(322) MRI as Hearing Loss Predictor in Children Receiving Chemotherapy

Introduction: Platinum-based therapies are commonly utilized as first-line treatments despite associations with permanent, dose-dependent ototoxic effects, including hearing loss, for pediatric brain tumors. Magnetic Resonance Imaging (MRI) can detect hearing loss due to cochlear signal changes and improve clinical decisions, such as therapeutic regimen and audiometric monitoring. This study presents the first longitudinal investigation of MRI signal changes and hearing outcomes in pediatric patients undergoing chemotherapy for intracranial neoplasm.

Methods: Comprehensive chart review of patients receiving treatment for intracranial neoplasms at Children’s National Hospital between 2000-2019. Data abstracted included demographics, clinical characteristics, evaluations, treatment course, and imaging. Patients with intracranial neoplasms who underwent serial MRI and audiologic examinations were included. The timeline of initial cochlear signal abnormality (T2 FLAIR hyperintensity) and audiometric four-tone pure tone average were assessed. Data was further analyzed to evaluate the temporal relationship between cochlear changes on MRI and onset of hearing loss. MRI changes were defined in two groups: mild vs moderate/severe.

Results: Of the 29 patients, 25 had medulloblastoma (86.2%) and 24 (82.8%) had localized disease. Median age at diagnosis was 8 years. Of the 29, all underwent radiation and 27 (93.1%) received Cisplatin. Hearing loss was diagnosed in 26 (89.7%) of the patients, with 19 (73.1%) being noted on MRI imaging changes prior to diagnosis. Median time to developing hearing loss from initial MRI change was 20 weeks, although degree of MRI change did not differ significantly.

Conclusions: Tumor evolution often involves ototoxic therapeutic interventions and can prove detrimental in children. Detection of biomarker alterations, such as hearing loss, can improve treatment timelines and outcomes.