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Detection of recurrent brain tumors in children: No significant difference in sensitivity between unenhanced and
Yasmina Bouzidi1, Emmanuel Barteau1, Julien Lejeune2
11 Pediatric Radiology Department, Clocheville Hospital, University Hospital Center of Tours, France.
Background:
Magnetic resonance imaging (MRI) with a gadolinium injection is currently used in the follow-up of children in remission of cerebral tumors (CTs). Intracerebral gadolinium deposition has been recently reported with unknown risks. The aim of this study was to evaluate the sensitivity of unenhanced brain MRI (U-MRI) in detection of tumor recurrence.
Methods And Materials:
A set of 58 U-MRIs of children in remission was retrospectively evaluated by three seniors (a neuroradiologist, a pediatric and a general radiologist) and one junior to look for any recurrence. Clinical, tumoral and imaging data were collected. The final diagnosis was anatomopathological when available, or the clinicoradiological evolution. Sensitivity, specificity, predictive values and interobserver agreement were calculated. A Fisher test and Fleiss kappa coefficient were performed.
Results:
For the seniors, the U-MRI had a sensitivity of 81% (95% confidence interval (CI): 0.56-0.90), and a negative predictive value (NPV) of 82% (95% CI: 0.63-0.94). The U-MRI sensitivity, regardless of the observer, was not significantly different from the contrast-enhanced MRI sensitivity (86%) according to a Fisher test (p > 0.05). No significant difference in sensitivity within the subgroups was found. The interobserver agreement of seniors was good (κ = 0.68).
Conclusion:
U-MRI brain was suboptimal for 80% of patients. Three-dimensional millimetric, fluid-attenuated inversion recovery, and diffusion would constitute helpful sequences in follow-up. Further specific studies depending on each tumor type are still required to determine whether a potential abstention of gadolinium intravenous injection should be discussed for children.
Insights
Unenhanced MRI (U-MRI) showed suboptimal sensitivity for detecting pediatric brain tumor recurrence. Advanced MRI sequences may improve detection, potentially reducing the need for gadolinium contrast agents in follow-up imaging.
Area of Science:
- Pediatric Radiology
- Neuroradiology
- Oncology Imaging
Background:
- Gadolinium-based contrast agents (GBCAs) are used in pediatric brain tumor follow-up.
- Intracerebral gadolinium deposition has been reported with unknown risks.
- This study evaluates unenhanced MRI (U-MRI) for detecting tumor recurrence.
Purpose of the Study:
- To assess the sensitivity and diagnostic performance of U-MRI in identifying recurrence in children with cerebral tumors in remission.
- To compare the efficacy of U-MRI with contrast-enhanced MRI for tumor recurrence detection.
Main Methods:
- Retrospective evaluation of 58 U-MRIs from children in remission by multiple radiologists.
- Data collected included clinical, tumoral, and imaging findings.
- Sensitivity, specificity, predictive values, and interobserver agreement were calculated; Fisher test and Fleiss kappa were used.
Main Results:
- U-MRI demonstrated a sensitivity of 81% and a negative predictive value of 82% among senior radiologists.
- Sensitivity of U-MRI was not significantly different from contrast-enhanced MRI (86%).
- Good interobserver agreement (κ = 0.68) was observed among senior readers.
Conclusions:
- U-MRI alone was suboptimal for detecting recurrence in a significant portion of pediatric patients.
- Advanced sequences like 3D FLAIR and diffusion-weighted imaging may enhance detection capabilities.
- Further research is needed to determine if gadolinium administration can be safely omitted in pediatric brain tumor follow-up.
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