gallium-ga-68-dotatate and Meningioma

A falcine meningioma was diagnosed in a 66-year-old woman and was treated by surgery and 2 times by radiotherapy during 9 years of follow-up with the diagnosis of atypical meningioma. Three months after the last radiotherapy, incidental liver lesions were detected on chest CT realized for suspected pneumonia. In view of the predisposing factors for meningioma metastases, 68Ga-DOTATOC hepatic and cerebral PET/MRI was performed and completed by total body PET/CT demonstrating a somatostatin receptor 2 overexpression of the multiple liver lesions and several bone lesions. Biopsies from the liver and iliac bone confirmed the metastatic origin of meningioma.

Topics: Aged; Female; Humans; Liver Neoplasms; Meningeal Neoplasms; Meningioma; Octreotide; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals

A 56-year-old woman was initially diagnosed with optic neuritis. However, several "red flags" were present: older age at presentation, no multiple sclerosis suspicious findings on MRI, and negative oligoclonal bands. 68Ga-DOTATATE PET/CT confirmed the differential diagnosis of an optic sheath meningioma. Our case stresses the value of the somatostatin receptor ligand PET/CT in patients with suspected optic neuritis if the diagnostic workup does not support immune-mediated pathogenesis.

Topics: Aged; Female; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Optic Nerve; Organometallic Compounds; Positron Emission Tomography Computed Tomography

A 43-year-old woman with suspected recurrence of atypical meningioma World Health Organization grade II presented extensive intracranial lesions with high Ga-DOTATATE uptake. Moreover, numerous Ga-DOTATATE-positive bone, lung, and liver lesions were seen. For final diagnosis, biopsies taken from a lung lesion revealed distant metastases of the atypical meningioma. This case underlines the high diagnostic power of Ga-DOTATATE PET/CT for the staging of meningioma even beyond cerebral or spinal lesions; in case of distant lesions in patients with known meningioma, differential diagnosis should also contain metastases despite their rare occurrence. Moreover, this case emphasizes radioligand therapy especially in metastatic meningioma.

Topics: Adult; Female; Humans; Meningeal Neoplasms; Meningioma; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Whole Body Imaging

Here we describe the results of superselective intraarterial application of diagnostic Ga-68-DOTA0,Tyr3-octreotate (Ga-68-DOTATATE) in a series of patients with inoperable WHO grade II meningiomas which were no longer amenable to radiotherapy.. Four patients with inoperable WHO grade II meningioma underwent systemic venous infusion of Ga-68-DOTATATE followed by PET/CT. Ga-68-DOTATATE application was repeated intraarterially via transfemoral catheterization of vessels supplying the meningioma and another PET/CT was performed.. Selective arterial infusion of Ga-68-DOTATATE increased the median value for the maximum standardized uptake value (SUV) by 2.6-fold (median venous: 7.1, median arterial: 21.6; range 2.0-5.0) and the median value for mean SUV by 2.7-fold (median venous: 4.3, median arterial: 11.2; range 1.6-5.6) compared to systemic intravenous infusion. Arterial application was well tolerated by all patients without complications. When compared to liver uptake, intravenous tracer uptake was insufficient for PRRT, whereas tracer uptake after superselective intraarterial tracer injection was sufficient to allow for peptide receptor radionuclide therapy (PRRT) in all patients.. Insufficient tracer uptake in meningiomas after intravenous application of Ga-68-DOTATATE may be safely increased by a factor of 2-5 using transfemoral selective intraarterial tracer application.. ZIEL: Wir beschreiben die Ergebnisse der superselektiven intra-arteriellen Applikation von diagnostischem Ga-68-DOTA0,Tyr3-octreotate (Ga-68-DOTATATE) in einer Patientenserie mit inoperablem, nicht mehr für Strahlentherapie in Betracht kommendem WHO-Grad-II-Meningeom.. Vier Patienten mit inoperablem WHO-Grad-II-Meningeom bekamen Ga-68-DOTATATE durch eine intravenöse Injektion, wonach eine PET/CT erfolgte. Die Applikation von Ga-68-DOTATATE wurde intraarteriell wiederholt via transfemorale Katheterisierung der dem Meningeom versorgenden Arterien, wonach eine weitere PET/CT Aufnahme erfolgte.. Die selektive arterielle Infusion des Ga-68-DOTATATE führte in Vergleich zu der venösen systemischen Infusion zu einem Anstieg des Medianwertes des maximalen standardisierten Uptake-Wertes (SUV) um einen Faktor 2.6 (Median nach venöser Applikation: 7,1, median nach arterieller Applikation: 21,6; Spannbreite 2,0–5,0-Fach) und des Medianwertes des mittleren SUV um einen Faktor 2,7 (median venös: 4.3, median arteriell: 11,2; Spannbreite 1,6–5,6-Fach). Arterielle Applikation wurde von allen Patienten komplikationslos vertragen. In Vergleich mit Leber-Uptake war die Uptake nach intravenöser Applikation nicht ausreichend für PRRT; nach superselektiver arterieller Injektion des Tracers hingegen war es bei allen Patienten ausreichend für eine peptid-rezeptor-vermittelte Radionuklidtherapie (PRRT).. Eine nicht-ausreichende Tracer-Uptake in Meningeomen nach intravenöser Applikation von Ga-68-DOTATATE kann sicher um das 2–5-Fache erhöht werden durch transfemorale selektive intraarterielle Applikation des Tracers.

