Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic-hypothalamic low-grade glioma

Authors: MALBARI, FATEMA - Texas Children'S Hospital; CHINTAGUMPALA, MURALI - Baylor College Of Medicine; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); LEVY, ADAM - Children'S Hospital At Montefiore; SU, JACK - Baylor College Of Medicine; OKCU, M - Baylor College Of Medicine; LIN, FRANK - Baylor College Of Medicine; LINDSAY, HOLLY - Baylor College Of Medicine; REDMAN, SURYA - Baylor College Of Medicine; BAXTER, PATRICIA - Baylor College Of Medicine; PAULINO, ARNOLD - Md Anderson Cancer Center; ALDAVE ORZAIZ, GUILLERMO - Texas Children'S Hospital; WHITEHEAD, WILLIAM - Texas Children'S Hospital; DAUSER, ROBERT - Texas Children'S Hospital; SUPAKUL, NUCHARIN - Indiana University School Of Medicine; KRALIK, STEPHEN - Texas Children'S Hospital

Submitted to: Pediatric Blood and Cancer
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/25/2021
Publication Date: 6/16/2021
Citation: Malbari, F., Chintagumpala, M.M., Wood, A.C., Levy, A.S., Su, J.M., Okcu, M.F., Lin, F.Y., Lindsay, H., Redman, S.P., Baxter, P.A., Paulino, A.C., Aldave Orzaiz, G., Whitehead, W.E., Dauser, R., Supakul, N., Kralik, S.F. 2021. Gadolinium is not necessary for surveillance MR imaging in children with chiasmatic-hypothalamic low-grade glioma. Pediatric Blood and Cancer. e29178. https://doi.org/10.1002/pbc.29178.
DOI: https://doi.org/10.1002/pbc.29178

Interpretive Summary: Obesity is associated with a host of adverse health consequences. Many such health outcomes, whether physical or mental, require diagnosis and monitoring via MRI and thus both children and adults with obesity, as a whole, undergo more MRIs that their normal weight counterparts. MRIs use gadolinium based contrast agents (GBCA) and gadolinium deposition is a potential concern. The purpose of this research was to establish whether MRI with GBCA is necessary, using tumor progression in children, which requires high quality MRI scan images for accurate diagnosis, as an example outcome. Using data from children receiving services at Texas Children's Cancer Center at Texas Children's Hospital, pre- and post-contrast MRI sequences were separately reviewed by one neuroradiologist who was blinded to the presence or absence of GBCAs, the current study found that MRI without GBCA can identify patients tumor progression as effectively as those with GBCAs. Our results suggest that the inclusion of GBCA when imaging of children needs to be carefully considered by clinicians, in order to provide the greatest health protections in children who need MRIs. These findings may ultimately help improve the long-term of health of children with obesity, given their increased MRI need.

Technical Abstract: Patients with chiasmatic-hypothalamic low-grade glioma (CHLGG) have frequent MRIs with gadolinium-based contrast agents (GBCA) for disease monitoring. Cumulative gadolinium deposition in the brains of children is a potential concern. The purpose of this study is to evaluate whether MRI with GBCA is necessary for determining radiographic tumor progression in children with CHLGG.Children who were treated for progressive CHLGG from 2005 to 2019 at Texas Children's Cancer Center were identified. Pre- and post-contrast MRI sequences were separately reviewed by one neuroradiologist who was blinded to the clinical course. Three dimensional measurements and tumor characteristics were evaluated. Radiographic progression was defined as a 25% increase in size (product of two largest dimensions) compared with baseline or best response after initiation of therapy. A total of 28 patients with progressive CHLGG were identified with a total of 683 MRIs with GBCA reviewed (mean 24 MRIs/patient; range, 11-43 MRIs). Radiographic progression was observed 92 times, 91 (99%) on noncontrast and 90 (98%) on contrast imaging. Sixty-seven progressions necessitating management changes were identified in all (100%) noncontrast sequences and 66 (99%) contrast sequences. Tumor growth >2 mm in any dimension was identified in 184/187 (98%) noncontrast and 181/187 (97%) with contrast imaging. Metastatic tumors were better visualized on contrast imaging in 4/7 (57%). MRI without GBCA effectively identifies patients with progressive disease. When imaging children with CHLGG, eliminating GBCA should be considered unless monitoring patients with metastatic disease.