Research published in JAMA Oncology shows that surveillance imaging for meningioma patients can be significantly reduced because most follow-up MRI scans do not result in treatment changes, suggesting that risk-adapted imaging protocols could lower costs and patient burden while maintaining stable treatment outcomes.
- Meningioma surveillance imaging led to treatment in only 16.5% of cases, with 83.5% of MRI scans resulting in no treatment changes
- Treatment did not increase despite incidence rates doubling from 6.4 to 12.6 per 100,000 person-years between 2010 and 2023
- Imaging beyond five years after diagnosis rarely prompted treatment, with only 1.4% of patients undergoing surgery after year five
- Extended routine surveillance MRI could be limited to select high-risk cases to reduce costs, logistical burden, and psychological impact on patients
Follow-up neuroimaging could be reduced overall for patients with meningioma, according to research published August 20 in JAMA Oncology.
Researchers led by Anders Rosendal Korshøj, MD, PhD, from Aarhus University Hospital in Denmark reported stable treatment rates despite rising incidence of meningioma. And most surveillance neuroimaging exams did not result in intervention.
“These results may provide a foundation for international efforts to optimize imaging protocols and integrate risk stratification into future guidelines,” Korshøj and co-authors wrote.
Meningiomas are the most common tumors in the central nervous system, with an incidence of approximately 10 per 100,000 person-years. Most tumors are found incidentally and managed conservatively.
Risk stratification models suggest that MRI surveillance and comorbidity features can help manage incidental meningiomas at the individual level. However, the researchers noted a lack of data on whether current surveillance intensity leads to meaningful treatment conversion at the population level.
Korshøj and colleagues studied how often meningioma surveillance imaging (via MRI or CT) leads to treatment decisions. They also investigated trends in incidence, treatment patterns, and imaging use in Denmark between 2010 and 2023.
The study included data from 8,134 patients with a median age of 66 years who were in the Danish National Patient Registry and Danish Pathology Registry.
The age- and sex-standardized incidence rate increased from 6.4 to 12.6 per 100,000 person-years during the study period, “yet yearly treatment rates remained stable.”
Of the total patients, 5,307 (65.2%) received no treatment, while 2,665 (32.8%) underwent surgery and 439 (5.4%) received radiotherapy. Histopathologic analysis confirmed grade 1 tumors in 2,379 patients who underwent surgery (89.3%).
Of the total patients, 7143 (87.8%) underwent one or more follow-up MRI scans. Treatment did not follow MRI scans in 83.5% of cases.
Finally, imaging beyond five years after diagnosis “rarely” led to changes in treatment but accounted for a large proportion of total scans.
“Only 78 of 5,547 patients [1.4%] underwent surgery after year five,” the researchers wrote.
The results suggest that extended routine surveillance MRI “could be limited to select cases” and that more imaging does not translate into increased treatment, the study authors highlighted. They added that repeated imaging increases costs and places logistical and psychological burdens on patients.
“These figures and the disproportion between diagnostic intensity and treatment conversion suggest a need for evidence-based and risk-adapted surveillance,” the authors wrote.
Read the full study here.
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