Topics: Aged; Angiography; Female; Humans; Injections, Intra-Arterial; Injections, Intravenous; Meningioma; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Meningiomas are the most common primary intracranial tumors, typically treated with surgery and adjuvant radiation in cases of subtotal resection and/or higher histopathologic grade. Contrast-enhanced magnetic resonance imaging (MRI) is the gold standard for postoperative assessment and adjuvant treatment planning. However, MRI can have limited accuracy particularly in the presence of posttreatment change. [68Ga]-DOTATATE is a Positron Emission Tomography (PET) radiotracer targeting somatostatin receptor 2A (SSTR2A). SSTR2A is a reliable biomarker of meningiomas. We report a consecutive case series of 20 patients evaluated with [68Ga]-DOTATATE PET/MRI, propose a novel approach to quantitative analysis, and discuss clinical implications.. We present a consecutive case series of 20 patients with clinically suspected or pathology-proven meningioma evaluated between July 2018 and February 2019. [68Ga]-DOTATATE PET/MRI was obtained in order to confirm the diagnosis or determine tumor recurrence/progression to help guide surgical and/or radiation therapy management in cases in which MRI findings were indeterminate or equivocal.. Seventeen (85%) patients had undergone prior surgery and 11 (55%) underwent adjuvant radiation therapy. In 17 patients [68Ga]-DOTATATE confirmed the presence of recurrent meningioma. A total of 49 meningiomas were identified (median: 2 meningiomas/patient, range 0-14). There was excellent differentiation between meningioma and posttreatment change based on our approach of target lesion/superior sagittal sinus maximum standardized uptake values ratio (16.6 vs. 1.6, P < .0001).. [68Ga]-DOTATATE PET/MRI is a promising tool in the assessment of both treatment naïve and resected/irradiated meningiomas, allowing improved diagnosis and extent of disease evaluation. Future prospective studies are needed to determine utility of [68Ga]-DOTATATE PET/MRI in treatment response assessment.

Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Female; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Organometallic Compounds; Positron-Emission Tomography; Prospective Studies

In this case of suspected sphenoid wing meningioma, Ga-DOTATATE PET/CT showed a somatostatin receptor (SSR)-expressing tumor with extension to the nasopharynx and SSR-expressing cervical lymph nodes. Subsequent biopsy from the nasopharynx revealed an Epstein-Barr virus (EBV)-associated, undifferentiated World Health Organization type 3 nasopharyngeal carcinoma (NPC), a potential clinical pitfall due to the reported high SSR expression of this tumor subtype. In consideration of the high target-to-background contrast, SSR ligands might be superior to F-FDG for EBV-associated NPC PET imaging, particularly at the skull base. Somatostatin receptor ligands might furthermore offer interesting theranostic possibilities for patients with advanced/extensive EBV-associated NPC.

