1
|
Ivanidze J, Chang SJ, Haghdel A, Kim JT, Roy Choudhury A, Wu A, Ramakrishna R, Schwartz TH, Cisse B, Stieg P, Muller L, Osborne JR, Magge RS, Karakatsanis NA, Roytman M, Lin E, Pannullo SC, Palmer JD, Knisely JPS. [Ga68] DOTATATE PET/MRI-guided radiosurgical treatment planning and response assessment in meningiomas. Neuro Oncol 2024; 26:1526-1535. [PMID: 38553990 PMCID: PMC11300004 DOI: 10.1093/neuonc/noae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Our purpose was to determine the utility of [68Ga]-DOTATATE PET/MRI in meningioma response assessment following radiosurgery. METHODS Patients with meningioma prospectively underwent postoperative DOTATATE PET/MRI. Co-registered PET and gadolinium-enhanced T1-weighted MRI were employed for radiosurgery planning. Follow-up DOTATATE PET/MRI was performed at 6-12 months post-radiosurgery. Maximum absolute standardized uptake value (SUV) and SUV ratio (SUVRSSS) referencing superior sagittal sinus (SSS) blood pool were obtained. Size change was determined by Response Assessment in Neuro-Oncology (RANO) criteria. Association of SUVRSSS change magnitude and progression-free survival (PFS) was evaluated using Cox regression. RESULTS Twenty-seven patients with 64 tumors (26% World Health Organization [WHO]-1, 41% WHO-2, 26% WHO-3, and 7% WHO-unknown) were prospectively followed post stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT; mean dose: 30 Gy, modal dose 35 Gy, mean of 5 fractions). Post-irradiation SUV and SUVRSSS decreased by 37.4% and 44.4%, respectively (P < .0001). Size product decreased by 8.9%, thus failing to reach the 25% significance threshold as determined by RANO guidelines. Mean follow-up time was 26 months (range: 6-44). Overall mean PFS was 83% and 100%/100%/54% in WHO-1/-2/-3 subcohorts, respectively, at 34 months. At maximum follow-up (42-44 months), PFS was 100%/83%/54% in WHO-1/-2/-3 subcohorts, respectively. Cox regression analyses revealed a hazard ratio of 0.48 for 10-unit reduction in SUVRSSS in the SRS cohort. CONCLUSIONS DOTATATE PET SUV and SUVRSSS demonstrated marked, significant decrease post-radiosurgery. Lesion size decrease was statistically significant; however, it was not clinically significant by RANO criteria. DOTATATE PET/MR thus represents a promising imaging biomarker for response assessment in meningiomas treated with radiosurgery. CLINICALTRIALS.GOV IDENTIFIER NCT04081701.
Collapse
Affiliation(s)
- Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Se Jung Chang
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Arsalan Haghdel
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Joon Tae Kim
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Arindam Roy Choudhury
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alan Wu
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Babacar Cisse
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Leland Muller
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Rajiv S Magge
- Brain Tumor Center, Weill Cornell Medicine, New York, New York, USA
| | | | - Michelle Roytman
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
2
|
Vassantachart AK, Ehret F, Chen E, Kumar R, Gogineni E, Andraos TY, Sahgal A, Redmond KJ, Lo SS, Chang EL, Sheehan J, Chao ST, Kim GGY, Kresl JJ, Schulder M, Palmer JD, Gibbs IC, Santacroce A, Shih HA. A Case-based Guide for World Health Organization (WHO) Grade 2 Meningioma Radiosurgery and Radiation Therapy from The Radiosurgery Society. Pract Radiat Oncol 2024:S1879-8500(24)00090-0. [PMID: 38970567 DOI: 10.1016/j.prro.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Meningiomas represent the most common primary tumor of the central nervous system. Current treatment options include surgical resection with or without adjuvant radiation therapy (RT), definitive RT, and observation. However, the radiation dose, fractionation, and margins used to treat patients with WHO grade 2 meningiomas, which account for approximately 20% of all meningiomas, are not clearly defined, and deciding on the optimal treatment modality can be challenging owing to the lack of randomized data. METHODS AND MATERIALS In this manuscript, 3 cases of patients with WHO grade 2 meningiomas are presented with descriptions of treatment options after gross total resection, subtotal resection, and previous irradiation. Treatment recommendations were compiled from 9 central nervous system radiation oncology and neurosurgery experts from The Radiosurgery Society, and the consensus of treatment recommendations is reported. RESULTS Both conventional and stereotactic RT are treatment options for WHO grade 2 meningiomas. The majority of prospective data in the setting of WHO grade 2 meningiomas involve larger margins. Stereotactic radiosurgery/hypofractionated stereotactic RT are less appropriate in this setting. Conventionally fractionated RT to at least 59.4 Gy is considered standard of care with utilization of preoperative and postoperative imaging to evaluate the extent of disease and possible osseous involvement. After careful discussion, stereotactic radiosurgery/hypofractionated stereotactic RT may play a role for the subset of patients who are unable to tolerate the standard lengthy conventionally fractionated treatment course, for those with prior RT, or for small residual tumors. However, more studies are needed to determine the optimal approach. CONCLUSIONS This case-based evaluation of the current literature seeks to provide examples for the management of grade 2 meningiomas and give examples of both conventional and stereotactic RT.
Collapse
Affiliation(s)
| | - Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany
| | - Eric Chen
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Therese Y Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California and Norris Cancer Center, Los Angeles, California
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia, Charlottesville, Virginia
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Grace Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - John J Kresl
- Phoenix CyberKnife and Radiation Oncology Center, Phoenix, Arizona
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Arthur G. James Cancer Hospital/The Ohio State University, Columbus, Ohio
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford Medicine, Stanford, California
| | - Antonio Santacroce
- European Radiosurgery Center Munich, Munich, Germany; Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3
|
Albert NL, Preusser M, Traub-Weidinger T, Tolboom N, Law I, Palmer JD, Guedj E, Furtner J, Fraioli F, Huang RY, Johnson DR, Deroose CM, Herrmann K, Vogelbaum M, Chang S, Tonn JC, Weller M, Wen PY, van den Bent MJ, Verger A, Ivanidze J, Galldiks N. Joint EANM/EANO/RANO/SNMMI practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor ligands: version 1.0. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06783-x. [PMID: 38898354 DOI: 10.1007/s00259-024-06783-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To provide practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor (SSTR) ligands. METHODS This joint practice guideline/procedure standard was collaboratively developed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the PET task force of the Response Assessment in Neurooncology Working Group (PET/RANO). RESULTS Positron emission tomography (PET) using somatostatin receptor (SSTR) ligands can detect meningioma tissue with high sensitivity and specificity and may provide clinically relevant information beyond that obtained from structural magnetic resonance imaging (MRI) or computed tomography (CT) imaging alone. SSTR-directed PET imaging can be particularly useful for differential diagnosis, delineation of meningioma extent, detection of osseous involvement, and the differentiation between posttherapeutic scar tissue and tumour recurrence. Moreover, SSTR-peptide receptor radionuclide therapy (PRRT) is an emerging investigational treatment approach for meningioma. CONCLUSION These practice guidelines will define procedure standards for the application of PET imaging in patients with meningiomas and related SSTR-targeted PRRTs in routine practice and clinical trials and will help to harmonize data acquisition and interpretation across centers, facilitate comparability of studies, and to collect larger databases. The current document provides additional information to the evidence-based recommendations from the PET/RANO Working Group regarding the utilization of PET imaging in meningiomas Galldiks (Neuro Oncol. 2017;19(12):1576-87). The information provided should be considered in the context of local conditions and regulations.
Collapse
Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, LMU Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Diagnostic and Therapeutic Nuclear Medicine, Clinic Donaustadt, Vienna Health Care Group, Vienna, Austria
| | - Nelleke Tolboom
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, Netherlands
- Division Imaging & Oncology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric Guedj
- Institut Fresnel, Nuclear Medicine Department, APHM, CNRS, Timone Hospital, CERIMED, Aix Marseille Univ, Marseille, France
| | - Julia Furtner
- Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK) - University Hospital Essen, Essen, Germany
| | | | - Susan Chang
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy and IADI INSERM UMR 1254, Université de Lorraine, Nancy, France
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
| |
Collapse
|
4
|
Perlow HK, Nalin AP, Handley D, Gokun Y, Blakaj DM, Beyer SJ, Thomas EM, Raval RR, Boulter D, Kleefisch C, Bovi J, Chen WC, Braunstein SE, Raleigh DR, Knisely JPS, Ivanidze J, Palmer JD. A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation Into Treatment Planning of Intracranial Meningiomas. Int J Radiat Oncol Biol Phys 2024; 118:979-985. [PMID: 37871886 DOI: 10.1016/j.ijrobp.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that 68Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy. METHODS AND MATERIALS A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a 68Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion. RESULTS Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation. CONCLUSIONS This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used 68Ga-DOTATATE PET-guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.
Collapse
Affiliation(s)
- Haley K Perlow
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ansel P Nalin
- Ohio State University College of Medicine, Columbus, Ohio
| | - Demond Handley
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Yevgeniya Gokun
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha J Beyer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Evan M Thomas
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raju R Raval
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Boulter
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William C Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - David R Raleigh
- Department of Radiation Oncology, University of California, San Francisco, California; Departments of Radiation Oncology, Neurological Surgery, and Pathology, University of California, San Francisco, California
| | | | - Jana Ivanidze
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
5
|
Ratnayake G, Huo M, Mehta A, Ramachandran P, Pinkham MB, Law P, Watkins T, Olson S, Hall B, Brown S, Lusk R, Jones C, O’Mahoney E, McGill G, Foote MC. Utility of 68Ga-DOTATATE PET-MRI for Gamma Knife® stereotactic radiosurgery treatment planning for meningioma. Br J Radiol 2024; 97:180-185. [PMID: 38263827 PMCID: PMC11027229 DOI: 10.1093/bjr/tqad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate the impact of adding 68Ga-DOTATATE PET/MRI to standard MRI for target volume delineation in Gamma Knife® stereotactic radiosurgery (GKSRS) for meningioma. METHODS Seventeen patients with 18 lesions undergoing GKSRS for WHO grade 1 meningioma were enrolled in a prospective study. All patients underwent pre-treatment 68Ga-DOTATATE PET/MRI examination in addition to standard procedures. Five clinicians independently contoured the gross tumour volume (GTV) based on standard MRI (GTVMRI) and PET/MRI (GTVPET/MRI) on separate occasions. Interobserver agreement was evaluated using Cohen's Kappa statistic (CKS), Dice similarity coefficient (DC), and Hausdorff distance (HD). Statistical analysis was performed with paired t-test and Wilcoxon signed rank test. RESULTS The addition of PET/MRI significantly increased GTV contour volume (mean GTVPET/MRI 3.59 cm3 versus mean GTVMRI 3.18 cm3, P = .008). Using the treating clinician's pre-treatment GTVMRI as the reference, median CKS (87.2 vs 77.5, P = .006) and DC (87.2 vs 77.4, P = .006) were significantly lower, and median HD (25.2 vs 31.0, P = .001) was significantly higher with the addition of PET/MRI. No significant difference was observed in interobserver contouring reproducibility between GTVMRI and GTVPET/MRI. CONCLUSION The addition of 68Ga-DOTATATE PET/MRI for target volume delineation in GKSRS for meningioma is associated with an increase in GTV volume and greater interobserver variation. PET/MRI did not affect interobserver contouring reproducibility. ADVANCES IN KNOWLEDGE This study provides novel insights into the impact of 68Ga-DOTATATE PET/MRI on GTV delineation and interobserver agreement in meningioma GKSRS, highlighting its potential for improving GKSRS treatment accuracy.
Collapse
Affiliation(s)
- Gishan Ratnayake
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Akash Mehta
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Prabhakar Ramachandran
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Mark B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Phillip Law
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Trevor Watkins
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Sarah Olson
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Bruce Hall
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Simon Brown
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Ryan Lusk
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Catherine Jones
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Eoin O’Mahoney
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - George McGill
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Matthew C Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| |
Collapse
|
6
|
Iglseder S, Iglseder A, Beliveau V, Heugenhauser J, Gizewski ER, Kerschbaumer J, Stockhammer G, Uprimny C, Virgolini I, Dudas J, Nevinny-Stickel M, Nowosielski M, Scherfler C. Somatostatin receptor subtype expression and radiomics from DWI-MRI represent SUV of [68Ga]Ga-DOTATOC PET in patients with meningioma. J Neurooncol 2023; 164:711-720. [PMID: 37707754 PMCID: PMC10589159 DOI: 10.1007/s11060-023-04414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE This retrospective study aimed to analyse the correlation between somatostatin receptor subtypes (SSTR 1-5) and maximum standardized uptake value (SUVmax) in meningioma patients using Gallium-68 DOTA-D-Phe1-Tyr3-octreotide Positron Emission Tomography ([68Ga]Ga-DOTATOC PET). Secondly, we developed a radiomic model based on apparent diffusion coefficient (ADC) maps derived from diffusion weighted magnetic resonance images (DWI MRI) to reproduce SUVmax. METHOD The study included 51 patients who underwent MRI and [68Ga]Ga-DOTATOC PET before meningioma surgery. SUVmax values were quantified from PET images and tumour areas were segmented on post-contrast T1-weighted MRI and mapped to ADC maps. A total of 1940 radiomic features were extracted from the tumour area on each ADC map. A random forest regression model was trained to predict SUVmax and the model's performance was evaluated using repeated nested cross-validation. The expression of SSTR subtypes was quantified in 18 surgical specimens and compared to SUVmax values. RESULTS The random forest regression model successfully predicted SUVmax values with a significant correlation observed in all 100 repeats (p < 0.05). The mean Pearson's r was 0.42 ± 0.07 SD, and the root mean square error (RMSE) was 28.46 ± 0.16. SSTR subtypes 2A, 2B, and 5 showed significant correlations with SUVmax values (p < 0.001, R2 = 0.669; p = 0.001, R2 = 0.393; and p = 0.012, R2 = 0.235, respectively). CONCLUSION SSTR subtypes 2A, 2B, and 5 correlated significantly with SUVmax in meningioma patients. The developed radiomic model based on ADC maps effectively reproduces SUVmax using [68Ga]Ga-DOTATOC PET.
Collapse
Affiliation(s)
- Sarah Iglseder
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Iglseder
- Department of Geodesy and Geoinformation, Technical University Vienna, Vienna, Austria
| | - Vincent Beliveau
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
- Neuroimaging Research Core Facility, Innsbruck Medical University, Innsbruck, Austria
| | | | - Elke R Gizewski
- Neuroimaging Research Core Facility, Innsbruck Medical University, Innsbruck, Austria
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Christian Uprimny
- Department of Nuclear Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Innsbruck Medical University, Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Martha Nowosielski
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Christoph Scherfler
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
7
|
Caccese M, Busato F, Guerriero A, Padovan M, Cerretti G, Gardiman MP, Zagonel V, Lombardi G. The role of radiation therapy and systemic treatments in meningioma: The present and the future. Cancer Med 2023; 12:16041-16053. [PMID: 37366279 PMCID: PMC10469847 DOI: 10.1002/cam4.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Meningiomas are the most prevalent tumors of the central nervous system. Their standard treatment is surgery, which can be curative. Adjuvant radiotherapy treatment is reserved for newly diagnosed cases of grade II and grade III meningiomas in cases of recurrent disease or when surgery is not radical or feasible. However, around 20% of these patients cannot undergo further surgical and/or radiotherapy treatment. Systemic oncological therapy can find its place in this setting. Several tyrosine kinase inhibitors have been tested (gefitinib, erlotinib, sunitinib) with unsatisfactory or negative results. Bevacizumab has shown encouraging results in these settings of patients. Immunotherapy with immune checkpoint inhibitors has reported interesting results with modest objective response rates. Several ongoing studies are assessing different target therapies and multimodal therapies; the results are to be disclosed. Not only a better understanding of the molecular characteristics in meningiomas has allowed the gathering of more information regarding pathogenesis and prognosis, but in addition, the availability of new target therapy, immunotherapy, and biological drugs has widened the scope of potentially effective treatments in this patient population. The aim of this review was to explore the radiotherapy and systemic treatments of meningioma with an analysis of ongoing trials and future therapeutic perspectives.
Collapse
Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology Unit 1Veneto Institute of Oncology IOV‐IRCCSPaduaItaly
| | - Fabio Busato
- Department of Radiation OncologyAbano Terme HospitalPaduaItaly
| | - Angela Guerriero
- General Pathology and Cytopathology Unit, Department of Medicine‐DMEDUniversity of PaduaPaduaItaly
| | - Marta Padovan
- Department of Oncology, Oncology Unit 1Veneto Institute of Oncology IOV‐IRCCSPaduaItaly
| | - Giulia Cerretti
- Department of Oncology, Oncology Unit 1Veneto Institute of Oncology IOV‐IRCCSPaduaItaly
| | - Marina Paola Gardiman
- General Pathology and Cytopathology Unit, Department of Medicine‐DMEDUniversity of PaduaPaduaItaly
| | - Vittorina Zagonel
- Department of Oncology, Oncology Unit 1Veneto Institute of Oncology IOV‐IRCCSPaduaItaly
| | - Giuseppe Lombardi
- Department of Oncology, Oncology Unit 1Veneto Institute of Oncology IOV‐IRCCSPaduaItaly
| |
Collapse
|
8
|
Rini JN, Keir G, Caravella C, Goenka A, Franceschi AM. Somatostatin Receptor-PET/CT/MRI of Head and Neck Neuroendocrine Tumors. AJNR Am J Neuroradiol 2023; 44:959-966. [PMID: 37442593 PMCID: PMC10411831 DOI: 10.3174/ajnr.a7934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND PURPOSE Due to its high sensitivity, somatostatin receptor-PET may detect smaller lesions and more extensive disease than contrast-enhanced MR imaging, while the superior spatial resolution of MR imaging enables lesions to be accurately localized. We compared results of somatostatin receptor-PET/MRI with those of MR imaging alone and assessed the added value of vertex-to-thigh imaging for head and neck neuroendocrine tumors. MATERIALS AND METHODS Somatostatin receptor-PET/CT was acquired as limited brain or head and neck imaging, with optional vertex-to-thigh imaging, following administration of 64CU/68GA DOTATATE. Somatostatin receptor-PET was fused with separately acquired contrast-enhanced MR imaging. DOTATATE activity was classified as comparable, more extensive, and/or showing additional lesions compared with MR imaging. Vertex-to-thigh findings were classified as positive or negative for metastatic disease or incidental. RESULTS Thirty patients (with 13 meningiomas, 11 paragangliomas, 1 metastatic papillary thyroid carcinoma, 1 middle ear neuroendocrine adenoma, 1 external auditory canal mass, 1 pituitary carcinoma, 1 olfactory neuroblastoma, 1 orbital mass) were imaged. Five had no evidence of somatostatin receptor-positive lesions and were excluded. In 11/25, somatostatin receptor-PET/MRI and MR imaging were comparable. In 7/25, somatostatin receptor-PET/MRI showed more extensive disease, while in 9/25, somatostatin receptor-PET/MRI identified additional lesions. On vertex-to-thigh imaging, 1 of 17 patients was positive for metastatic disease, 8 of 17 were negative, and 8 of 17 demonstrated incidental findings. CONCLUSIONS Somatostatin receptor-PET detected additional lesions and more extensive disease than contrast-enhanced MR imaging alone, while vertex-to-thigh imaging showed a low incidence of metastatic disease. Somatostatin receptor-PET/MRI enabled superior anatomic delineation of tumor burden, while any discrepancies were readily addressed. Somatostatin receptor-PET/MRI has the potential to play an important role in presurgical and radiation therapy planning of head and neck neuroendocrine tumors.
Collapse
Affiliation(s)
- J N Rini
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - G Keir
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - C Caravella
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - A Goenka
- Department of Radiation Oncology (A.G.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - A M Franceschi
- Neuroradiology Division (A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
| |
Collapse
|
9
|
Loken EK, Huang RY. Advanced Meningioma Imaging. Neurosurg Clin N Am 2023; 34:335-345. [PMID: 37210124 DOI: 10.1016/j.nec.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Noninvasive imaging methods are used to accurately diagnose meningiomas and track their growth and location. These techniques, including computed tomography, MRI, and nuclear medicine, are also being used to gather more information about the biology of the tumors and potentially predict their grade and impact on prognosis. In this article, we will discuss the current and developing uses of these imaging techniques including additional analysis using radiomics in the diagnosis and treatment of meningiomas, including treatment planning and prediction of tumor behavior.
Collapse
Affiliation(s)
- Erik K Loken
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
10
|
Stetter I, Werner JM, Schroeter M, Baumann C, Neuneier J, Schlamann M, Schmidt M, Drzezga A, Fink GR, Galldiks N. Differentiation of a Falcine Meningioma From Cerebral Venous Sinus Thrombosis Using DOTATATE PET. Clin Nucl Med 2023; 48:e235-e236. [PMID: 36758554 DOI: 10.1097/rlu.0000000000004594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
ABSTRACT Differentiating brain tumors from nonneoplastic lesions using conventional MRI may be challenging. Clinical symptoms often remain unspecific, and imaging findings from MRI may be inconclusive. We present the case of a 23-year-old woman in whom an MRI suggested a cerebral venous sinus thrombosis. On the other hand, additional atypical MRI findings raised doubts regarding the initial diagnosis. Given the need for a diagnostic procedure with higher sensitivity and specificity for neoplastic tissue, PET with the radiolabeled somatostatin receptor ligand DOTATATE ( 68 Ga-DOTA- d -Phe1-Tyr3-octreotate) was performed. DOTATATE PET facilitated the diagnosis of a falcine meningioma consistent with its value for the differential diagnosis of meningioma.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Matthias Schmidt
- Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, Cologne
| | - Alexander Drzezga
- Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, Cologne
| | | | | |
Collapse
|
11
|
Clynch AL, Norrington M, Mustafa MA, Richardson GE, Doherty JA, Humphries TJ, Gillespie CS, Keshwara SM, McMahon CJ, Islim AI, Jenkinson MD, P Millward C, Brodbelt AR. Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochir (Wien) 2023; 165:1355-1363. [PMID: 36877330 PMCID: PMC10140130 DOI: 10.1007/s00701-023-05535-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients. METHODS A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0. RESULTS Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%). CONCLUSION Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.
Collapse
Affiliation(s)
- Abigail L Clynch
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
| | - Max Norrington
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Mohammad A Mustafa
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - George E Richardson
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - John A Doherty
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Thomas J Humphries
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Sumirat M Keshwara
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Catherine J McMahon
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Michael D Jenkinson
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Christopher P Millward
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Andrew R Brodbelt
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.,The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| |
Collapse
|
12
|
Galldiks N, Hattingen E, Langen KJ, Tonn JC. Imaging Characteristics of Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:21-33. [PMID: 37432617 DOI: 10.1007/978-3-031-29750-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Contemporary neuroimaging of meningiomas has largely relied on computed tomography, and more recently magnetic resonance imaging. While these modalities are frequently used in nearly all clinical settings where meningiomas are treated for the routine diagnosis and follow-up of these tumors, advances in neuroimaging have provided novel opportunities for prognostication and treatment planning (including both surgical planning and radiotherapy planning). These include perfusion MRIs, and positron emission tomography (PET) imaging modalities. Here we will summarize the contemporary uses for neuroimaging in meningiomas, and future applications of novel, cutting edge imaging techniques that may be routinely implemented in the future to enable more precise treatment of these challenging tumors.
Collapse
Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany.
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt am Main, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians-University of Munich (LMU), Munich, Germany
| |
Collapse
|
13
|
Park J, Young BD, Miller EJ. Potential novel imaging targets of inflammation in cardiac sarcoidosis. J Nucl Cardiol 2022; 29:2171-2187. [PMID: 34734365 DOI: 10.1007/s12350-021-02838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
Cardiac sarcoidosis (CS) is an inflammatory disease with high morbidity and mortality, with a pathognomonic feature of non-caseating granulomatous inflammation. While 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality to image inflammation and diagnose CS, there are limitations to its specificity and reproducibility. Imaging focused on the molecular processes of inflammation including the receptors and cellular microenvironments present in sarcoid granulomas provides opportunities to improve upon FDG-PET imaging for CS. This review will highlight the current limitations of FDG-PET imaging for CS while discussing emerging new nuclear imaging molecular targets for the imaging of cardiac sarcoidosis.
Collapse
Affiliation(s)
- Jakob Park
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bryan D Young
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| |
Collapse
|
14
|
Kriwanek F, Ulbrich L, Lechner W, Lütgendorf-Caucig C, Konrad S, Waldstein C, Herrmann H, Georg D, Widder J, Traub-Weidinger T, Rausch I. Impact of SSTR PET on Inter-Observer Variability of Target Delineation of Meningioma and the Possibility of Using Threshold-Based Segmentations in Radiation Oncology. Cancers (Basel) 2022; 14:cancers14184435. [PMID: 36139596 PMCID: PMC9497299 DOI: 10.3390/cancers14184435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: The aim of this study was to assess the effects of including somatostatin receptor agonist (SSTR) PET imaging in meningioma radiotherapy planning by means of changes in inter-observer variability (IOV). Further, the possibility of using threshold-based delineation approaches for semiautomatic tumor volume definition was assessed. Patients and Methods: Sixteen patients with meningioma undergoing fractionated radiotherapy were delineated by five radiation oncologists. IOV was calculated by comparing each delineation to a consensus delineation, based on the simultaneous truth and performance level estimation (STAPLE) algorithm. The consensus delineation was used to adapt a threshold-based delineation, based on a maximization of the mean Dice coefficient. To test the threshold-based approach, seven patients with SSTR-positive meningioma were additionally evaluated as a validation group. Results: The average Dice coefficients for delineations based on MRI alone was 0.84 ± 0.12. For delineation based on MRI + PET, a significantly higher dice coefficient of 0.87 ± 0.08 was found (p < 0.001). The Hausdorff distance decreased from 10.96 ± 11.98 mm to 8.83 ± 12.21 mm (p < 0.001) when adding PET for the lesion delineation. The best threshold value for a threshold-based delineation was found to be 14.0% of the SUVmax, with an average Dice coefficient of 0.50 ± 0.19 compared to the consensus delineation. In the validation cohort, a Dice coefficient of 0.56 ± 0.29 and a Hausdorff coefficient of 27.15 ± 21.54 mm were found for the threshold-based approach. Conclusions: SSTR-PET added to standard imaging with CT and MRI reduces the IOV in radiotherapy planning for patients with meningioma. When using a threshold-based approach for PET-based delineation of meningioma, a relatively low threshold of 14.0% of the SUVmax was found to provide the best agreement with a consensus delineation.
Collapse
Affiliation(s)
- Florian Kriwanek
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Leo Ulbrich
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Lechner
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Stefan Konrad
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Cora Waldstein
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Harald Herrmann
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Joachim Widder
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
15
|
Kong MJ, Yang AF, Vora SA, Ross JS, Yang M. The Complementary Role of 68Ga-DOTATATE PET/CT in Diagnosis of Recurrent Meningioma. J Nucl Med Technol 2022; 50:jnmt.122.263949. [PMID: 36041874 DOI: 10.2967/jnmt.122.263949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Contrast-enhanced brain MRI is the choice of imaging modality in diagnosis and posttreatment evaluation, its role is limited in distinguishing recurrent lesion from postoperative change. 68Ga-DOTATATE is a somatostatin analog PET tracer which has high affinity to meningioma expressing somatostatin receptor. Methods and subjects: In this case series review, we described 8 patients with brain MRI suspected of recurrent meningioma who underwent focused 68Ga-DOTATATE PET/CT scan for radiation treatment planning. Results: The combined brain MRI and PET/CT allowed improved conspicuity of the lesions and aided radiation treatment planning. The time from the initial surgery to PET/CT scans varied widely ranging from 1 year to 12 years. Three patients had PET/CT shortly after the initial surgery (1-3 years) and underwent targeted radiation therapy. Subsequent imaging showed no evidence of recurrence. Four patients had prolonged time between the PET/CT and the initial surgery (7-12 years) which showed extensive tumor burden. All four patients expired shortly after the last PET/CT scan. Conclusion: 68Ga-DOTATATE PET shows promising complementary role in detection and treatment planning of recurrent meningioma.
Collapse
|
16
|
The Role of [ 68Ga]Ga-DOTA-SSTR PET Radiotracers in Brain Tumors: A Systematic Review of the Literature and Ongoing Clinical Trials. Cancers (Basel) 2022; 14:cancers14122925. [PMID: 35740591 PMCID: PMC9221214 DOI: 10.3390/cancers14122925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary [68Ga]Ga-DOTA-SSTR PET imaging has recently been introduced in the management of patients with brain tumors, mostly meningiomas and pituitary adenomas or carcinomas. The current literature demonstrated the superior diagnostic accuracy of this imaging modality, especially for lesions difficult to be detected or characterized on conventional imaging protocols, such as skull base or transosseous meningiomas. [68Ga]Ga-DOTA-SSTR PET tracers also seem to provide superior volume contouring for radiotherapy planning and may also be used to evaluate the tumor’s overexpression of somatostatin receptors for devising patient-tailored peptide receptor radionuclide therapy. In this review, we comprehensively analyzed the current literature discussing the implementation of [68Ga]Ga-DOTA-SSTR PET imaging in brain tumors, further presenting ongoing clinical trials and suggesting potential future applications. Abstract Background: The development of [68Ga]Ga-DOTA-SSTR PET tracers has garnered interest in neuro-oncology, to increase accuracy in diagnostic, radiation planning, and neurotheranostics protocols. We systematically reviewed the literature on the current uses of [68Ga]Ga-DOTA-SSTR PET in brain tumors. Methods: PubMed, Scopus, Web of Science, and Cochrane were searched in accordance with the PRISMA guidelines to include published studies and ongoing trials utilizing [68Ga]Ga-DOTA-SSTR PET in patients with brain tumors. Results: We included 63 published studies comprising 1030 patients with 1277 lesions, and 4 ongoing trials. [68Ga]Ga-DOTA-SSTR PET was mostly used for diagnostic purposes (62.5%), followed by treatment planning (32.7%), and neurotheranostics (4.8%). Most lesions were meningiomas (93.6%), followed by pituitary adenomas (2.8%), and the DOTATOC tracer (53.2%) was used more frequently than DOTATATE (39.1%) and DOTANOC (5.7%), except for diagnostic purposes (DOTATATE 51.1%). [68Ga]Ga-DOTA-SSTR PET studies were mostly required to confirm the diagnosis of meningiomas (owing to their high SSTR2 expression and tracer uptake) or evaluate their extent of bone invasion, and improve volume contouring for better radiotherapy planning. Some studies reported the uncommon occurrence of SSTR2-positive brain pathology challenging the diagnostic accuracy of [68Ga]Ga-DOTA-SSTR PET for meningiomas. Pre-treatment assessment of tracer uptake rates has been used to confirm patient eligibility (high somatostatin receptor-2 expression) for peptide receptor radionuclide therapy (PRRT) (i.e., neurotheranostics) for recurrent meningiomas and pituitary carcinomas. Conclusion: [68Ga]Ga-DOTA-SSTR PET studies may revolutionize the routine neuro-oncology practice, especially in meningiomas, by improving diagnostic accuracy, delineation of radiotherapy targets, and patient eligibility for radionuclide therapies.
Collapse
|
17
|
Evaluating diagnostic accuracy and determining optimal diagnostic thresholds of different approaches to [ 68Ga]-DOTATATE PET/MRI analysis in patients with meningioma. Sci Rep 2022; 12:9256. [PMID: 35661809 PMCID: PMC9166786 DOI: 10.1038/s41598-022-13467-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple approaches with [68Ga]-DOTATATE, a somatostatin analog PET radiotracer, have demonstrated clinical utility in evaluation of meningioma but have not been compared directly. Our purpose was to compare diagnostic performance of different approaches to quantitative brain [68Ga]-DOTATATE PET/MRI analysis in patients with suspected meningioma recurrence and to establish the optimal diagnostic threshold for each method. Patients with suspected meningioma were imaged prospectively with [68Ga]-DOTATATE brain PET/MRI. Lesions were classified as meningiomas and post-treatment change (PTC), using follow-up pathology and MRI as reference standard. Lesions were reclassified using the following methods: absolute maximum SUV threshold (SUV), SUV ratio (SUVR) to superior sagittal sinus (SSS) (SUVRsss), SUVR to the pituitary gland (SUVRpit), and SUVR to the normal brain parenchyma (SUVRnorm). Diagnostic performance of the four methods was compared using contingency tables and McNemar’s test. Previously published pre-determined thresholds were assessed where applicable. The optimal thresholds for each method were identified using Youden’s J statistics. 166 meningiomas and 41 PTC lesions were identified across 62 patients. SUV, SUVRsss, SUVRpit, and SUVRnorm of meningioma were significantly higher than those of PTC (P < 0.0001). The optimal thresholds for SUV, SUVRsss, SUVRpit, and SUVRnorm were 4.7, 3.2, 0.3, and 62.6, respectively. At the optimal thresholds, SUV had the highest specificity (97.6%) and SUVRsss had the highest sensitivity (86.1%). An ROC analysis of SUV, SUVRsss, SUVRpit, and SUVRnorm revealed AUC of 0.932, 0.910, 0.915, and 0.800, respectively (P < 0.0001). Developing a diagnostic threshold is key to wider clinical translation of [68Ga]-DOTATATE PET/MRI in meningioma evaluation. We found that the SUVRsss method may have the most robust combination of sensitivity and specificity in the diagnosis of meningioma in the post-treatment setting, with the optimal threshold of 3.2. Future studies validating our findings in different patient populations are needed to continue optimizing the diagnostic performance of [68Ga]-DOTATATE PET/MRI in meningioma patients. Trial registration: ClinicalTrials.gov Identifier: NCT04081701. Registered 9 September 2019. https://clinicaltrials.gov/ct2/show/NCT04081701.
Collapse
|
18
|
Galldiks N, Angenstein F, Werner JM, Bauer EK, Gutsche R, Fink GR, Langen KJ, Lohmann P. Use of advanced neuroimaging and artificial intelligence in meningiomas. Brain Pathol 2022; 32:e13015. [PMID: 35213083 PMCID: PMC8877736 DOI: 10.1111/bpa.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 01/04/2023] Open
Abstract
Anatomical cross‐sectional imaging methods such as contrast‐enhanced MRI and CT are the standard for the delineation, treatment planning, and follow‐up of patients with meningioma. Besides, advanced neuroimaging is increasingly used to non‐invasively provide detailed insights into the molecular and metabolic features of meningiomas. These techniques are usually based on MRI, e.g., perfusion‐weighted imaging, diffusion‐weighted imaging, MR spectroscopy, and positron emission tomography. Furthermore, artificial intelligence methods such as radiomics offer the potential to extract quantitative imaging features from routinely acquired anatomical MRI and CT scans and advanced imaging techniques. This allows the linking of imaging phenotypes to meningioma characteristics, e.g., the molecular‐genetic profile. Here, we review several diagnostic applications and future directions of these advanced neuroimaging techniques, including radiomics in preclinical models and patients with meningioma.
Collapse
Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany
| | - Frank Angenstein
- Functional Neuroimaging Group, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.,Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robin Gutsche
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
19
|
Kowalski ES, Khairnar R, Gryaznov AA, Kesari V, Koroulakis A, Raghavan P, Chen W, Woodworth G, Mishra M. 68Ga-DOTATATE PET-CT as a tool for radiation planning and evaluating treatment responses in the clinical management of meningiomas. Radiat Oncol 2021; 16:151. [PMID: 34399805 PMCID: PMC8365988 DOI: 10.1186/s13014-021-01875-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/01/2021] [Indexed: 12/17/2022] Open
Abstract
Background and purpose Meningiomas express the somatostatin receptor (SSTR), which normal bone and brain lack. PET imaging with SSTR ligands such as 68 Ga-DOTATATE have been recently shown to aid in the imaging and identification of menginiomas. We hypothesize that 68 Ga-DOTATATE PET/CT in conjunction with MRI aids in radiation (RT) target volume delineation and evaluating treatment response. Materials and methods Nineteen patients with meningiomas underwent 68 Ga-DOTATATE PET/CT and MRI for RT planning and/or post-treatment follow-up. Meningiomas were grade I (n = 9) or not biopsied (n = 8) and frequently involved base of skull (n = 10). Ten (53%) patients received post-operative RT and 9 (47%) received fractaionted RT. In the subgroup that underwent both pre- and post-RT 68 Ga-DOTATATE PET as well as MRI (n = 10), ROVER (ABX GmbH, Radeberg, Germany) adaptive thresholding software was utilized to measure total lesion activity (mean and max) before and after treatment. Tumor volume based on MRI was calculated before and after treatment. Total lesion activity and tumor volume changes were compared using Wilcoxon signed rank test. Results 68 Ga-DOTATATE PET/CT identified intraosseous (n = 4, 22%), falcine (n = 5, 26%) and satellite lesions (n = 3, 19%) and clarified the diagnosis of meningioma, resulting in a change in management in three patients. Mean total lesion activity decreased 14.7% (median), from pre to post-RT 68 Ga-DOTATATE PET [range 97–8.5% (25–75%),S = − 26.5, p = 0.0039]. Max total lesion activity decreased 36% (median) over the same period [range 105–15% (25–75%), S = − 26.5 p = 0.0039]. In contrast, meningioma volumes based on MRI measurements did not significantly change per RECIST criteria and Wilcoxon signed rank test (S = − 3, p = 0.7422). Conclusion 68 Ga-DOTATATE PET/CT helped confirm suspected diagnoses and delineate target volumes particularly when lesions involved osseous structures and the falx. Mean and max total tumor 68 Ga-DOTATATE activity on PET/CT decreased at three months following RT despite stable tumor volumes on MRI. Future studies are warranted to (1) assess the sensitivity and specificity of 68 Ga-DOTATATE PET/CT, (2) evaluate the impact of 68 Ga-DOTATATE PET/CT-based planning on treatment outcomes, and (3) assess the prognostic significance of these post-treatment imaging changes.
Collapse
Affiliation(s)
- Emily S Kowalski
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rahul Khairnar
- Department of Pharmaceuticals Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Anton A Gryaznov
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Vivek Kesari
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Antony Koroulakis
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Prashant Raghavan
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wengen Chen
- Department of Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Graeme Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
20
|
Lapa C, Nestle U, Albert NL, Baues C, Beer A, Buck A, Budach V, Bütof R, Combs SE, Derlin T, Eiber M, Fendler WP, Furth C, Gani C, Gkika E, Grosu AL, Henkenberens C, Ilhan H, Löck S, Marnitz-Schulze S, Miederer M, Mix M, Nicolay NH, Niyazi M, Pöttgen C, Rödel CM, Schatka I, Schwarzenboeck SM, Todica AS, Weber W, Wegen S, Wiegel T, Zamboglou C, Zips D, Zöphel K, Zschaeck S, Thorwarth D, Troost EGC. Value of PET imaging for radiation therapy. Strahlenther Onkol 2021; 197:1-23. [PMID: 34259912 DOI: 10.1007/s00066-021-01812-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and image analysis methods are discussed. The authors believe this contribution to be of crucial value for experts in the field as well as for policy makers deciding on the reimbursement of this powerful imaging modality.
Collapse
Affiliation(s)
- Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
- Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Baues
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Ambros Beer
- Department of Nuclear Medicine, Ulm University Hospital, Ulm, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Stephanie E Combs
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Neuherberg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Cihan Gani
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Anca-L Grosu
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Löck
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Simone Marnitz-Schulze
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Matthias Miederer
- Department of Nuclear Medicine, University Hospital Mainz, Mainz, Germany
| | - Michael Mix
- Department of Nuclear Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Maximilian Niyazi
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Cancer Centre, University of Duisburg-Essen, Essen, Germany
| | - Claus M Rödel
- German Cancer Consortium (DKTK), Partner Site Frankfurt, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Imke Schatka
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - Andrei S Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, Ulm University Hospital, Ulm, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Klaus Zöphel
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Daniela Thorwarth
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany.
| |
Collapse
|
21
|
Lapa C, Nestle U, Albert NL, Baues C, Beer A, Buck A, Budach V, Bütof R, Combs SE, Derlin T, Eiber M, Fendler WP, Furth C, Gani C, Gkika E, Grosu AL, Henkenberens C, Ilhan H, Löck S, Marnitz-Schulze S, Miederer M, Mix M, Nicolay NH, Niyazi M, Pöttgen C, Rödel CM, Schatka I, Schwarzenboeck SM, Todica AS, Weber W, Wegen S, Wiegel T, Zamboglou C, Zips D, Zöphel K, Zschaeck S, Thorwarth D, Troost EGC. Value of PET imaging for radiation therapy. Nuklearmedizin 2021; 60:326-343. [PMID: 34261141 DOI: 10.1055/a-1525-7029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and image analysis methods are discussed. The authors believe this contribution to be of crucial value for experts in the field as well as for policy makers deciding on the reimbursement of this powerful imaging modality.
Collapse
Affiliation(s)
- Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany.,Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Baues
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Ambros Beer
- Department of Nuclear Medicine, Ulm University Hospital, Ulm, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Stephanie E Combs
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Neuherberg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Cihan Gani
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | | | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Löck
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Simone Marnitz-Schulze
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Matthias Miederer
- Department of Nuclear Medicine, University Hospital Mainz, Mainz, Germany
| | - Michael Mix
- Department of Nuclear Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Maximilian Niyazi
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Cancer Centre, University of Duisburg-Essen, Essen, Germany
| | - Claus M Rödel
- German Cancer Consortium (DKTK), Partner Site Frankfurt, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Imke Schatka
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - Andrei S Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, Ulm University Hospital, Ulm, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Klaus Zöphel
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Daniela Thorwarth
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | | |
Collapse
|
22
|
68Ga-DOTATOC-PET/MRI-A Secure One-Stop Shop Imaging Tool for Robotic Radiosurgery Treatment Planning in Patients with Optic Nerve Sheath Meningioma. Cancers (Basel) 2021; 13:cancers13133305. [PMID: 34282752 PMCID: PMC8267930 DOI: 10.3390/cancers13133305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are rare but can lead to irreversible blindness. Hybrid imaging may enhance tumor delineation and diagnostic accuracy via receptor binding. However, relevant clinical data for ONSM are lacking. We evaluated the feasibility of receptor-based hybrid imaging prior to robotic radiosurgery (RRS). We retrospectively analyzed all of our institution's patients with suspected ONSM who underwent combined positron emission tomography and magnetic resonance imaging (PET/MRI) with gallium-68-labeled (DOTA0-Phe1-Tyr3) octreotide (Ga68-DOTATOC) before RRS between 2018 and 2019. Eight patients with ten suspected ONSM (female = 7; median age, 51.2 years; IQR, 43.0-66.0) were included. Nine out of ten ONSM were deemed PET-positive with a median standard uptake value (SUV) max of 5.6 (IQR, 2.6-7.8). For all nine ONSM that presented 68Ga-DOTATOC uptake, hybrid PET/MRI was used for target volume contouring prior to RSS. At a median follow-up of 11.7 months (IQR, 9.4-16.4), tumor control was achieved in all patients. Radiosurgery resulted in the improvement of visual acuity in two of eight patients, whereas six showed stable vision. Ga68-DOTATOC-PET/MRI can be used for target volume contouring prior to RRS for ONSM as it enables safe treatment planning and improves diagnostic accuracy.
Collapse
|
23
|
Comparison of diagnostic value of 68 Ga-DOTATOC PET/MRI and standalone MRI for the detection of intracranial meningiomas. Sci Rep 2021; 11:9064. [PMID: 33907204 PMCID: PMC8079685 DOI: 10.1038/s41598-021-87866-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5-1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5-1.0 and 1.0-2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.
Collapse
|
24
|
Holzgreve A, Albert NL, Galldiks N, Suchorska B. Use of PET Imaging in Neuro-Oncological Surgery. Cancers (Basel) 2021; 13:cancers13092093. [PMID: 33926002 PMCID: PMC8123649 DOI: 10.3390/cancers13092093] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The use of positron emission tomography (PET) imaging in neuro-oncological surgery is an exciting field with thriving perspectives. Increasing evidence exists for amino acid-based PET to facilitate interpretation of imaging findings following therapeutic interventions in patients with glioma and brain metastases. In meningioma patients, radiolabeled somatostatin receptor ligands provide an improved tumor tissue visualization in lesions located in the vicinity of the skull base and differentiate between scar tissue and tumor recurrence. Moreover, they can be applied as an individual treatment option in recurrent atypical and anaplastic meningioma not eligible for further surgery and radiotherapy. With a focus on its clinical application, this review provides an overview of the emerging field of PET imaging in neuro-oncological surgery. Abstract This review provides an overview of current applications and perspectives of PET imaging in neuro-oncological surgery. The past and future of PET imaging in the management of patients with glioma and brain metastases are elucidated with an emphasis on amino acid tracers, such as O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET). The thematic scope includes surgical resection planning, prognostication, non-invasive prediction of molecular tumor characteristics, depiction of intratumoral heterogeneity, response assessment, differentiation between tumor progression and treatment-related changes, and emerging new tracers. Furthermore, the role of PET using specific somatostatin receptor ligands for the management of patients with meningioma is discussed. Further advances in neuro-oncological imaging can be expected from promising new techniques, such as hybrid PET/MR scanners and the implementation of artificial intelligence methods, such as radiomics.
Collapse
Affiliation(s)
- Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (A.H.); (N.L.A.)
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (A.H.); (N.L.A.)
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, 52425 Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, 50937 Cologne, Germany
| | - Bogdana Suchorska
- Department of Neurosurgery, Sana Kliniken Duisburg, 47055 Duisburg, Germany
- Correspondence: ; Tel.: +49-203-733-2401
| |
Collapse
|
25
|
Bashir A, Larsen VA, Ziebell M, Fugleholm K, Law I. Improved Detection of Postoperative Residual Meningioma with [ 68Ga]Ga-DOTA-TOC PET Imaging Using a High-resolution Research Tomograph PET Scanner. Clin Cancer Res 2021; 27:2216-2225. [PMID: 33526423 DOI: 10.1158/1078-0432.ccr-20-3362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE PET with somatostatin receptor ligand [68Ga]Ga-DOTA-D-Phe1-Tyr3-octreotide ([68Ga]Ga-DOTA-TOC) is an established method in radiotherapy planning because of the improved detection and delineation of meningioma tissue. We investigated the diagnostic accuracy of supplementary [68Ga]Ga-DOTA-TOC PET in patients with a 3-month postoperative MRI reporting gross-total resection (GTR). EXPERIMENTAL DESIGN Thirty-seven patients with a histologically proven meningioma and GTR on postoperative MRI were prospectively referred to [68Ga]Ga-DOTA-TOC PET. Detection and volume measurements of [68Ga]Ga-DOTA-TOC-avid lesions in relation to the primary tumor site were recorded. Residual tumor in suspicious lesions suggested by [68Ga]Ga-DOTA-TOC PET was verified by (i) tumor recurrence/progression on subsequent MRI scans according to the Response Assessment of Neuro-Oncology criteria, (ii) subsequent histology, and (iii) follow-up [68Ga]Ga-DOTA-TOC PET scan. RESULTS Twenty-three PET scans demonstrated [68Ga]Ga-DOTA-TOC-avid lesions suspicious of residual meningioma, where 18 could be verified by (i) tumor progression on subsequent MRI scans (n = 6), (ii) histologic confirmation (n = 3), and (iii) follow-up [68Ga]Ga-DOTA-TOC PET scans confirming the initial PET findings (n = 9) after an overall median follow-up time of 17 months (range, 9-35 months). In contrast, disease recurrence was seen in only 2 of 14 patients without [68Ga]Ga-DOTA-TOC-avid lesions (P < 0.0001). The sensitivity, specificity, and diagnostic accuracy of [68Ga]Ga-DOTA-TOC PET in detecting meningioma residue was 90% [95% confidence interval (CI), 67-99], 92% (95% CI, 62-100), and 90% (95% CI, 74-98; P < 0.0001), respectively. CONCLUSIONS The majority of patients with GTR on 3-month postoperative MRI may have small unrecognized meningioma residues that can be detected using [68Ga]Ga-DOTA-TOC PET.
Collapse
Affiliation(s)
- Asma Bashir
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Vibeke A Larsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark
| |
Collapse
|
26
|
Gupta N, Khare A. Multifocal Meningioma Recurrence Detected on Ga68-DOTANOC Scan. Indian J Nucl Med 2020; 35:264-266. [PMID: 33082693 PMCID: PMC7537927 DOI: 10.4103/ijnm.ijnm_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/04/2022] Open
Abstract
Meningiomas arise from meningothelial cells of the arachnoid membranes. They are classified into three grades according to the WHO criteria, Grade I (Benign), Grade II (atypical), and Grade III (anaplastic). Radiological and structural imaging computed tomography (CT) and magnetic resonance imaging are done routinely for defining the location, extent, and follow-up. However, these imaging techniques have their limitations. Since meningiomas have overexpression of somatostatin receptor 2, DOTANOC positron-emission tomography (PET)/CT scan is suggested for their delineation and distinguish postradiotherapy necrosis from recurrence. Here, we present a case where DOTANOC PET/CT scan helped in confirming recurrence postsurgery and radiotherapy.
Collapse
Affiliation(s)
- Nitin Gupta
- Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhishek Khare
- Department of Nuclear Medicine and PET/CT, Platinum Imaging Centre, New Delhi, India
| |
Collapse
|
27
|
Acker G, Kluge A, Lukas M, Conti A, Pasemann D, Meinert F, Anh Nguyen PT, Jelgersma C, Loebel F, Budach V, Vajkoczy P, Furth C, Baur ADJ, Senger C. Impact of 68Ga-DOTATOC PET/MRI on robotic radiosurgery treatment planning in meningioma patients: first experiences in a single institution. Neurosurg Focus 2020; 46:E9. [PMID: 31153151 DOI: 10.3171/2019.3.focus1925] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEFor stereotactic radiosurgery (SRS) planning, precise contouring of tumor boundaries and organs at risk is of utmost importance. Correct interpretation of standard neuroimaging (i.e., CT and MRI) can be challenging after previous surgeries or in cases of skull base lesions with complex shapes. The aim of this study was to evaluate the impact of 68Ga-DOTATOC PET/MRI on treatment planning for image-guided SRS by CyberKnife.METHODSThe authors retrospectively identified 11 meningioma treatments in 10 patients who received a 68Ga-DOTATOC PET/MRI prior to SRS. The planning target volume (PTV) used for the patients' treatment was defined as the reference standard. This was contoured by a treating radiosurgeon (RS0) using fused planning CT and PET/MRI data sets. The same tumors were then contoured by another experienced radiosurgeon (RS1) and by a less-experienced radiosurgeon (RS2), both blinded to PET data sets. A comparison of target volumes with focus on volume-based metrics and distance to critical structures was performed. RS1 and RS2 also filled in a questionnaire analyzing the confidence level and the subjective need for the implementation of PET data sets for contouring.RESULTSAnalysis showed a subjective personal preference for PET/MRI in all cases for both radiosurgeons, particularly in proximity to critical structures. The analysis of the planning volumes per physician showed significantly smaller RS2-PTV in comparison to RS1-PTV and to RS0-PTV, whereas the median volumes were comparable between RS1-PTV and RS2-PTV (median: RS0: 4.3 cm3 [IQR 3.4-6.5 cm3] and RS1: 4.5 cm3 [IQR 2.7-6 cm3] vs RS2: 2.6 cm3 [IQR 2-5 cm3]; p = 0.003). This was also reflected in the best spatial congruency between the 2 experienced physicians (RS0 and RS1). The percentage of the left-out volume contoured by RS1 and RS2 compared to RS0 with PET/MRI demonstrated a relevant left-out-volume portion in both cases with greater extent for the less-experienced radiosurgeon (RS2) (RS1: 19.1% [IQR 8.5%-22%] vs RS2: 40.2% [IQR 34.2%-53%]). No significant differences were detected regarding investigated critical structures.CONCLUSIONSThis study demonstrated a relevant impact of PET/MRI on target volume delineation of meningiomas. The extent was highly dependent on the experience of the treating physician. This preliminary study supports the relevance of 68Ga-DOTATOC PET/MRI as a tool for radiosurgical treatment planning of meningiomas.
