Imaging of pediatric brain tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper

Abstract

Tumors of the central nervous system are the most common solid malignancies in children and the most common cause of pediatric cancer‐related mortality. Imaging plays a central role in diagnosis, staging, treatment planning, and response assessment of pediatric brain tumors. However, the substantial variability in brain tumor imaging protocols across institutions leads to variability in patient risk stratification and treatment decisions, and complicates comparisons of clinical trial results. This White Paper provides consensus‐based imaging recommendations for evaluating pediatric patients with primary brain tumors. The proposed brain magnetic resonance imaging protocol recommendations balance advancements in imaging techniques with the practicality of deployment across most imaging centers.

You cannot diagnose what you cannot see: The importance of optimized imaging protocols for accurate disease staging and assessment

“…3,4,6 Moreover, in response to concerns about inadequate imaging and/or misinterpretation, recent COG brain tumor trials have adopted a rapid central imaging review with optimized MRI sequences. 5 The early experience of centralized imaging on the COG ACNS1422 study for average-risk WNT medulloblastoma patients (NCT02724579) was consistent with previous reports that approximately 10% of patients are wrongly staged by imaging locally. 7 This improved quality control, alone, affords the opportunity to improve survival in a subgroup of patients even without any new therapeutic interventions.…”

“…Recognizing the breadth of the over 220 COG participating institutions and following the principles advocated by Trout et al., 2 the COG Imaging Discipline is publishing a series of white papers on pediatric cancer imaging to promulgate standards of care for tumor imaging. Notably, these magnetic resonance imaging (MRI) parameters have been designed for implementation in routine clinical practice, as well as multi‐center clinical trials, 5 and supported by conclusive data from generations of studies over decades 3,4,6 . Moreover, in response to concerns about inadequate imaging and/or misinterpretation, recent COG brain tumor trials have adopted a rapid central imaging review with optimized MRI sequences 5 .…”

“…Notably, these magnetic resonance imaging (MRI) parameters have been designed for implementation in routine clinical practice, as well as multi‐center clinical trials, 5 and supported by conclusive data from generations of studies over decades 3,4,6 . Moreover, in response to concerns about inadequate imaging and/or misinterpretation, recent COG brain tumor trials have adopted a rapid central imaging review with optimized MRI sequences 5 . The early experience of centralized imaging on the COG ACNS1422 study for average‐risk WNT medulloblastoma patients (NCT02724579) was consistent with previous reports that approximately 10% of patients are wrongly staged by imaging locally 7 .…”

“…Notably, these magnetic resonance imaging (MRI) parameters have been designed for implementation in routine clinical practice, as well as multi-center clinical trials, 5 and supported by conclusive data from generations of studies over decades. 3,4,6 Moreover, in response to concerns about inadequate imaging and/or misinterpretation, recent COG brain tumor trials have adopted a rapid central imaging review with optimized MRI sequences.…”

Children's Oncology Group's 2023 blueprint for research: Central nervous system tumors

“…The rapid screening process also includes a COG‐wide effort for improved technical radiologic staging by magnetic resonance imaging (MRI) for CNS tumors prone to leptomeningeal dissemination 11–13 . Current and future clinical trials for children with CNS tumors are dependent on precise diagnosis and staging.…”