Topics: Adult; Carcinoma; Herpesvirus 4, Human; Humans; Male; Meningeal Neoplasms; Meningioma; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Organometallic Compounds; Positron Emission Tomography Computed Tomography

We present a case of metastatic meningioma detected on Ga-DOTA-octreotate PET. A 52-year-old woman presented with multiply recurrent multifocal meningioma. A staging Ga-DOTATATE PET/CT demonstrated focal radiotracer uptake within the known intracranial meningiomas. In addition, a DOTATATE-avid mass was found in the liver that was biopsied, confirming metastatic meningioma. This report suggests that Ga-DOTATATE PET/CT should be considered whenever screening meningioma patients for metastases.

Topics: Female; Humans; Liver Neoplasms; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

We report a woman with multifocal lesions suggestive of meningiomas in MRI, which also presented with high Ga-DOTATATE uptake in PET, a finding characteristic for meningioma. A whole-body staging due to a pathological fracture revealed multiple neoplastic lesions throughout the body without detection of a primary site. Subsequent pathological workup of a lung lesion revealed multifocal metastases from follicular thyroid cancer despite thyroidectomy 10 years ago (without pathological finding), and posttreatment scans after radioiodine therapy confirmed the multiple brain lesions to be metastases as well. Our case shows that epidural metastases from endocrine origin might represent a clinical pitfall in Ga-DOTATATE PET.

Topics: Adenocarcinoma, Follicular; Diagnosis, Differential; Epidural Neoplasms; Female; Humans; Meningeal Neoplasms; Meningioma; Organometallic Compounds; Positron-Emission Tomography

Ga DOTATATE PET/CT in noninvasive characterization of synchronous pituitary neoplasm and meningioma in a 38-year-old man is illustrated. The patient presented with an MRI-detected lobulated enhancing sellar-suprasellar mass with erosion of bony sella measuring 4.5 × 3.5 × 3.4 cm (with differential diagnosis with germ cell tumor) and a right parafalcine mass (2.7 × 2.6 cm) suggesting meningioma. Ga DOTATATE PET/CT demonstrated intense uptake in both lesions, suggesting the sellar mass to be pituitary macroadenoma. The finding of high serum prolactin and normal LH, FSH, cortisol, and testosterone levels suggested diagnosis of prolactinoma, and the patient was started on cabergoline.

Topics: Adult; Humans; Male; Meningeal Neoplasms; Meningioma; Multimodal Imaging; Neoplasms, Multiple Primary; Organometallic Compounds; Pituitary Neoplasms; Positron-Emission Tomography; Prolactinoma; Radiopharmaceuticals; Tomography, X-Ray Computed

The prognosis of patients with progressive meningioma after failure of surgery and radiotherapy is poor.. We retrospectively evaluated the safety and efficacy of somatostatin-receptor (SSTR)-targeted radionuclide therapy (. SSTR-targeted radionuclide treatment has activity in a subset of patients with meningioma. Expression of SSTR via immunohistochemistry or radionuclide uptake might serve as a predictive biomarker for outcome to facilitate individualized treatment optimization in patients with uni- and multifocal meningiomas.

Topics: Adolescent; Adult; Aged; Disease-Free Survival; Female; Gallium Radioisotopes; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Octreotide; Organometallic Compounds; Radiopharmaceuticals; Receptors, Somatostatin; Retrospective Studies; Survival Rate; Treatment Outcome; Young Adult

Radiolabelled somatostatin analogues detect neuroendocrine tumours (NETs), but may reveal other tumour types. We examined the prevalence of possible meningioma in patients with known or suspected NETs imaged with Ga-DOTATATE PET-computed tomography (CT) on the basis of central nervous system uptake and compared with findings on magnetic resonance and contrast-enhanced CT imaging.. Retrospective imaging reports from 313 patients who had undergone Ga-DOTATATE PET imaging for primary or repeat NET staging were searched to identify suspected meningiomas on PET. Images were then compared with findings on subsequent complementary MRI or contrast-enhanced CT scanning (performed within mean±112 days of PET-CT) if available.. Of 313 patients, 22 had regions of uptake suggestive of meningioma. MRI was available for 12 patients and contrast-enhanced CT was available for one patient. Of these, one patient with known von Hippel-Lindau syndrome had probable cerebellar NET metastasis. Six patient scans indicated lesions consistent with PET. Two of these reported initially did not comment on meningioma. No obvious lesion was found in the remaining six patients; however, five showed a possible correlation to venous structures. The mean maximum standardized uptake value±SEM for lesions in all 21 probable meningioma patients was 4.90±0.45.. Ga-DOTATATE is a sensitive marker of probable meningioma and may identify small lesions not reported on subsequent MRI. Lesions clearly observed on PET were identified on review in half of patients where complementary MR or CT imaging was available. Haemangioblastoma and metastatic NETs may have focal peripheral uptake similar to meningioma on Ga-DOTATATE PET and should be considered in the differential.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain; Female; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Young Adult