Collapse
Affiliation(s)
- Güliz Acker
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,2Berlin Institute of Health (BIH), Berlin, Germany; and.,3Charité CyberKnife Center
| | - Anne Kluge
- 3Charité CyberKnife Center.,4Department of Radiation Oncology, and
| | - Mathias Lukas
- 5Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Alfredo Conti
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center.,6Department of Neurosurgery, University of Messina, Messina, Italy
| | - Diana Pasemann
- 3Charité CyberKnife Center.,4Department of Radiation Oncology, and
| | - Franziska Meinert
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center
| | - Phuong Thuy Anh Nguyen
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center
| | - Claudius Jelgersma
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center
| | - Franziska Loebel
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center
| | - Volker Budach
- 3Charité CyberKnife Center.,4Department of Radiation Oncology, and
| | - Peter Vajkoczy
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB).,3Charité CyberKnife Center
| | - Christian Furth
- 5Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Alexander D J Baur
- 5Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Carolin Senger
- 3Charité CyberKnife Center.,4Department of Radiation Oncology, and
| |
Collapse
|
28
|
Integration of PET-imaging into radiotherapy treatment planning for low-grade meningiomas improves outcome. Eur J Nucl Med Mol Imaging 2019; 47:1391-1399. [PMID: 31758226 DOI: 10.1007/s00259-019-04591-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Meningiomas have an excellent survival prognosis, and radiotherapy (RT) is a central component of interdisciplinary treatment. During treatment planning, the definition of the target volume remains challenging using MR and CT imaging alone. This is the first study to analyze the impact of additional PET-imaging on local control (LC) and overall survival (OS) after high-precision RT. METHODS We analyzed 339 meningiomas treated between 2000 and 2018. For analyses, we divided the patients in low-grade (n = 276) and high-grade (n = 63) cases. We performed RT in an adjuvant setting due to subtotal resection or later due to recurrent tumor growth. The target volumes were delineated based on diagnostic CT and MRI and, if available, additional PET-imaging (low-grade: n = 164, 59.4%; high-grade: n = 39, 61.9%) with either 68Ga-Dotanoc/Dotatoc, 18F-fluoroethyltyrosine or 11C-methionine tracer. Patients were treated with fractionated stereotactic RT with a median total dose and dose per fraction of 54 Gy and 1.8 Gy, respectively. RESULTS Median follow-up was 5.6 years. For low-grade meningiomas, mean OS was 15.6 years and mean LC was 16.9 years; for high-grade cases mean OS was 11.6 years, and mean LC was 11.1 years. In univariate analyses, PET-imaging had a significant impact on OS (p = 0.035) and LC (p = 0.041) for low-grade meningiomas and remained significant (p = 0.015) for LC in the multivariate analysis. For high-grade cases, PET did not influence both OS and LC. Further prognostic factors could be identified. CONCLUSIONS For low-grade meningiomas, we showed that the addition of PET-imaging for target volume definition led to a significantly enhanced LC. Thus, PET improves the detection of tumor cells and helps distinguish between healthy tissue and meningioma tissue, especially during the treatment planning process.
Collapse
|
29
|
Laudicella R, Albano D, Annunziata S, Calabrò D, Argiroffi G, Abenavoli E, Linguanti F, Albano D, Vento A, Bruno A, Alongi P, Bauckneht M. Theragnostic Use of Radiolabelled Dota-Peptides in Meningioma: From Clinical Demand to Future Applications. Cancers (Basel) 2019; 11:cancers11101412. [PMID: 31546734 PMCID: PMC6826849 DOI: 10.3390/cancers11101412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022] Open
Abstract
Meningiomas account for approximately 30% of all new diagnoses of intracranial masses. The 2016 World Health Organization's (WHO) classification currently represents the clinical standard for meningioma's grading and prognostic stratification. However, watchful waiting is frequently the chosen treatment option, although this means the absence of a certain histological diagnosis. Consequently, MRI (or less frequently CT) brain imaging currently represents the unique available tool to define diagnosis, grading, and treatment planning in many cases. Nonetheless, these neuroimaging modalities show some limitations, particularly in the evaluation of skull base lesions. The emerging evidence supporting the use of radiolabelled somatostatin receptor analogues (such as dota-peptides) to provide molecular imaging of meningiomas might at least partially overcome these limitations. Moreover, their potential therapeutic usage might enrich the current clinical offering for these patients. Starting from the strengths and weaknesses of structural and functional neuroimaging in meningiomas, in the present article we systematically reviewed the published studies regarding the use of radiolabelled dota-peptides in surgery and radiotherapy planning, in the restaging of treated patients, as well as in peptide-receptor radionuclide therapy of meningioma.
Collapse
Affiliation(s)
- Riccardo Laudicella
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125 Messina, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, 25123 Brescia, Italy
| | - Salvatore Annunziata
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Diletta Calabrò
- Nuclear Medicine, DIMES University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | | | - Elisabetta Abenavoli
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità di Radiologia Diagnostica ed Interventistica, 20161 Milano, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127 Palermo, Italy
| | - Antonio Vento
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125 Messina, Italy
| | - Antonio Bruno
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Pierpaolo Alongi
- Unit of Nuclear Medicine, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| |
Collapse
|
30
|
|
31
|
|
32
|
Galldiks N, Lohmann P, Albert NL, Tonn JC, Langen KJ. Current status of PET imaging in neuro-oncology. Neurooncol Adv 2019; 1:vdz010. [PMID: 32642650 PMCID: PMC7324052 DOI: 10.1093/noajnl/vdz010] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Over the past decades, a variety of PET tracers have been used for the evaluation of patients with brain tumors. For clinical routine, the most important clinical indications for PET imaging in patients with brain tumors are the identification of neoplastic tissue including the delineation of tumor extent for the further diagnostic and therapeutic management (ie, biopsy, resection, or radiotherapy planning), the assessment of response to a certain anticancer therapy including its (predictive) effect on the patients’ outcome and the differentiation of treatment-related changes (eg, pseudoprogression and radiation necrosis) from tumor progression at follow-up. To serve medical professionals of all disciplines involved in the diagnosis and care of patients with brain tumors, this review summarizes the value of PET imaging for the latter-mentioned 3 clinically relevant indications in patients with glioma, meningioma, and brain metastases.
Collapse
Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Karl-Josef Langen
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
33
|
Nguyen QBD, Amato R, Riascos R, Ballester L, Tandon N, Blanco A, Esquenazi Y. Fluciclovine, Anti-1-Amino-3-[18F]-Fluorocyclobutane-1-Carboxylic Acid: A Novel Radiotracer for Meningioma. World Neurosurg 2018; 119:132-136. [DOI: 10.1016/j.wneu.2018.07.231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
|
34
|
Management of meningioma. Presse Med 2018; 47:e245-e252. [DOI: 10.1016/j.lpm.2018.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/14/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022] Open
|
35
|
Magnetic resonance imaging in radiotherapy treatment target volumes definition for brain tumours: a systematic review and meta-analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeThe aim of this study is to establish clinical evidence regarding the use of magnetic resonance imaging (MRI) in target volume definition for radiotherapy treatment planning of brain tumours.MethodsPrimary studies were systematically retrieved from six electronic databases and other sources. Studies included were only those that quantitatively compared computed tomography (CT) and MRI in target volume definition for radiotherapy of brain tumours. Study characteristics and quality were assessed and the data were extracted from eligible studies. Effect estimates for each study was computed as mean percentage difference based on individual patient data where available. The included studies were then combined in meta-analysis using Review Manager (RevMan) software version 5.0.ResultFive studies with a total number of 72 patients were included in this review. The quality of the studies was rated strong. The percentages mean differences of the studies were 7·47, 11·36, 30·70, 41·69 and −24·6% using CT as the baseline. The result of statistical analysis showed small-to-moderate heterogeneity; τ2=36·8; χ2=6·23; df=4 (p=0·18); I2=36%. The overall effect estimate was −1·85 [95% confidence interval (CI); −7·24, 10·94], Z=0·40 (p=0·069>0·5).ConclusionBrain tumour volumes measured using MRI-based method for radiotherapy treatment planning were larger compared with CT defined volumes but the difference lacks statistical significance.
Collapse
|
36
|
Nowosielski M, Galldiks N, Iglseder S, Kickingereder P, von Deimling A, Bendszus M, Wick W, Sahm F. Diagnostic challenges in meningioma. Neuro Oncol 2018; 19:1588-1598. [PMID: 28531331 DOI: 10.1093/neuonc/nox101] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Advances in molecular profiling and the application of advanced imaging techniques are currently refreshing diagnostic considerations in meningioma patients. Not only technical refinements but also sophisticated histopathological and molecular studies have the potential to overcome some of the challenges during meningioma management. Exact tumor delineation, assessment of tumor growth, and pathophysiological parameters were recently addressed by "advanced" MRI and PET. In the field of neuropathology, high-throughput sequencing and DNA methylation analysis of meningioma tissue has greatly advanced the knowledge of molecular aberrations in meningioma patients. These techniques allow for more reliable prediction of the biological behavior and clinical course of meningiomas and subsequently have the potential to guide individualized meningioma therapy. However, higher costs and longer duration of full molecular work-up compared with histological assessment may delay the implementation into clinical routine.This review highlights the diagnostic challenges of meningiomas from both the neuroimaging as well as the neuropathological side and presents the latest scientific achievements and studies potentially helping in overcoming these challenges. It complements the recently proposed European Association of Neuro-Oncology guidelines on treatment and diagnosis of meningiomas by integrating data on nonstandard imaging and molecular assessments most likely impacting the future.
Collapse
Affiliation(s)
- Martha Nowosielski
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Norbert Galldiks
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Sarah Iglseder
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Philipp Kickingereder
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Wolfgang Wick
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Felix Sahm
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
37
|
Ly KI, Gerstner ER. The Role of Advanced Brain Tumor Imaging in the Care of Patients with Central Nervous System Malignancies. Curr Treat Options Oncol 2018; 19:40. [PMID: 29931476 DOI: 10.1007/s11864-018-0558-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT T1-weighted post-contrast and T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) constitute the gold standard for diagnosis and response assessment in neuro-oncologic patients but are limited in their ability to accurately reflect tumor biology and metabolism, particularly over the course of a patient's treatment. Advanced MR imaging methods are sensitized to different biophysical processes in tissue, including blood perfusion, tumor metabolism, and chemical composition of tissue, and provide more specific information on tissue physiology than standard MRI. This review provides an overview of the most common and emerging advanced imaging modalities in the field of brain tumor imaging and their applications in the care of neuro-oncologic patients.
