The Utility of Routine MRI Surveillance Screening in Pediatric CNS Tumor Survivors

Purpose Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in pediatric central nervous system (CNS) tumors. Frequency of neuroimaging surveillance varies with no standardized approach. Methods We sought via a single institution retrospective cohort study to evaluate the frequency of recurrence identified by surveillance neuroimaging versus those detected clinically. Results This study included 476 patients; the majority diagnosed with a low-grade glioma (LGG) (n = 138; 29%), high grade glioma (HGG) (n = 77; 16%), ependymoma (n = 70; 15%) or medulloblastoma (n = 61; 13%). Patients with LGG, HGG and ependymoma more commonly had multiply recurrent disease (p = 0.08), with those with ependymoma demonstrating two or more relapses in 49% of cases. Recurrent disease was identified by imaging more often than clinical symptoms (65% vs 32%; p = < 0.01). Mean time to first relapse and subsequent relapse for the entire cohort was 30 months (range 1 day − 24.8 years) and 19.5 months (range 1 week-19.6 years), respectively. Patients diagnosed with meningioma demonstrated the longest mean time to first relapse (74.7 months), whereas those with Atypical Teratoid Rhabdoid Tumor (ATRT) and Choroid plexus papilloma tended to have the shortest time to relapse (8.9 months and 5.5 months, respectively). Overall, 22 patients sustained the first relapse > 10 years from initial diagnosis (9 LGG, 4 medulloblastoma, 3 meningioma, 2 germ cell tumor, 1 pineoblastoma, 1 craniopharyngioma, and 2 other). Conclusion With a higher tendency towards detection of tumor recurrence/progression on MRI surveillance in comparison to clinical progression, surveillance imaging should be considered in routine follow up of pediatric CNS tumor survivors. With some relapses > 10 years from initial diagnosis, imaging beyond this time point may be useful in particular tumor types.