How Useful is Contrast-enhanced MRI in the Long-term Surveillance of Glioma? A Multicentre Retrospective Longitudinal Cohort Study

Overview

Journal Eur Radiol

Specialty Radiology

Date 2025 Feb 27

PMID 40016316

Authors

Marcus Cakmak

Sepehr Mohammadian

Vera C W Keil

Joost W Schouten

Philip C de Witt Hamer

Thijs van der Vaart

Rutger K Balvers

Ivar J H G Wamelink

Frederik Barkhof

Martin van den Bent

Mark Vries

Marion Smits

Affiliations

Soon will be listed here.

Abstract

Objective: To examine whether MRI with routine gadolinium-based contrast agent (GBCA) administration in the long-term surveillance of adult-type diffuse glioma identifies tumour progression earlier than T2-weighted (T2w) and/or T2w fluid-attenuated inversion recovery (FLAIR) MRI only.

Materials And Methods: In this longitudinal retrospective multicentre cohort study patients with histopathologically confirmed adult-type diffuse glioma and at least two years survival after diagnosis in 2009-2010 were included. Progression was determined by the treating physician or during the multidisciplinary team meeting and defined as the moment a change in treatment or follow-up was required. The primary outcome was the proportion of patients that showed an increase of abnormalities on both contrast-enhanced T1-weighted (CET1w) and T2w/T2w-FLAIR at the time of progression. Chi-square testing was performed to analyse the relationship between the detection of progression on both scan sequences, with calculating the Phi coefficient to determine the degree of association.

Results: One hundred eight consecutive patients were included (58 male; 53 grade 2, 21 grade 3, 34 grade 4). Progression was present in 82 patients and was determined on both CET1w and T2w/T2w-FLAIR images in 59 patients (72.0%). In 20 patients (24.4%), progression was determined based solely on T2w/T2w-FLAIR abnormalities. Only three patients showed progression exclusively on CET1w (3.7%). There was a strong positive significant relationship between the detection of progression on both scan types (p < 0.001; Phi = 0.467).

Conclusion: An increase in CET1w abnormalities was generally accompanied by an increase in T2w/T2w-FLAIR abnormalities, raising the question of whether routine administration of GBCA is always necessary for long-term survivors of glioma.

Key Points: Question Long-term survivors with glioma undergo many contrast-enhanced MRI scans, which involve a patient, financial, and environmental burden. Findings In almost all patients, an increase in T2w/T2w-FLAIR abnormalities was present at the time of tumour progression, mostly but not always accompanying contrast-enhancing findings. Clinical relevance T2w/T2-FLAIR MRI seems to detect glioma progression in long-term surviving patients similar to contrast-enhanced T1w MRI, raising the question of whether the routine administration of GBCA is necessary and justified in patients under long-term surveillance of glioma.

References

McFaline-Figueroa J, Lee E . Brain Tumors. Am J Med. 2018; 131(8):874-882. DOI: 10.1016/j.amjmed.2017.12.039. View

Goodenberger M, Jenkins R . Genetics of adult glioma. Cancer Genet. 2012; 205(12):613-21. DOI: 10.1016/j.cancergen.2012.10.009. View

Ghosh M, Shubham S, Mandal K, Trivedi V, Chauhan R, Naseera S . Survival and prognostic factors for glioblastoma multiforme: Retrospective single-institutional study. Indian J Cancer. 2017; 54(1):362-367. DOI: 10.4103/ijc.IJC_157_17. View

Louis D, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee W . The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; 131(6):803-20. DOI: 10.1007/s00401-016-1545-1. View

Wen P, van den Bent M, Youssef G, Cloughesy T, Ellingson B, Weller M . RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults. J Clin Oncol. 2023; 41(33):5187-5199. PMC: 10860967. DOI: 10.1200/JCO.23.01059. View

Leao D, Craig P, Godoy L, Leite C, Policeni B . Response Assessment in Neuro-Oncology Criteria for Gliomas: Practical Approach Using Conventional and Advanced Techniques. AJNR Am J Neuroradiol. 2019; 41(1):10-20. PMC: 6975322. DOI: 10.3174/ajnr.A6358. View

Wamelink I, Azizova A, Booth T, Mutsaerts H, Ogunleye A, Mankad K . Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy?. Radiology. 2024; 310(2):e230793. PMC: 10902600. DOI: 10.1148/radiol.230793. View

Akgun H, Gonlusen G, Cartwright Jr J, Suki W, Truong L . Are gadolinium-based contrast media nephrotoxic? A renal biopsy study. Arch Pathol Lab Med. 2006; 130(9):1354-7. DOI: 10.5858/2006-130-1354-AGCMNA. View

Rogosnitzky M, Branch S . Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals. 2016; 29(3):365-76. PMC: 4879157. DOI: 10.1007/s10534-016-9931-7. View

10.

Erdogan M, Apaydin M, Armagan G, Taskiran D . Evaluation of toxicity of gadolinium-based contrast agents on neuronal cells. Acta Radiol. 2020; 62(2):206-214. DOI: 10.1177/0284185120920801. View

11.

Guo B, Yang Z, Zhang L . Gadolinium Deposition in Brain: Current Scientific Evidence and Future Perspectives. Front Mol Neurosci. 2018; 11:335. PMC: 6158336. DOI: 10.3389/fnmol.2018.00335. View

12.

Kiviniemi A, Gardberg M, Ek P, Frantzen J, Bobacka J, Minn H . Gadolinium retention in gliomas and adjacent normal brain tissue: association with tumor contrast enhancement and linear/macrocyclic agents. Neuroradiology. 2019; 61(5):535-544. DOI: 10.1007/s00234-019-02172-6. View

13.

Stanescu A, Shaw D, Murata N, Murata K, Rutledge J, Maloney E . Brain tissue gadolinium retention in pediatric patients after contrast-enhanced magnetic resonance exams: pathological confirmation. Pediatr Radiol. 2020; 50(3):388-396. DOI: 10.1007/s00247-019-04535-w. View

14.

Bruder O, Schneider S, Nothnagel D, Pilz G, Lombardi M, Sinha A . Acute adverse reactions to gadolinium-based contrast agents in CMR: multicenter experience with 17,767 patients from the EuroCMR Registry. JACC Cardiovasc Imaging. 2011; 4(11):1171-6. DOI: 10.1016/j.jcmg.2011.06.019. View

15.

Brunjes R, Hofmann T . Anthropogenic gadolinium in freshwater and drinking water systems. Water Res. 2020; 182:115966. PMC: 7256513. DOI: 10.1016/j.watres.2020.115966. View

16.

Smits M, van den Bent M . Imaging Correlates of Adult Glioma Genotypes. Radiology. 2017; 284(2):316-331. DOI: 10.1148/radiol.2017151930. View

17.

Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn J, Minniti G . EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2020; 18(3):170-186. PMC: 7904519. DOI: 10.1038/s41571-020-00447-z. View

18.

Guillevin R, Herpe G, Verdier M, Guillevin C . Low-grade gliomas: the challenges of imaging. Diagn Interv Imaging. 2014; 95(10):957-63. DOI: 10.1016/j.diii.2014.07.005. View

19.

Louis D, Ohgaki H, Wiestler O, Cavenee W, Burger P, Jouvet A . The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007; 114(2):97-109. PMC: 1929165. DOI: 10.1007/s00401-007-0243-4. View

20.

Louis D, Perry A, Wesseling P, Brat D, Cree I, Figarella-Branger D . The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021; 23(8):1231-1251. PMC: 8328013. DOI: 10.1093/neuonc/noab106. View