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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.
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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
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2
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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.
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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
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Teske N, Biczok A, Quach S, Dekorsy FJ, Forbrig R, Bodensohn R, Niyazi M, Tonn JC, Albert NL, Schichor C, Ueberschaer M. Postoperative [ 68Ga]Ga-DOTA-TATE PET/CT imaging is prognostic for progression-free survival in meningioma WHO grade 1. Eur J Nucl Med Mol Imaging 2023; 51:206-217. [PMID: 37642702 PMCID: PMC10684417 DOI: 10.1007/s00259-023-06400-3] [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: 04/23/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Tumor resection represents the first-line treatment for symptomatic meningiomas, and the extent of resection has been shown to be of prognostic importance. Assessment of tumor remnants with somatostatin receptor PET proves to be superior to intraoperative estimation with Simpson grading or MRI. In this preliminary study, we evaluate the prognostic relevance of postoperative PET for progression-free survival in meningiomas. METHODS We conducted a post hoc analysis on a prospective patient cohort with resected meningioma WHO grade 1. Patients received postoperative MRI and [68Ga]Ga-DOTA-TATE PET/CT and were followed regularly with MRI surveillance scans for detection of tumor recurrence/progression. RESULTS We included 46 patients with 49 tumors. The mean age at diagnosis was 57.8 ± 1.7 years with a male-to-female ratio of 1:1.7. Local tumor progression occurred in 7/49 patients (14%) after a median follow-up of 52 months. Positive PET was associated with an increased risk for progression (*p = 0.015) and a lower progression-free survival (*p = 0.029), whereas MRI was not. 20 out of 20 patients (100%) with negative PET findings remained recurrence-free. The location of recurrence/progression on MRI was adjacent to regions where postoperative PET indicated tumor remnants in all cases. Gross tumor volumes were higher on PET compared to MRI (*p = 0.032). CONCLUSION Our data show that [68Ga]Ga-DOTA-TATE PET/CT is highly sensitive in revealing tumor remnants in patients with meningioma WHO grade 1. Negative PET findings were associated with a higher progression-free survival, thus improving surveillance. In patients with tumor remnants, additional PET can optimize adjuvant radiotherapy target planning of surgically resected meningiomas.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Annamaria Biczok
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Franziska J Dekorsy
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Nathalie L Albert
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Moritz Ueberschaer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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Abstract
Meningiomas comprise a histologically and clinically diverse set of tumors arising from the meningothelial lining of the central nervous system. In the past decade, remarkable progress has been made in deciphering the biology of these common neoplasms. Nevertheless, effective systemic or molecular therapies for meningiomas remain elusive and are active areas of preclinical and clinical investigation. Thus, standard treatment modalities for meningiomas are limited to maximal safe resection, radiotherapy, or radiosurgery. This review examines the history, clinical rationale, and future directions of radiotherapy and radiosurgery as integral and effective treatments for meningiomas.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, UT, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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5
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Filis P, Alexiou GA, Zigouris A, Sioka C, Filis N, Voulgaris S. Meningioma grading based on positron emission tomography: A systematic review and meta-analysis. World Neurosurg X 2023; 18:100167. [PMID: 36825220 PMCID: PMC9941365 DOI: 10.1016/j.wnsx.2023.100167] [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: 09/13/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade. Materials and methods The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented. Results Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18F-FDG, one study used 18F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61). Conclusion PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.
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Key Words
- 1/LR-, inverse of the negative likelihood ratio
- 11C-MET, 11C-methionine
- 18F-FDG, fluorine-18 fluorodeoxyglucose
- 18F-FET, O-(2-[18F]Fluoroethyl)-l-tyrosine
- CIs, 95% confidence intervals
- CT, computerized tomography
- DOR, diagnostic odds ratio
- HSROC, hierarchical summary receiver operating characteristic
- LR+, positive likelihood ratios
- LR−, negative likelihood ratios
- MRI, magnetic resonance imaging
- Mendingioma
- Meta-analysis
- PET
- PET, positron emission tomography
- SPECT, single-photon emission computerized tomography
- SUV, standardized uptake value
- SUVmax, maximum standardized uptake value
- TBR, tumour-to-brain ratios
- TGR, tumor-to-contralateral gray matter ratios
- WHO, World Health Organization
- [18F]FLT, 3′-deoxy-3′-[18F]fluorothymidine
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Affiliation(s)
- Panagiotis Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Corresponding author.
| | - Andreas Zigouris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, University of Ioannina, Greece
| | - Nikolaos Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
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Chen WC, Perlow HK, Choudhury A, Nguyen MP, Mirchia K, Youngblood MW, Lucas CHG, Palmer JD, Magill ST, Raleigh DR. Radiotherapy for meningiomas. J Neurooncol 2022; 160:505-515. [PMID: 36315366 PMCID: PMC9722800 DOI: 10.1007/s11060-022-04171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
Meningiomas are the most common primary central nervous system neoplasm. Despite promising recent progress in elucidating the genomic landscape and underlying biology of these histologically, molecularly, and clinically diverse tumors, the mainstays of meningioma treatment remain maximal safe resection and radiation therapy. The aim of this review of meningioma radiotherapy is to provide a concise summary of the history, current evidence, and future for application of radiotherapy in meningioma treatment.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA. .,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Haley K Perlow
- Department of Radiation Oncology, Ohio State University, Columbus, OH, 43210, USA
| | - Abrar Choudhury
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Minh P Nguyen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Kanish Mirchia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA.,Department of Pathology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60611, USA
| | | | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, OH, 43210, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60611, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA. .,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA.
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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.
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A new uPAR-targeting fluorescent probe for optical guided intracranial surgery in resection of a meningioma-a case report. Acta Neurochir (Wien) 2022; 164:267-271. [PMID: 34748074 DOI: 10.1007/s00701-021-05051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Meningiomas are benign lesion although anot insignificant number experiences recurrences despite Simpson grade 1 removal. FG001 is a compound with a fluorophore (ICG) that binds to a urokinase-type plasminogen activator receptor (uPAR) and is currently investigated at our institution in a first-in-human trial. The patient presented with a plausible malignant glioma but proved to be a grade 1 meningioma. FG001 could delineated the tumor not only on the surface but supplementary in the cavity to remove safely the dural attachment. We present FG001 as a new promising tool for improved surgical radicality beyond the intended indication, provided that a prospective validation in a consecutive meningioma cohort demonstrates similar results.
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