Collapse
Affiliation(s)
- K Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA.
| |
Collapse
|
38
|
Stade F, Dittmar JO, Jäkel O, Kratochwil C, Haberkorn U, Debus J, Combs SE. Influence of 68Ga-DOTATOC on sparing of normal tissue for radiation therapy of skull base meningioma: differential impact of photon and proton radiotherapy. Radiat Oncol 2018; 13:58. [PMID: 29606149 PMCID: PMC5880004 DOI: 10.1186/s13014-018-1008-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/23/2018] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the impact of 68Ga-DOTATOC-PET on treatment planning and sparing of normal tissue in the treatment of skull base meningioma with advanced photons and protons. Methods From the institutional database consisting of 507 skull base meningiomas 10 patients were chosen randomly for the present analysis. Target volume definition was performed based on CT and MRI only, as well as with additional 68Ga-DOTATOC-PET. Treatment plans were performed for Intensity Modulated Radiotherapy (IMRT) and proton therapy using active raster scanning on both target volumes. We calculated doses to relevant organs at risk (OAR), conformity indices as well as differences in normal tissue sparing between both radiation modalities based on CT/MRI planning as well as CT/MRI/PET planning. Results For photon treatment plans, PET-based treatment plans showed a reduction of brain stem Dmax and Dmedian for different levels of total dose. At the optic chiasm, use of 68Ga-DOTATOC significantly reduces Dmax; moreover, the Dmedian is reduced in most cases, too. For both right and left optic nerve, reduction of dose by addition of 68Ga-DOTATOC-PET is minimal and depends on the anatomical location of the meningioma. In protons, the impact of 68Ga-DOTATOC-PET is minimal compared to photons. Conclusion Addition of 68Ga-DOTATOC-PET information into treatment planning for skull base meningiomas has a significant impact on target volumes. In most cases, PET-planning leads to significant reductions of the treatment volumes. Subsequently, reduced doses are applied to OAR. Using protons, the benefit of additional PET is smaller since target coverage is more conformal and dose to OAR is already reduced compared to photons. Therefore, PET-imaging has the greatest margin of benefit in advanced photon techniques, and combination of PET-planning and high-precision treatment leads to comparable treatment plans as with protons.
Collapse
Affiliation(s)
- Falk Stade
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Heidelberg, Heidelberg, Germany
| | - Jan-Oliver Dittmar
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Heidelberg, Heidelberg, Germany.,Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Munich, Munich, Germany
| | - Oliver Jäkel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Heidelberg, Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Heidelberg, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Munich, Munich, Germany. .,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany.
| |
Collapse
|
39
|
Galldiks N, Albert NL, Sommerauer M, Grosu AL, Ganswindt U, Law I, Preusser M, Le Rhun E, Vogelbaum MA, Zadeh G, Dhermain F, Weller M, Langen KJ, Tonn JC. PET imaging in patients with meningioma-report of the RANO/PET Group. Neuro Oncol 2017; 19:1576-1587. [PMID: 28605532 PMCID: PMC5716194 DOI: 10.1093/neuonc/nox112] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Meningiomas are the most frequent nonglial primary brain tumors and represent about 30% of brain tumors. Usually, diagnosis and treatment planning are based on neuroimaging using mainly MRI or, rarely, CT. Most common treatment options are neurosurgical resection and radiotherapy (eg, radiosurgery, external fractionated radiotherapy). For follow-up after treatment, a structural imaging technique such as MRI or CT is used. However, these structural imaging modalities have limitations, particularly in terms of tumor delineation as well as diagnosis of posttherapeutic reactive changes. Molecular imaging techniques such as PET can characterize specific metabolic and cellular features which may provide clinically relevant information beyond that obtained from structural MR or CT imaging alone. Currently, the use of PET in meningioma patients is steadily increasing. In the present article, we provide recommendations for the use of PET imaging in the clinical management of meningiomas based on evidence generated from studies being validated by histology or clinical course.
Collapse
Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
- Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany
| | - Nathalie L Albert
- Departments of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - Ute Ganswindt
- Departments of Radiation Oncology, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Centre CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Lille, Lille, France
| | - Michael A Vogelbaum
- Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gelareh Zadeh
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - Michael Weller
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Jörg C Tonn
- Departments of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany
- German Cancer Consortium, Partner Sites, Freiburg and Munich, Germany
| |
Collapse
|
40
|
Preclinical Assessment of a 68Ga-DOTA-Functionalized Depsipeptide as a Radiodiagnostic Infection Imaging Agent. Molecules 2017; 22:molecules22091403. [PMID: 28837117 PMCID: PMC6151697 DOI: 10.3390/molecules22091403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022] Open
Abstract
The study assessed a radiolabeled depsipeptide conjugate (68Ga-DOTA-TBIA101) for its potential as an imaging agent targeting infection or infection-associated inflammation. 68Ga-labeled DOTA-TBIA101 imaging was performed in (NZR1) healthy rabbits; (NZR2) rabbits bearing muscular sterile inflammation and Staphylococcus aureus (SA) infection; and (NZR3) rabbits infected with Mycobacterium tuberculosis (MTB) combined with a subcutaneous scruff infection of SA in the same animal. All animals were imaged using a PET/CT scanner at 5 and 60 min post injection. Images showed elevated accumulation of 68Ga-DOTA-TBIA101 in the sterile muscular inflammation site (T/NT ratio = 2.6 ± 0.37 (5 min) and 2.8 ± 2.3 (60 min)) and muscles infected with MTB (T/NT ratio = 2.6 ± 0.35 (5 min) and 2.8 ± 0.16 (60 min)). The findings suggest that 68Ga-DOTA-TBIA101-PET/CT may detect MTB-associated inflammation, although more foundational studies need to be performed to rationalize the diagnostic value of this technique.
Collapse
|
41
|
Kunz WG, Jungblut LM, Kazmierczak PM, Vettermann FJ, Bollenbacher A, Tonn JC, Schichor C, Rominger A, Albert NL, Bartenstein P, Reiser MF, Cyran CC. Improved Detection of Transosseous Meningiomas Using 68Ga-DOTATATE PET/CT Compared with Contrast-Enhanced MRI. J Nucl Med 2017; 58:1580-1587. [DOI: 10.2967/jnumed.117.191932] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022] Open
|
42
|
Maclean J, Fersht N, Sullivan K, Kayani I, Bomanji J, Dickson J, O'Meara C, Short S. Simultaneous 68Ga DOTATATE Positron Emission Tomography/Magnetic Resonance Imaging in Meningioma Target Contouring: Feasibility and Impact Upon Interobserver Variability Versus Positron Emission Tomography/Computed Tomography and Computed Tomography/Magnetic Resonance Imaging. Clin Oncol (R Coll Radiol) 2017; 29:448-458. [PMID: 28433399 DOI: 10.1016/j.clon.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
Abstract
AIMS The increasing use of highly conformal radiation techniques to treat meningioma confers a greater need for accurate targeting. Several groups have shown that positron emission tomography/computed tomography (PET/CT) information alters meningioma targets contoured by single observers, but whether this translates into improved accuracy has not been defined. As magnetic resonance imaging (MRI) is the cornerstone of meningioma target contouring, simultaneous PET/MRI may be superior to PET/CT. We assessed whether 68Ga DOTATATE PET imaging (from PET/CT and PET/MRI) reduced interobserver variability (IOV) in meningioma target volume contouring. MATERIALS AND METHODS Ten patients with meningioma underwent simultaneous 68Ga DOTATATE PET/MRI followed by PET/CT. They were selected as it was anticipated that target volume definition in their cases would be particularly challenging. Three radiation oncologists contoured target volumes according to an agreed protocol: gross tumour volume (GTV) and clinical target volume (CTV) on CT/MRI alone, CT/MRI+PET(CT) and CT/MRI+PET(MRI). GTV/CTV Kouwenhoven conformity levels (KCL), regions of contour variation and qualitative differences between PET(CT) and PET(MRI) were evaluated. RESULTS There was substantial IOV in contouring. GTV mean KCL: CT/MRI 0.34, CT/MRI+PET(CT) 0.38, CT/MRI+PET(MRI) 0.39 (P = 0.06). CTV mean KCL: CT/MRI 0.31, CT/MRI+PET(CT) 0.35, CT/MRI+PET(MRI) 0.35 (P = 0.04 for all groups; P > 0.05 for individual pairs). One observer consistently contoured largest and one smallest. Observers rarely decreased volumes in relation to PET. Most IOV occurred in bone followed by dural tail, postoperative bed and venous sinuses. Tumour edges were qualitatively clearer on PET(MRI) versus PET(CT), but this did not affect contouring. CONCLUSION IOV in contouring challenging meningioma cases was large and only slightly improved with the addition of 68Ga DOTATATE PET. Simultaneous PET/MRI for meningioma contouring is feasible, but did not improve IOV versus PET/CT. Whether volumes can be safely reduced according to PET requires evaluation.
Collapse
Affiliation(s)
- J Maclean
- University College London Hospitals NHS Trust, London, UK.
| | - N Fersht
- University College London Hospitals NHS Trust, London, UK
| | - K Sullivan
- University College London Hospitals NHS Trust, London, UK
| | - I Kayani
- University College London Hospitals NHS Trust, London, UK
| | - J Bomanji
- University College London Hospitals NHS Trust, London, UK
| | - J Dickson
- University College London Hospitals NHS Trust, London, UK
| | - C O'Meara
- University College London Hospitals NHS Trust, London, UK
| | - S Short
- University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
43
|
Harding R, Trnková P, Weston SJ, Lilley J, Thompson CM, Short SC, Loughrey C, Cosgrove VP, Lomax AJ, Thwaites DI. Benchmarking of a treatment planning system for spot scanning proton therapy: comparison and analysis of robustness to setup errors of photon IMRT and proton SFUD treatment plans of base of skull meningioma. Med Phys 2015; 41:111710. [PMID: 25370624 DOI: 10.1118/1.4897571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was to benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. METHODS Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. RESULTS It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. CONCLUSIONS Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.
