Prognostic implications for gadolinium enhancement of the meninges in low-grade astrocytomas of childhood.
BACKGROUND
Persistent gadolinium enhancement on MRI of the meninges in some children with low-grade astrocytomas (LGA) is a widely recognized phenomenon. The relationship of this finding with the clinical course is unclear.


METHODS
From a consecutive cohort of 282 children with pathologically confirmed LGA we identified all patients with asymptomatic gadolinium enhancement of the meninges found on surveillance MRI. A nested case-control study was performed, comparing patients with meningeal enhancement to controls without enhancement.


RESULTS
Twenty-one children were identified with meningeal enhancement. The median follow-up was 5.2 years with enhancement noted for a median of 2.2 years. The 5-year overall survival for this cohort was 91.2% (Greenwood SE 8.0%), and the 5-year progression-free survival was 20.9% (SE 11.9%). Five patients are now free of disease, while 15 continue to have stable disease. The overall and progression-free survival was not significantly different compared to controls.


CONCLUSIONS
Gadolinium enhancement of the meninges on MRI may occur in a significant number of children with LGA, particularly juvenile pilocytic astrocytoma, but does not appear to affect progression-free or overall survival. Change in management based on this finding alone is unwarranted.
Hurwitz
M D
MD
Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. mhurwitz@bics.bwh.harvard.edu
Burger
P C
PC
Goldthwaite
P T
PT
Tihan
T
T
Wharam
M D
MD
Fisher
P G
PG
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate