Meningioma Screening with MRI in Childhood Leukemia Survivors Treated with Cranial Radiation.

Purpose:

Radiation induced meningioma (RIM) is a known late effect of cranial radiotherapy. Cranial MRI can detect small meningiomas, but its potential value as a screening tool is unknown.

Methods and Materials:

MRI was used to screen asymptomatic survivors of childhood ALL treated with CRT ≥10 years previously. The incidence of RIM and outcomes of this group were compared with a historical cohort of survivors with the same exposure who underwent imaging only to investigate clinical signs or symptoms.

Results:

176 childhood leukemia survivors were included in this study, 70 in the screening group, 106 unscreened. Screening MRI was performed a median of 25 years post-RT and detected meningioma in 15 (21.4%). In the unscreened group, 17 patients (16.0%) had neurologic symptoms leading to an MRI after a median interval of 24 years following RT, 9 of whom (8.5%) were diagnosed with meningioma. There was no significant difference between screened vs. unscreened patients in the size of meningioma (mean diameter 1.6cm vs 2.6cm; p =0.13), meningioma incidence (7.4% vs. 4.0% at 25 years; p =0.19), or extent of resection. There were 3 patients who had persistent neurologic symptoms in the unscreened group versus none in among screened patients (p= 0.28).

Conclusion:

Screening MRI was able to detect small meningiomas that were not clinically apparent, however we could not demonstrate a significant improvement in the chance of total resection or a significant decrease in morbidity. A larger sample could clarify potential reduction in neurologic sequelae associated with screening.