Collapse
Affiliation(s)
- R Harding
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Abertawe Bro Morgannwg University Health Board, Medical Physics and Clinical Engineering, Swansea SA2 8QA, United Kingdom
| | - P Trnková
- Paul Scherrer Institute, Centre for Proton Therapy, Villigen 5232, Switzerland
| | - S J Weston
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - J Lilley
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - C M Thompson
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - S C Short
- Leeds Institute of Molecular Medicine, Oncology and Clinical Research, Leeds LS9 7TF, United Kingdomand St James's Institute of Oncology, Oncology, Leeds LS9 7TF, United Kingdom
| | - C Loughrey
- St James's Institute of Oncology, Oncology, Leeds LS9 7TF, United Kingdom
| | - V P Cosgrove
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - A J Lomax
- Paul Scherrer Institute, Centre for Proton Therapy, Villigen 5232, Switzerland
| | - D I Thwaites
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Institute of Medical Physics, School of Physics, University of Sydney, Sydney NSW 2006, Australia
| |
Collapse
|
44
|
Badakhshi H, Graf R, Prasad V, Budach V. The impact of 18 F-FET PET-CT on target definition in image-guided stereotactic radiotherapy in patients with skull base lesions. Cancer Imaging 2014; 14:25. [PMID: 25608761 PMCID: PMC4331830 DOI: 10.1186/1470-7330-14-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 05/30/2014] [Indexed: 02/01/2023] Open
Abstract
Background 18 F-fluoro-ethyl-tyrosine PET is gaining more indications in the field of oncology. We investigated the potentials of usage of FET-PET/CT in addition to MRI for definition of gross tumor volume (GTV) in stereotactic radiotherapy of lesions of skull base. Methods We included in a prospective setting 21 cases. An MRI was performed, completed by FET PET/CT. Different GTV’s were defined based on respective imaging tools: 1. GTVMRI, 2. GTV MRI /CT, 3. GTV composit (1 + 2), and GTVPET = GTV Boost. Lesions could be visualised by MRI and FET-PET/CT in all patients. Results FET tracer enhancement was found in all cases. Skull base infiltration by these lesions was observed by MRI, CT (PET/CT) and FET-PET (PET/CT) in all patients. Totally, brain tissue infiltration was seen in 10 patients. While, in 7 (out 10) cases, MRI and CT (from PET/CT) were indicating brain infiltration, FET-PET could add additional information regarding infiltrative behaviour: in 3 (out 10) patients, infiltration of the brain was displayed merely in FET-PET. An enlargement of GTVMRI/CT due to the FET-PET driven information, which revealed GTVcomposite , was necessary in 7 cases,. This enlargement was significant by definition (> 10% of GTVMRI/CT). The mean PET-effect on GTV counted for 1 ± 4 cm3. The restricted boost fields were based mainly on the GTVPET volume. In mean, about 8.5 cm3 of GTVMRI/CT, which showed no FET uptake, were excluded from target volume. GTVboost driven by only-PET-activity, was in mean by 33% smaller than the initial large treatment field, GTVcomposite, for those cases received boost treatment. FET-PET lead to significant (>10%) changes in the initial treatment fields in 11/21 patients and showed additional tumour volume relevant for radiation planning in 6/21 cases, and led to a subsequent decrease of more than 10% of the initial volumes for the boost fields. Conclusion The implementation of FET PET into the planning procedures showed a benefit in terms of accurate definition of skull base lesions as targets for Image-guided stereotactic Radiotherapy. This has to be investigated prospectively in larger cohorts.
Collapse
|
45
|
Sollini M, Erba PA, Fraternali A, Casali M, Di Paolo ML, Froio A, Frasoldati A, Versari A. PET and PET/CT with 68gallium-labeled somatostatin analogues in Non GEP-NETs Tumors. ScientificWorldJournal 2014; 2014:194123. [PMID: 24693229 PMCID: PMC3947736 DOI: 10.1155/2014/194123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/30/2013] [Indexed: 12/27/2022] Open
Abstract
Somatostatin (SST) is a 28-amino-acid cyclic neuropeptide mainly secreted by neurons and endocrine cells. A major interest for SST receptors (SSTR) as target for in vivo diagnostic and therapeutic purposes was born since a series of stable synthetic SST-analouges PET became available, being the native somatostatin non feasible for clinical use due to the very low metabolic stability. The rationale for the employment of SST-analogues to image cancer is both based on the expression of SSTR by tumor and on the high affinity of these compounds for SSTR. The primary indication of SST-analogues imaging is for neuroendocrine tumors (NETs), which usually express a high density of SSTR, so they can be effectively targeted and visualized with radiolabeled SST-analogues in vivo. Particularly, SST-analogues imaging has been widely employed in gastroenteropancreatic (GEP) NETs. Nevertheless, a variety of tumors other than NETs expresses SSTR thus SST-analogues imaging can also be used in these tumors, particularly if treatment with radiolabeled therapeutic SST-analouges PET is being considered. The aim of this paper is to provide a concise overview of the role of positron emission tomography/computed tomography (PET/CT) with (68)Ga-radiolabeled SST-analouges PET in tumors other than GEP-NETs.
Collapse
Affiliation(s)
- Martina Sollini
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, University of Pisa, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 56125 Pisa, Italy
| | - Alessandro Fraternali
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Massimiliano Casali
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Maria Liberata Di Paolo
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Armando Froio
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, 42123 Reggio Emilia, Italy
| |
Collapse
|
46
|
68Ga DOTATATE PET/CT Uptake in Spinal Lesions and MRI Correlation on a Patient With Neuroendocrine Tumor. Clin Nucl Med 2013; 38:e449-53. [DOI: 10.1097/rlu.0b013e31827a2325] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
47
|
Maclean J, Fersht N, Short S. Controversies in radiotherapy for meningioma. Clin Oncol (R Coll Radiol) 2013; 26:51-64. [PMID: 24207113 DOI: 10.1016/j.clon.2013.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/21/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
Meningiomas are the most common primary intracranial tumour. Although external beam radiotherapy and radiosurgery are well-established treatments, affording local control rates of 85-95% at 10 years, the evidence base is mainly limited to single institution case series. This has resulted in inconsistent practices. It is generally agreed that radiotherapy is an established primary therapy in patients requiring treatment for surgically inaccessible disease and postoperatively for grade 3 tumours. Controversy exists surrounding whether radiotherapy should be upfront or reserved for progression for incompletely excised and grade 2 tumours. External beam radiotherapy and radiosurgery have not been directly compared, but seem to offer comparable rates of control for benign disease. Target volume definition remains contentious, including the inclusion of hyperostotic bone, dural tail and surrounding brain, but pathological studies are shedding some light. Most agree that doses around 50-54 Gy are appropriate for benign meningiomas and ongoing European Organization for Research and Treatment of Cancer and Radiation Therapy Oncology Group studies are evaluating dose escalation for higher risk disease. Here we address the 'who, when and how' of radiotherapy for meningioma.
Collapse
Affiliation(s)
- J Maclean
- Department of Radiotherapy, University College London Hospitals NHS Trust, London, UK.
| | - N Fersht
- Department of Radiotherapy, University College London Hospitals NHS Trust, London, UK
| | - S Short
- Leeds Institute of Molecular Medicine, St James' University Hospital, Leeds, UK
| |
Collapse
|
48
|
Evaluation of feasibility and image quality of 68Ga-DOTATOC positron emission tomography/magnetic resonance in comparison with positron emission tomography/computed tomography in patients with neuroendocrine tumors. Invest Radiol 2013; 48:263-72. [PMID: 23385399 DOI: 10.1097/rli.0b013e31828234d0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The primary aims of this study were to evaluate the feasibility of simultaneous 68(DOTA(0)-Phe(1)-Tyr(3))octreotide positron emission tomography (PET)/magnetic resonance (MR) acquisition on a fully integrated PET/MR scanner in patients and to compare the quality of PET images acquired with a PET/MR device with those acquired with a PET/computed tomography (CT) scanner. PATIENTS AND METHODS Sequential PET/CT and PET/MR imaging was performed in 24 patients with neuroendocrine tumors using a single-injection/dual-imaging protocol. After intravenous injection of 68Ga-DOTATOC (mean, 120 MBq), PET/CT imaging including low-dose CT was performed at a mean time of 17 minutes post injection, and subsequently, PET/MR imaging including a Dixon sequence for attenuation correction was started at a mean time of 82 minutes post injection. The PET/CT and PET/MR images were analyzed visually using a 4-point scale for quality, coregistration, anatomical correlation, and lesion conspicuity. The standardized uptake value of background organs and focal lesions was measured and compared between the PET/CT and PET/MR acquisitions. RESULTS 68Ga-DOTATOC PET acquired on the PET/MR delivered images with a good diagnostic quality (average visual rating PET/CT, 2.83; PET/MR, 2.08; P <; 0.01). The standardized uptake value of focal lesions did not differ between the PET/CT and PET/MR acquisitions (P >; 0.3) and correlated in a linear fashion (correlation coefficient ρ = 0.90). Lesion conspicuity was slightly, but significantly, higher on the PET/CT acquisitions (PET/CT, 2.71; PET/MR, 2.62; P = 0.01). Positron emission tomography/MR detected 153 of 157 lesions identified by PET/CT; however, there was no difference in sensitivity on a patient basis or organ system basis. Anatomical correlates for focal PET lesions could significantly more often be delineated using MR Dixon images compared with low-dose CT (average visual rating PET/CT, 1.78; PET/MR, 2.30; P <; 0.01). Coregistration of functional and morphological data was better on PET/MR compared with PET/CT, which, however, did not reach significance (average visual rating PET/CT, 2.17; PET/MR, 2.46; P = 0.10). CONCLUSIONS 68Ga-DOTATOC PET/MR imaging is feasible in patients, with good image quality, and detectability of focal PET lesions was equivalent to PET/CT on a patient basis and organ system basis. Now, the clinical value of 68Ga-DOTATOC PET/MR with additional diagnostic MR protocols has to be evaluated against PET/CT with multiphase contrast-enhanced CT protocols in future studies.
Collapse
|
49
|
|
50
|
Thorwarth D, Müller AC, Pfannenberg C, Beyer T. Combined PET/MR imaging using (68)Ga-DOTATOC for radiotherapy treatment planning in meningioma patients. Recent Results Cancer Res 2013; 194:425-439. [PMID: 22918773 DOI: 10.1007/978-3-642-27994-2_23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hybrid imaging is beneficial for improved medical diagnosis and therapy planning today. Hybrid imaging describes the prospective correlation of two or more complementary sets of imaging information, such as functional and anatomical image volumes. Correlation can be performed through physically combined imaging modalities, such as PET/CT, SPECT/CT, or PET/MR. Here we present first results from employing fully integrated PET/MR tomography for intensity-modulated radiotherapy (IMRT) treatment planning in patients with meningioma using [(68)Ga]-DOTATOC as the biomarker of choice. Combined PET/MR offers higher soft tissue contrast and the ability to add functional information to the plain combination of MR-based anatomy and PET-based metabolic and molecular information. Furthermore, fully integrated PET/MR employs novel PET technology that is neither available in PET-only nor PET/CT systems. Despite the current lack of broad clinical evidence, integrated PET/MR may become particularly important and clinically useful for improved, individualized RT therapy planning for brain lesions. In particular, logistical and diagnostic benefits of integrated PET/MR-based treatment planning over treatment planning based on PET/CT data may be expected in meningioma patients.
Collapse
Affiliation(s)
- Daniela Thorwarth
- University Hospital for Radiation Oncology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
| | | | | | | |
Collapse
|