Prognostic implications for gadolinium enhancement of the meninges in low-grade astrocytomas of childhood

Mark D. Hurwitz, Peter C. Burger, Patricia T. Goldthwaite, Tarik Tihan, Moody D. Wharam, Paul G. Fisher

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalPediatric Neurosurgery
Issue number2
StatePublished - Apr 12 2001


  • Astrocytoma
  • MRI enhancement
  • Meninges
  • Pediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology


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