68Ga-DOTATOC PET in Extracranial Hepatic and Bone Metastasis of Atypical Refractory Meningioma: A Case Report

Joint EANM/EANO/RANO/SNMMI practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor ligands: version 1.0

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.

A Single Hepatic Metastasis of Cranial Meningioma on [18F]FDG PET/CT 16 Years After Initial Surgery

Hepatic metastases of cranial meningiomas are rare, particularly when they present as a delayed, solitary metastasis, which poses a challenge for imaging-based diagnosis. [18F]FDG PET/CT facilitates diagnosis and posttreatment restaging, whereas somatostatin receptor-targeted PET demonstrates high sensitivity and specificity in the diagnosis of meningiomas and may potentially evaluate the viability of theranostics approaches, particularly for treatment-resistant meningiomas.

68 Ga-DOTATATE and 18 F-FDG PET Imaging of a Rare Chordoid Meningioma With Intracranial Recurrence and Extracranial Metastases

ABSTRACT

Chordoid meningiomas, rare meningioma variants, are characterized by their histopathological features and clinical behavior resembling that of other chondroid/myxoid neoplasms. We present a case of pathology-proven chordoid meningioma imaged with both 68 Ga-DOTATATE and 18 F-FDG PET images during a complicated postoperative course with multiple episodes of local recurrence and, ultimately, extracranial metastasis. This case underscores the aggressive behavior of chordoid meningiomas while highlighting how molecular imaging plays an important role in clinical monitoring and guidance of management.

Transformation From Atypical to Anaplastic Metastatic Meningioma: Evolutionary Turning Point Marked by Strong 18 F-FDG Avidity and Uptake Collapse From 68 GA-DOTATOC

ABSTRACT

World Health Organization (WHO) grade III anaplastic meningioma is scarce. In this way, most studies compared WHO grade I and II. Otherwise, some authors are uncertain about using 18 F-FDG as a diagnostic tool to estimate the WHO grade, especially high. We report the case from a man with a grading tumor evolution from WHO grade II atypical to grade III anaplastic metastatic meningioma. This turning point was imaged using 68 Ga-DOTATOC and 18 F-FDG. Diagnostic was confirmed by histology. The case underlines the unparalleled power of molecular imaging characterized by high sensitivity staging and spectacular avidity changing relationship with grading tumor evolution.