Positron imaging with radiolabeled synthetic somatostatin receptor analogs such as Ga DOTATATE (Gallium-68-1,4,7,10-tetraazacyclododecane-N,N',N″,N‴-tetra acetic acid-DPhe1,Tyr3-octreotate) is used for diagnosis and target volume delineation of intracranial meningiomas. We report a case of a somatostatin receptor-positive extra-axial necrotizing granulomatous inflammation mimicking as meningioma on simultaneous Ga DOTATATE PET/MRI. This case illustrates a Ga DOTATATE-positive granuloma bearing a striking resemblance to meningioma.

Topics: Aged; Diagnosis, Differential; Female; Granuloma; Humans; Inflammation; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Receptors, Somatostatin

Symptomatic tumors of the optic nerve pathway may endanger vision. They are difficult to classify by imaging alone and biopsy may damage visual function. Tumor pathology influences treatment decision and a diagnostic tool with a high sensitivity and specificity would therefore be invaluable. We hypothesized that Ga-68-DOTA-TATE PET/CT may help in discriminating optic nerve tumors as uptake of somatostatin is elevated in meningiomas.. Ga-68-DOTA-TATE PET/CT was used to examine 13 patients with ambiguous, symptomatic lesions of the optic pathway for treatment planning. The presence or absence of meningioma was validated by histopathology or supplementary diagnostic work-up.. Ga-68-DOTA-TATE PET/CT identified 10 meningiomas (en plaque = 1, optic nerve sheath = 4, sphenoidal = 5) correctly via increased SSTR (somatostatin receptor) expression (mean SUVmax (maximum standardized uptake value) = 14.3 ± 15.4). 3 tumors did not show elevated Ga-68-DOTA-TATE uptake (SUVmax = 2.1 ± 1.0). Subsumizing all clinical-radiological follow-up tools available, these lesions were classified as an intracerebral metastasis of an advanced gastric carcinoma, histologically proven inflammatory collagenous connective tissue and presumed leukemic infiltration of a newly diagnosed chronic lymphocytic leukemia. In this case series, Ga-68-DOTA-TATE PET/CT demonstrated both a sensitivity and specificity of 100%. Yet, the golden standard of histopathology was only available in a subset of patients included.. Ga-68-DOTA-TATE PET/CT proved to be a valuable diagnostic tool for the correct classification of equivocal, symptomatic tumors of the anterior optic pathway requiring therapy. PET/CT results influenced therapy decision essentially in all cases.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Meningioma; Middle Aged; Multimodal Imaging; Optic Nerve; Organometallic Compounds; Positron-Emission Tomography; Tomography, X-Ray Computed; Treatment Outcome

Meningiomas are known to express somatostatin receptor 2 (SSTR2). PET using the SSTR2 analog (68)Ga-DOTATATE has recently been introduced for imaging of meningiomas. However, a systematic correlation between (68)Ga-DOTATATE uptake, SSTR2 expression, and histology (including tumor-free scar tissue) is still lacking. For elucidation, we conducted this prospective study.. Twenty-one adult patients with primary (n = 12) or recurrent (n = 9) meningiomas were prospectively enrolled. Preoperative MR imaging and (68)Ga-DOTATATE PET scans were fused and used for a spatially precise neuronavigated tissue-sampling procedure during tumor resection. Histopathologic diagnosis included immunohistochemical determination of SSTR2 expression. At each individual sampling site, the maximum standardized uptake value (SUVmax) of (68)Ga-DOTATATE was correlated with MR imaging findings, histology, and semiquantitative SSTR2 expression.. One hundred fifteen samples (81 tumor, 34 tumor-free) were obtained. There was a significant positive correlation between SUVmax and SSTR2 expression. Receiver-operating characteristic analysis revealed a threshold of 2.3 for SUVmax to discriminate between tumor and nontumoral tissue. Regarding the detection of tumor tissue, PET imaging showed a higher sensitivity (90% vs. 79%; P = 0.049), with specificity and positive predictive values similar to MR imaging, for both de novo and recurrent tumors.. (68)Ga-DOTATATE uptake correlates with SSTR2 expression and offers high diagnostic accuracy to delineate meningioma from tumor-free tissue even in recurrent tumors after previous therapy. Our findings substantiate an important role for (68)Ga-DOTATATE PET in meningioma management.

