Long-term medical imaging use in children with central nervous system tumors

• Published in: PloS one 2021-04, Vol.16 (4), p.e0248643-e0248643
• Main Authors: Bowles, Erin J A, Miglioretti, Diana L, Kwan, Marilyn L, Bartels, Ute, Furst, Adam, Cheng, Stephanie Y, Lau, Cindy, Greenlee, Robert T, Weinmann, Sheila, Marlow, Emily C, Rahm, Alanna K, Stout, Natasha K, Bolch, Wes E, Theis, Mary Kay, Smith-Bindman, Rebecca, Pole, Jason D
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Auroral kilometric radiation; Biology and Life Sciences; Biomedical engineering; Biomedical materials; Brain cancer; Cancer; Central nervous system; Central nervous system diseases; Central Nervous System Neoplasms - diagnostic imaging; Child; Child, Preschool; Children; Classification; Codes; Cohort Studies; Computed tomography; Diagnosis; Diagnostic imaging; Diagnostic Imaging - statistics & numerical data; Diagnostic Imaging - trends; Editing; Epidemiology; Ethics; Exposure; Female; Fetuses; Funding; Health care; Health care policy; Health policy; Health risks; Health sciences; Health surveillance; Hospitals; Human subjects; Humans; Infant; Ionizing radiation; Leukemia; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - trends; Male; Malignancy; Medical diagnosis; Medical electronics; Medical imaging; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Methodology; Morphology; Nervous system; Neuroimaging; Oncology; Ontario; Pediatric research; Pediatrics; Public health; Radiation; Radiation effects; Radiography - trends; Radiology; Research and Analysis Methods; Retrospective Studies; Review boards; Statistics; Survival; Tomography, X-Ray Computed - trends; Tumors; Tumors in children; Ultrasonography - trends; United States; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248643

Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. We conducted a retrospective cohort study of children aged 0-20 years diagnosed with CNS tumors between 1996-2016 at six U.S. integrated healthcare systems and Ontario, Canada. We collected computed topography (CT), magnetic resonance imaging (MRI), radiography, ultrasound, nuclear medicine examinations from 12 months before through 10 years after CNS diagnosis censoring six months before death or a subsequent cancer diagnosis, disenrollment from the health system, age 21 years, or December 31, 2016. We calculated imaging rates per child per month stratified by modality, country, diagnosis age, calendar year, time since diagnosis, and tumor grade. We observed 1,879 children with median four years follow-up post-diagnosis in the U.S. and seven years in Ontario, Canada. During the diagnosis period (±15 days of diagnosis), children averaged 1.10 CTs (95% confidence interval [CI] 1.09-1.13) and 2.14 MRIs (95%CI 2.12-2.16) in the U.S., and 1.67 CTs (95%CI 1.65-1.68) and 1.86 MRIs (95%CI 1.85-1.88) in Ontario. Within one year after diagnosis, 19% of children had ≥5 CTs and 45% had ≥5 MRIs. By nine years after diagnosis, children averaged one MRI and one radiograph per year with little use of other imaging modalities. MRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.