Differentiating dural metastases from meningioma: role of 68Ga DOTA-NOC PET/CT

Abstract

Objective To assess the ability of 68Ga DOTA-NOC PET/computed tomography (CT) to differentiate dural metastases from meningioma. Patients and methods Patients who underwent a 68Ga DOTA-NOC PET/CT for differentiating meningiomas from dural metastases were included in the study. A visual score was assigned to the dural lesions (visual score – 1 to 3) in relation to the uptake in liver and spleen and variation in the visual score was evaluated. SUVmax of the dural lesions was also noted and difference in the values of the two pathologies were compared for statistical significance using nonparametric statistical tests. Final diagnosis was decided by histopathological confirmation whenever available. Results Imaging, histopathology or follow-up data of 42 patients was available for analysis. Meningioma was the final diagnosis in 31 (73.8%) patients, whereas dural metastases were diagnosed in 9 (21.4%) patients. In two patients, histopathology revealed inflammatory pseudotumor and hemangioblastoma. Meningiomas showed intense tracer uptake in 30/31 patients (visual score 3). All metastatic lesions showed some degree of tracer uptake though the intensity was lesser compared to meningioma (visual score 1, 2). Meningiomas showed a significantly higher median SUV max value compared to metastases (12.7 vs. 6.0, P = 0.001). Conclusion Meningiomas can be differentiated from dural metastases by virtue of their higher uptake of 68Ga-labeled DOTA peptides reflecting higher SSTR expression. An asymptomatic meningeal based lesion with a high visual score (Visual score 3) has a very high probability to be a meningioma rather than dural metastasis.

68Ga-DOTATOC PET/CT Follow Up after Single or Hypofractionated Gamma Knife ICON Radiosurgery for Meningioma Patients

“…Other authors investigated the utility of 68 Ga-DOTATOC-PET in fractionated stereotactic radiation therapy (FSRT) planning. They reported a significant reduction in the size of the lesion in 10-38% of cases [18] and better definition of the target in 73% of patients [13,19].…”

“…On the other hand, surgical resection is the treatment required for symptomatic meningiomas, usually due to the fact of their growth. Radiosurgery represents an alternative and/or complementary treatment for both small lesions and tumor residues [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In the literature, Gamma Knife radiosurgery (GKRS) (Elekta AB, Stockholm, Sweden) has been reported to be safe and effective, with a tumor control rate ranging from 88% to 100%, offering reduced morbidity and mortality rates if compared with surgical resection [16].…”

The Role of [68Ga]Ga-DOTA-SSTR PET Radiotracers in Brain Tumors: A Systematic Review of the Literature and Ongoing Clinical Trials

“…The initial search yielded 1606 published articles (PubMed: 803; Scopus: 673; Web of Science: 107; Cochrane: 23). A total of 63 studies were included with the a priori criteria: 25 were case reports and 38 were case series, categorized with levels of evidence IV and V, respectively [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ,…”

Solitary Isolated Dural Metastasis From Lung Adenocarcinoma Mimicking Meningioma

“…However, it may be difficult to differentiate a solitary dural metastasis from meningioma on FDG PET/CT, particularly in patients with cancers, and the suspected metastasis needs histopathologic or other imaging confirmation [9][10][11]. Somatostatin receptor and amyloid PET imaging are promising means for differentiating dural metastasis from meningioma in equivocal cases [12][13][14][15][16][17].…”