRI scans per patient was six.…”

Section: Resultsmentioning

confidence: 99%

The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high‐grade central nervous system tumors: a systematic review

Stevens

Main

Bailey

et al. 2018

Pediatric Blood & Cancer

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Background Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in children with high‐grade central nervous system (CNS) tumors, although no consensus has been reached regarding its effectiveness and whether earlier detection is associated with improved patient outcomes. This review aimed to evaluate this practice and any associated benefits and harms. Methods Systematic searches for relevant studies were undertaken in a number of databases, including MEDLINE and EMBASE, from 1985 to August 2018. Study selection and data extraction was undertaken independently by two reviewers. Due to heterogeneity between studies, no pooling of data was undertaken. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results No comparative studies were identified. Three retrospective observational studies involving 306 patients were reviewed. All had high risk of bias by virtue of study design. Two studies reported outcomes by symptomatic status—both recurrence rates and overall survival for asymptomatic patients were comparable with those for clinically symptomatic patients. No quality‐of‐life outcomes were reported. Conclusion There is a paucity of evidence to guide clinical practice as to the effectiveness of MRI surveillance in pediatric patients with high‐grade CNS tumors. These studies do not clearly demonstrate benefit or harm for the practice. With more research needed, there is a role for researchers to build into future trials data collection on surveillance imaging to give more information for the assessment of imaging frequency and duration in asymptomatic patients. This is an important question not only to clinicians and patients and their families but also from a health service resource perspective.

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“…However, DIPGs are infiltrative tumors with indistinct borders, and tumor measurements are difficult to obtain reliably and consistently, even among experienced readers [5]. MRI findings such as contrast enhancement are variable among patients, non-specific and not predictive of outcome [6–8]. Advanced imaging techniques such as magnetic resonance spectroscopy (MRS) and perfusion imaging have been used to evaluate DIPG and have yielded potential biomarkers.…”

Section: Introductionmentioning

confidence: 99%

Measurements of the pons as a biomarker of progression for pediatric DIPG

et al. 2013

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Treatment of pediatric diffuse intrinsic pontine glioma (DIPG) remains challenging, and reliable biomarkers of response are lacking. Radiographic response is a primary endpoint in many investigational studies of brain tumors, but there is no standard method of tumor measurement for DIPG, significant inter-observer variability exists given the invasive nature of these tumors, and tumor measurements are not predictive of outcome. Because DIPGs involve a significant portion of the pons, we evaluated the reliability and prognostic value of one-dimensional (1D) and two-dimensional (2D) pons measurements using anatomical landmarks rather than tumor boundaries. Patients with DIPG (n = 75) were evaluated longitudinally at our institution using MRI. Four readers independently performed 1D and 2D measurements of the pons using FLAIR images. Agreement and inter-reader variability were evaluated using differences among the six reader pairs and the coefficient of variation (CV). Prognostic value of pons measurements was calculated using Cox proportional hazards models, where relative hazard (RH) represents risk of death. Readers evaluated 384 exams. Agreement of readers' 1D and 2D measurements was strong (median difference between reader pairs 3.1 and 5.4%, respectively), with low inter-reader variability (median CV = 3.1% and median CV = 4.8%, respectively). Increases in 1D and 2D pons measurements over time indicated poorer prognosis (RH = 2.29, p = 0.0025 and RH = 1.13, p = 0.0016, respectively), with shorter overall survival. Pons measurements had low inter-reader variability compared to previously reported tumor measurement techniques and correlated with outcome in children with DIPG. Measurements of the pons (as opposed to direct measurements of tumor) are a viable in vivo biomarker for DIPG.

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Role of MRI in the management of children with diffuse pontine tumors: a study of 15 patients and review of the literature

Abstract: MR is the mainstay for the diagnosis and management of pontine tumors. Cranial growth seems to be an ominous sign. However, the prognostic value of MR is limited. MR findings correlate well with the clinical examination.

Cited by 30 publications

References 26 publications

Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma

Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma

The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high‐grade central nervous system tumors: a systematic review

Measurements of the pons as a biomarker of progression for pediatric DIPG

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