The Prognostic value of pretreatment gallium-68 DOTATATE positron emission tomography/computed tomography in irradiated non-benign meningioma

Abstract

Purpose of the study:The purpose of this study was to evaluate the potential value of gallium-68 (Ga-68)-DOTATATE positron emission tomography/computed tomography (PET/CT) in predicting the risk of progression in nonbenign meningioma after definite irradiation. We retrospectively reviewed our patients with meningiomas who had the highest risk of progression: WHO histological Grade II and III tumors and with macroscopic disease as identified in Ga-68-DOTATATE PET/CT.Materials and Methods:Thirteen patients were included in this study. For each tumor, the following quantifiers were measured: maximum and mean standardized uptake volume (SUV), standard deviation, metabolic tumor volume (MTV), total lesion activity, and coefficient of variation. Each of the quantifiers except for maximum SUV was obtained with three different SUV thresholds: muscle based (ms), liver based (liv), and gradient based (gb). The quantifiers were analyzed in univariate Cox model for their prognostic value for progression-free survival (PFS) and overall survival (OS).Results:Mean follow-up of the patients was 28.2 months. The 2-year PFS and OS was 28.1% and 76.9%, respectively. The MTVgb was a significant predictor for PFS (risk of progression of disease above vs. below the 34 cm3 threshold: 100% vs. 28.3%, P = 0.0003). Clinically, the male sex also influenced PFS (Hazard ratio =13.06; 95% confidence interval: 1.56–109.25; P = 0.018). The mean SUVms(P = 0.041) and SUVgb(P = 0.048) had a prognostic value for predicting the risk of death.Conclusion:Ga-68-DOTATATE PET/CT has potential to predict disease progression in nonbenign meningioma patients. Further prospective studies for validating and standardizing these findings are indicated.

Evaluating Diagnostic Accuracy and Determining Optimal Diagnostic Thresholds of Three Different Approaches to [68Ga]-DOTATATE PET/MRI Analysis in Patients with Meningioma

“…In order to effectively utilize [68Ga]-DOTATATE PET in the clinical context of meningioma, an SUV threshold that constitutes as the diagnostic threshold must be established. Prior studies often employed reference tissue SUVR approaches, such as contralateral brain parenchyma, contralateral subarachnoid space, liver, gluteal muscle, and superior sagittal sinus [4,5,[13][14][15]. One prospective study of 21 patients reported absolute SUV threshold of 2.3 with 90% sensitivity and 73% speci city for the purpose of diagnosing meningioma from tumor free tissue, which have been utilized in several other studies [5,17,18].…”

“…Furthermore, the speci city of [68Ga]-DOTATATE avidity in meningioma is affected by the variable physiologic uptake in other tissues including the pituitary, salivary, thyroid glands, liver, spleen, and urinary tract [12]. Several different methods have been utilized in previous studies to classify lesions as meningioma on the basis of [68Ga]-DOTATATE PET when interpreting standard uptake value (SUV) in meningioma, often with reference to SUV in a background tissue, such as contralateral brain parenchyma, contralateral subarachnoid space, liver, gluteal muscle, and superior sagittal sinus [4,5,[13][14][15]. While the liver reference recapitulates the Krenning score, rst established on the basis of Indium-111-Octreotide scintigraphic imaging, it does not re ect the differences in receptor speci city between [68Ga]-DOTATATE and Octreotide.…”

Incidental detection of brain steam meningioma by Ga-68 DOTATATE PET/CT in a patient with neuroendocrine tumor

“…However if the patient is symptomatic or radiological progression occurs there are treatment options. These 'nonbenign menegioma's might be evaluated by means of Ga-68 DOTATATE PET/CT as a pretreatment imaging method [7]. This imaging modality has prognostic value in the preoperative imaging of this neoplasm which can predict risk of recurrence according to a previous study [7].…”

“…These 'nonbenign menegioma's might be evaluated by means of Ga-68 DOTATATE PET/CT as a pretreatment imaging method [7]. This imaging modality has prognostic value in the preoperative imaging of this neoplasm which can predict risk of recurrence according to a previous study [7]. Another study compared the value of intra arterial versus intravenous methods of Ga-68 DOTA imaging in patients with inoperable meningioma and achieved significantly increased accumulation [8].…”

Multifocal meningioma recurrence detected on Ga68-DOTANOC scan

“…The literature review describes SSTR expression and various DOTANOC positive meningioma,[ 8 9 ] detecting recurrence pattern on DOTA PET/CT scan,[ 10 11 ] predicting tumor growth. [ 12 ] The one limitation of the 68Ga-DOTANOC scan is the parasellar region because of the pituitary gland expressing SSTR2.…”