Dynamic contrast-enhanced magnetic resonance imaging in paediatric brain tumours systematically reviewed

Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an advanced imaging technique that quantifies blood-brain permeability using dynamic contrast uptake.

The clinical utility of DCE in paediatric brain tumours is unclear. This systematic review evaluates the efficacy of DCE for tumour differentiation and progression assessment in paediatric brain tumours, and summarises current technical implementation to inform clinical practice.

A string-based literature search was performed in PubMed and Web of Science. Original articles evaluating the utility of DCE were included. A modified quality assessment of diagnostic accuracy studies-2 (QUADAS-2) instrument evaluated the risk of bias.

Nine studies (2008-2025) were eligible (sample size 6-72 cases). Six studies investigated low-grade versus high-grade differentiation in mixed paediatric tumours (cumulative sample n=196) with successful discrimination through K^trans and/or k_ep in three studies (60 patients). Discrimination of two distinct histologies was usually more successful. Two studies evaluated the response to different treatments. Results for survival prediction based on DCE parameters were not promising. One study attempted to predict tumour aggressiveness in optic pathway glioma with good prognostic capacity for K^trans. DCE technical execution varied substantially among studies and was usually not compliant with current guidelines. Meta-analyses were impossible.

DCE may be of added value to discriminate between two different paediatric brain tumour entities, but a general discrimination potential between low- and high-grade lesions is doubtful. More studies and greater technical homogeneity are needed to investigate the technique's prognostic potential for paediatric cohorts.