Abstract
BackgroundChildren 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.ProcedureWe 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.ResultsWe 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.ConclusionsMRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.
Highlights
Central nervous system (CNS) tumors are the second most common pediatric malignancy after leukemia in children under the age of 19 years, accounting for one in four childhood cancers [1,2,3,4,5]
magnetic resonance imaging (MRI) and computed tomography (CT) are commonly used for central nervous system (CNS) tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors
Because of the relatively high survival rates of these children, concerns about ionizing radiation exposure from repeated computed tomography (CT) have been raised, and studies in pediatric cancer patients have noted a shift in CT use to magnetic resonance imaging (MRI), which does not use ionizing radiation [19, 20]
Summary
Central nervous system (CNS) tumors are the second most common pediatric malignancy after leukemia in children under the age of 19 years, accounting for one in four childhood cancers [1,2,3,4,5]. A recent review of studies of children with brain tumors showed that the median time to relapse across all tumor types was 13.7 months [11] While they did not evaluate imaging surveillance frequency, the authors concluded that routine surveillance may provide no benefit beyond 10 years after diagnosis [11]. The Children’s Oncology Group recommend surveillance imaging starting two years after completing treatment while the National Comprehensive Cancer Network recommendations for surveillance imaging vary depending on the type of tumor, histology, grade, and other factors [12, 13]. We described medical imaging in children before and after malignant CNS tumor diagnosis
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