Neuroimaging to Diagnose Central Nervous System Tumours in Children

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2023 Mar 21

PMID 36944513

Authors

Sylvia Cheng

Ran D Goldman

Affiliations

Soon will be listed here.

Abstract

Question: Headache, vomiting, lethargy, and seizures are common symptoms in healthy children with benign viral illnesses, but they are also signs that could represent a central nervous system (CNS) tumour. Primary care providers and guardians are hesitant to expose children to radiation associated with computed tomography scans or take on risks associated with the sedation frequently needed for magnetic resonance imaging. When should primary care providers order radiologic head imaging for children with common symptoms to identify those with a CNS tumour?

Answer: Central nervous system tumours have no pathognomonic features, which often results in delays in diagnosis. Owing to the high prevalence of infratentorial tumours, children commonly present with symptoms of increased intracranial pressure, making a detailed history and a comprehensive physical examination, including ophthalmoscopy for papilledema, especially important. Magnetic resonance imaging is the criterion standard test but it may take time to access, and young children may need sedation. Hence, computed tomography may be a preferable first option.The HeadSmart initiative in the United Kingdom provides guidance to obtain brain imaging within 4 weeks of onset of persistent symptoms that are associated with CNS tumours. We advocate applying the same criteria in Canada in order to reduce delay in diagnosis of CNS tumours in children.

References

Honig P, Charney E . Children with brain tumor headaches. Distinguishing features. Am J Dis Child. 1982; 136(2):121-4. DOI: 10.1001/archpedi.1982.03970380033008. View

Wilne S, Collier J, Kennedy C, Jenkins A, Grout J, Mackie S . Progression from first symptom to diagnosis in childhood brain tumours. Eur J Pediatr. 2011; 171(1):87-93. DOI: 10.1007/s00431-011-1485-7. View

Ostrom Q, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C . CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009-2013. Neuro Oncol. 2017; 18(suppl_5):v1-v75. PMC: 8483569. DOI: 10.1093/neuonc/now207. View

Goldman R, Cochrane D, Dahiya A, Mah H, Buttar A, Lambert C . Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors. J Pediatr Hematol Oncol. 2020; 43(8):e1093-e1098. DOI: 10.1097/MPH.0000000000002012. View

. A new clinical guideline from the Royal College of Paediatrics and Child Health with a national awareness campaign accelerates brain tumor diagnosis in UK children--"HeadSmart: Be Brain Tumour Aware". Neuro Oncol. 2015; 18(3):445-54. PMC: 4767243. DOI: 10.1093/neuonc/nov187. View

Dixon-Woods M, Findlay M, Young B, Cox H, Heney D . Parents' accounts of obtaining a diagnosis of childhood cancer. Lancet. 2001; 357(9257):670-4. DOI: 10.1016/S0140-6736(00)04130-1. View

Ronsley R, Crowell C, Irvine M, Kang M, Goldman R, Erker C . Impact of Time to Diagnosis on Morbidity and Survival in Children With Malignant Central Nervous System Tumors. J Pediatr Hematol Oncol. 2022; 45(2):e188-e193. DOI: 10.1097/MPH.0000000000002424. View

Jones J, Hunter D . Consensus methods for medical and health services research. BMJ. 1995; 311(7001):376-80. PMC: 2550437. DOI: 10.1136/bmj.311.7001.376. View

Azizi A, Hessler K, Leiss U, Grylli C, Chocholous M, Peyrl A . From Symptom to Diagnosis-The Prediagnostic Symptomatic Interval of Pediatric Central Nervous System Tumors in Austria. Pediatr Neurol. 2017; 76:27-36. DOI: 10.1016/j.pediatrneurol.2017.08.006. View

10.

Goldman R, Cheng S, Cochrane D . Improving diagnosis of pediatric central nervous system tumours: aiming for early detection. CMAJ. 2016; 189(12):E459-E463. PMC: 5367991. DOI: 10.1503/cmaj.160074. View

11.

Fukuoka K, Yanagisawa T, Suzuki T, Shirahata M, Adachi J, Mishima K . Duration between onset and diagnosis in central nervous system tumors: impact on prognosis and functional outcome. Pediatr Int. 2014; 56(6):829-833. DOI: 10.1111/ped.12369. View

12.

Shanmugavadivel D, Liu J, Murphy L, Wilne S, Walker D . Accelerating diagnosis for childhood brain tumours: an analysis of the HeadSmart UK population data. Arch Dis Child. 2019; 105(4):355-362. DOI: 10.1136/archdischild-2018-315962. View

13.

Brasme J, Chalumeau M, Doz F, Lacour B, Valteau-Couanet D, Gaillard S . Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study. Eur J Pediatr. 2011; 171(1):25-32. DOI: 10.1007/s00431-011-1480-z. View

14.

Wilne S, Koller K, Collier J, Kennedy C, Grundy R, Walker D . The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour. Arch Dis Child. 2010; 95(7):534-9. DOI: 10.1136/adc.2009.162057. View

15.

. The epidemiology of headache among children with brain tumor. Headache in children with brain tumors. The Childhood Brain Tumor Consortium. J Neurooncol. 1991; 10(1):31-46. DOI: 10.1007/BF00151245. View

16.

Dobrovoljac M, Hengartner H, Boltshauser E, Grotzer M . Delay in the diagnosis of paediatric brain tumours. Eur J Pediatr. 2002; 161(12):663-7. DOI: 10.1007/s00431-002-1088-4. View

17.

Jogendran M, Ronsley R, Goldman R, Cheng S . Perceived Barriers to the Time to Diagnosis of Central Nervous System Tumors in Children: Surveying the Perspectives From the Frontline. J Pediatr Hematol Oncol. 2021; 43(8):e1262-e1265. DOI: 10.1097/MPH.0000000000002245. View

18.

Armstrong G . Long-term survivors of childhood central nervous system malignancies: the experience of the Childhood Cancer Survivor Study. Eur J Paediatr Neurol. 2010; 14(4):298-303. PMC: 2885448. DOI: 10.1016/j.ejpn.2009.12.006. View