Improved Detection of Transosseous Meningiomas Using ⁶⁸Ga-DOTATATE PET/CT Compared with Contrast-Enhanced MRI

Abstract

Ga-DOTATATE PET/CT enables detection of meningioma tissue based on somatostatin receptor 2 expression. Transosseous extension of intracranial meningiomas is known to be an important risk factor for tumor recurrence and patient mortality. We analyzed the diagnostic performance of Ga-DOTATATE PET/CT and contrast-enhanced MRI (CE-MRI) for the detection of osseous infiltration using qualitative and quantitative imaging parameters. In this institutional review board-approved retrospective study, subjects were selected from 327 consecutive Ga-DOTATATE PET/CT examinations for evaluation of confirmed or suspected meningioma. Inclusion criteria were CE-MRI within 30 d and pathology-confirmed meningioma diagnosis with inclusion or exclusion of transosseous extension as the standard of reference. Imaging was analyzed by two readers. Tracer uptake values and meningioma volumes were determined. χ, Mann-Whitney U, Wilcoxon signed rank, and McNemar tests, as well as receiver-operating-characteristic analyses, were performed to compare variables and diagnostic performance. Eighty-two patients fulfilled the inclusion criteria. Patients with transosseous extension of meningioma ( = 67) showed significantly larger lesions (median, 12.8 vs. 3.3 mL; < 0.001) and significantly higher tracer uptake values (median SUV, 14.2 vs. 7.6; = 0.011) than patients with extraosseous meningiomas ( = 15). Ga-DOTATATE PET/CT in comparison to CE-MRI performed at a higher sensitivity (98.5% vs. 53.7%) while maintaining high specificity (86.7% vs. 93.3%) in the detection of osseous involvement ( < 0.001). In receiver-operating-characteristic analysis, PET/CT assessment performed better than CE-MRI (area under the curve, 0.932 vs. 0.773). PET/CT- and CE-MRI-based volume estimation yielded comparable results for extraosseous meningiomas ( = 0.132) and the extraosseous part of transosseous meningiomas ( = 0.636), whereas the volume of the intraosseous part was assessed as significantly larger by PET/CT ( < 0.001). Ga-DOTATATE PET/CT enables improved detection of the transosseous extension of intracranial meningiomas compared with CE-MRI.

Gallium‐68 DOTATATE PET in the Evaluation of Intracranial Meningiomas

“…[68Ga]‐DOTATATE PET/MRI additionally was helpful for the confirmation and delineation of the extent of osseous invasion. As transosseous extension of intracranial meningiomas is a known risk factor for tumor recurrence with an associated increased patient mortality, the identification of transosseous extension can steer the neuro‐oncologist toward a more aggressive treatment . Furthermore, [68Ga]‐DOTATATE PET confirmed suspected meningiomas as well as identified additional meningiomas not previously identified on contrast‐enhanced MRI.…”

“…However, there are situations in which MRI sensitivity/specificity may be suboptimal, particularly in the postsurgical/post‐radiation setting . PET/CT imaging with SSTR ligands was previously found to have utility in detection and target volume definition of meningiomas, specifically prior to radiation therapy; however, to date, this imaging has not entered clinical practice . Furthermore, PET imaging has superior physical properties compared to scintigraphic cross‐sectional imaging, i.e., single‐photon emission computed tomography (SPECT), including higher sensitivity, improved spatial resolution, and improved temporal resolution of PET .…”

“…[68Ga]‐DOTATATE PET/CT has been shown to be far superior to In‐111‐Octreotide scintigraphic imaging due to higher target‐to‐background ratio as well as improved specificity, since DOTATATE specifically targets SSTR2 . The detection rate of transosseous meningiomas improved with [68Ga]‐DOTATATE PET/CT compared to contrast‐enhanced MRI, with higher diagnostic accuracy . In the case series presented here, [68Ga]‐DOTATATE PET/MRI was utilized to assess the extent of residual/recurrent tumor, specifically in patients in whom tumor location limits gross total resectability (for example, in the skull base) and patients with WHO‐II/III disease.…”

“…Gallium 68 ([68Ga])‐DOTATATE PET/Computed Tomography (CT) has been shown to be far superior to In‐111‐Octreotide scintigraphic imaging due to improved target‐to‐background ratio as well as improved specificity, since DOTATATE specifically targets SSTR2A, as opposed to other somatostatin analogs used in molecular imaging . Furthermore, [68Ga]‐DOTATATE PET/CT was found to have an improved detection rate of transosseous meningiomas when compared to contrast‐enhanced MRI, with higher sensitivity and accuracy . PET/MRI allows simultaneous acquisition of PET and MRI data, thereby exploiting the superior soft‐tissue resolution of MRI .…”

“…[68Ga]‐DOTATATE and [68Ga]‐DOTATOC PET/MR are novel imaging modalities that offer promise in the diagnosis and management of intracranial meningiomas with high sensitivity and specificity. While [68Ga]‐DOTATOC and [68Ga]‐DOTATATE share a similar SSTR binding pattern, the in vitro affinity of [68Ga]‐DOTATATE is approximately 10‐fold higher than that of DOTATOC, yet few reports exist documenting its utility . We present a series of 20 patients in whom [68Ga]‐DOTATATE PET/MRI demonstrated utility in the assessment of meningioma, including assessment for postsurgical/post‐radiation recurrence, detection of additional lesions not visualized on MRI alone, and evaluation of osseous invasion.…”