Clinical utility of early MRI follow-up after radiosurgery for solitary meningiomas: A single center, retrospective analysis.

Abstract

Stereotactic radiosurgery (SRS) is a well-established treatment for intracranial meningiomas. The optimal timing of post-treatment imaging follow-up ideally promotes early detection of clinically significant radiographic changes while minimizing resource utilization and patient distress. This study explores the patient and tumor characteristics that may impact early imaging timing following radiosurgery. We conducted a single-center cohort analysis of solitary meningiomas treated with SRS between January 2015 and December 2022. Patients were included if they completed at least one follow-up appointment with an MRI within 12-months of treatment. Early (<12 month) follow-up appointments were reviewed for any instances of clinical action. Clinical action was defined as major if the patient underwent additional meningioma directed treatment, or minor if early follow-up resulted in a change in follow-up schedule or medication administration. One-hundred and twenty-five radiosurgical treatments across one-hundred and fifteen patients were included in the final analysis. Fifteen (12%) had major (6; 5%) or minor (9; 7%) clinical action because of early follow-up. The odds of clinical action increased if there was a prior treatment history before SRS (OR 7.833, 95% CI 1.079-56.843) and higher grade (WHO2/3) meningiomas (OR 13.571, 95% CI: 3.703-49.736). The negative predictive value (NPV) of no prior treatment, and low-grade lesions was 96% and 93% respectively. There were no instances of major clinical action without a prior history of treatment. Elimination of an early follow-up visit was projected to save $20,812 annually. Routine early imaging follow-up after SRS for solitary meningiomas rarely leads to clinical action in patients with benign pathology, and no prior treatment. While early screening may be prudent in certain populations, clinical change prompting action is often minor, and the impact of early intervention on long-term clinical outcomes warrants further study.