Topics: Adult; Aged; Female; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Organometallic Compounds; Positron-Emission Tomography; Prospective Studies; Receptors, Somatostatin; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

The goal of this study was to compare the tumor uptake kinetics and diagnostic value of three (68)Ga-DOTA-labeled somatostatin analogues ((68)Ga-DOTATOC, (68)Ga-DOTANOC, and (68)Ga-DOTATATE) using PET/CT in a murine model with subcutaneous meningioma xenografts.. The experiment was performed with 16 male NUDE NU/NU mice bearing xenografts of a human meningioma cell line (CH-157MN). (68)Ga-DOTATOC, (68)Ga-DOTANOC, and (68)Ga-DOTATATE were produced in a FASTLab automated platform. Imaging was performed on an Argus small-animal PET/CT scanner. The SUVmax of the liver and muscle, and the tumor-to-liver (T/L) and tumor-to-muscle (T/M) SUV ratios were computed. Kinetic analysis was performed using Logan graphical analysis for a two-tissue reversible compartmental model, and the volume of distribution (Vt) was determined.. Hepatic SUVmax and Vt were significantly higher with (68)Ga-DOTANOC than with (68)Ga-DOTATOC and (68)Ga-DOTATATE. No significant differences between tracers were found for SUVmax in tumor or muscle. No differences were found in the T/L SUV ratio between (68)Ga-DOTATATE and (68)Ga-DOTATOC, both of which had a higher fraction than (68)Ga-DOTANOC. The T/M SUV ratio was significantly higher with (68)Ga-DOTATATE than with (68)Ga-DOTATOC and (68)Ga-DOTANOC. The Vt for tumor was higher with (68)Ga-DOTATATE than with (68)Ga-DOTANOC and relatively similar to that of (68)Ga-DOTATOC.. This study demonstrates, for the first time, the ability of the three radiolabeled somatostatin analogues tested to image a human meningioma cell line. Although Vt was relatively similar with (68)Ga-DOTATATE and (68)Ga-DOTATOC, uptake was higher with (68)Ga-DOTATATE in the tumor than with (68)Ga-DOTANOC and (68)Ga-DOTATOC, suggesting a higher diagnostic value of (68)Ga-DOTATATE for detecting meningiomas.

Topics: Animals; Humans; Male; Meningeal Neoplasms; Meningioma; Mice; Mice, Nude; Molecular Imaging; Octreotide; Organometallic Compounds; Positron-Emission Tomography

Gallium-68 ((68) Ga)-labelled somatostatin analogue imaging by positron emission tomography (PET) is increasingly replacing single photon (such as (111) In-labelled octreotide) imaging in the detection and staging of carcinoid and other neuroendocrine tumours. Among other tissues, pituitary uptake of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-octreotate (DOTA-TATE) and other somatostatin analogues is physiological. DOTA-TATE also accumulates in meningiomas, which have a high density of somatostatin receptor expression. The combination of pituitary and skull base meningioma uptake results in a characteristic 'double hot spot' appearance, which indicates the presence of a meningioma. This is a case of a middle-aged woman who underwent (68) Ga-DOTA-TATE PET for confirmation and staging of clinically suspected carcinoid tumour, in whom a skull base meningioma was incidentally discovered. With the increasing use of PET in the management of neuroendocrine tumours - and the not infrequent occurrence of meningiomas - the appearance of meningiomas on somatostatin analogue imaging should be one with which reporting clinicians are familiar.

Topics: Female; Humans; Incidental Findings; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Skull Base Neoplasms; Somatostatin