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Surveillance magnetic resonance imaging for isolated optic pathway gliomas: is gadolinium necessary?

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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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Authors and Affiliations

  1. Department of Radiology,, University of Washington,, Seattle, WA, USA

    Ezekiel Maloney, A. Luana Stanescu, Francisco A. Perez, Ramesh S. Iyer, Randolph K. Otto & Dennis W. W. Shaw

  2. Department of Radiology,, Seattle Children’s Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA

    Ezekiel Maloney, A. Luana Stanescu, Francisco A. Perez, Ramesh S. Iyer, Randolph K. Otto & Dennis W. W. Shaw

  3. Cancer and Blood Disorders,, University of Washington, Seattle Children’s Hospital,, Seattle, WA, USA

    Sarah Leary

  4. Department of Pharmacy,, University of Washington, Fred Hutchinson Cancer Research Center,, Seattle, WA, USA

    Lotte Steuten

  5. Department of Epidemiology,, University of Washington School of Public Health,, Seattle, WA, USA

    Amanda I. Phipps

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  1. Ezekiel Maloney
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  2. A. Luana Stanescu
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Correspondence to Dennis W. W. Shaw.

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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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