Abstract
Background
Pediatric optic pathway gliomas are typically indolent but have a variable clinical course. Treatment is dictated by symptoms and changes on contrast-enhanced MRI examinations. Gadolinium retention in children has motivated parsimonious use of gadolinium-based contrast agents.
Objectives
To determine surveillance MR factors that motivate changes in tumor-directed therapies and extrapolate cost-efficacy of a non-contrast follow-up protocol.
Materials and methods
Using an imaging database search we identified children with isolated optic pathway gliomas and ≥3 follow-up contrast-enhanced MRIs. We reviewed medical records and imaging for: (1) coincident changes on contrast-enhanced MRI and tumor-directed therapy, (2) demographics and duration of follow-up, (3) motivations for intervention, (4) assessment of gadolinium-based contrast agents’ utility and (5) health care utilization data. We assessed cost impact in terms of relative value unit (RVU) burden.
Results
We included 17 neurofibromatosis type 1 (NF1) and 21 non-NF1 patients who underwent a median 16.9 and 24.3 cumulative contrast-enhanced MR exams over 7.7 years and 8.1 years of follow-up, respectively. Eight children (one with NF1) had intervention based on contrast-enhanced MR findings alone. For these eight, increased tumor size was the only common feature, and it was apparent on non-contrast T2 sequences. For the median patient, a non-contrast follow-up protocol could result in 15.9 (NF1) and 23.3 (non-NF1) fewer gadolinium-based contrast agent administrations, and a 39% lower yearly RVU burden.
Conclusion
Pediatric patients with isolated optic pathway gliomas undergo a large number of routine contrast-enhanced MR follow-up exams. Gadolinium might not be needed for these exams to inform management decisions. Secondary benefits of a non-contrast follow-up protocol include decreased cost and risk to the patient.
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Acknowledgment
Dr. Maloney is supported, in part, through a National Institutes of Health, National Research Service Award training grant (grant number 5 T32 DK0072).
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This article was awarded the John Kirkpatrick Young Investigator Award at the Society for Pediatric Radiology 2017 meeting.
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Maloney, E., Stanescu, A.L., Perez, F.A. et al. Surveillance magnetic resonance imaging for isolated optic pathway gliomas: is gadolinium necessary?. Pediatr Radiol 48, 1472–1484 (2018). https://doi.org/10.1007/s00247-018-4154-4
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DOI: https://doi.org/10.1007/s00247-018-4154-4