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Jeltema HR, van Dijken BRJ, Tamási K, Drost G, Heesters MAAM, van der Hoorn A, Glaudemans AWJM, van Dijk JMC. 11C-Methionine uptake in meningiomas after stereotactic radiotherapy. Ann Nucl Med 2024; 38:596-606. [PMID: 38720053 PMCID: PMC11282149 DOI: 10.1007/s12149-024-01932-6] [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: 02/06/2024] [Accepted: 04/16/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE 11C-Methionine positron emission tomography (MET-PET) is used for stereotactic radiotherapy planning in meningioma patients. The role of MET-PET during subsequent follow-up (FU) is unclear. We analyzed the uptake of 11C-Methionine before and after stereotactic radiotherapy (SRT) in patients with a complex meningioma and investigated if there was a difference between patients with progressive disease (PD) and stable disease (SD) during FU. METHODS This retrospective study investigates 62 MET-PETs in 29 complex meningioma patients. Standardized uptake value (SUV)max and SUVpeak tumor-to-normal ratios (T/N-ratios) were calculated, comparing the tumor region with both the mirroring intracranial area and the right frontal gray matter. The difference in 11C-Methionine uptake pre- and post-SRT was analyzed, as well as the change in uptake between PD or SD. RESULTS Median (IQR) FU duration was 67 months (50.5-91.0). The uptake of 11C-Methionine in meningiomas remained increased after SRT. Neither a statistically significant difference between MET-PETs before and after SRT was encountered, nor a significant difference in one of the four T/N-ratios between patients with SD versus PD with median (IQR) SUVmax T/NR front 2.65 (2.13-3.68) vs 2.97 (1.55-3.54) [p = 0.66]; SUVmax T/Nmirror 2.92 (2.19-3.71) vs 2.95 (1.74-3.60) [p = 0.61]; SUVpeak T/NR front 2.35 (1.64-3.40) vs 2.25 (1.44-3.74) [p = 0.80]; SUVpeak T/Nmirror 2.38 (1.91-3.36) vs 2.35 (1.56-3.72) [p = 0.95]. CONCLUSIONS Our data do not support use of MET-PET during FU of complex intracranial meningiomas after SRT. MET-PET could not differentiate between progressive or stable disease.
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Affiliation(s)
- Hanne-Rinck Jeltema
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands.
| | - Bart R J van Dijken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Katalin Tamási
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mart A A M Heesters
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
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Dong W, Wang N, Qi Z. Advances in the application of neuroinflammatory molecular imaging in brain malignancies. Front Immunol 2023; 14:1211900. [PMID: 37533851 PMCID: PMC10390727 DOI: 10.3389/fimmu.2023.1211900] [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: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
The prevalence of brain cancer has been increasing in recent decades, posing significant healthcare challenges. The introduction of immunotherapies has brought forth notable diagnostic imaging challenges for brain tumors. The tumor microenvironment undergoes substantial changes in induced immunosuppression and immune responses following the development of primary brain tumor and brain metastasis, affecting the progression and metastasis of brain tumors. Consequently, effective and accurate neuroimaging techniques are necessary for clinical practice and monitoring. However, patients with brain tumors might experience radiation-induced necrosis or other neuroinflammation. Currently, positron emission tomography and various magnetic resonance imaging techniques play a crucial role in diagnosing and evaluating brain tumors. Nevertheless, differentiating between brain tumors and necrotic lesions or inflamed tissues remains a significant challenge in the clinical diagnosis of the advancements in immunotherapeutics and precision oncology have underscored the importance of clinically applicable imaging measures for diagnosing and monitoring neuroinflammation. This review summarizes recent advances in neuroimaging methods aimed at enhancing the specificity of brain tumor diagnosis and evaluating inflamed lesions.
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Affiliation(s)
- Wenxia Dong
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Ning Wang
- Department of Medical Imaging, Jining Third People’s Hospital, Jining, Shandong, China
| | - Zhe Qi
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, China
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Horowitz T, Salgues B, Padovani L, Farah K, Dufour H, Chinot O, Guedj E, Graillon T. Optic Nerve Sheath Meningiomas: Solving Diagnostic Challenges with 68Ga-DOTATOC PET/CT. Diagnostics (Basel) 2023; 13:2307. [PMID: 37443701 DOI: 10.3390/diagnostics13132307] [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: 04/09/2023] [Revised: 06/18/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
68Ga-DOTATOC PET could be a noninvasive, highly sensitive, and specific technique for the challenging diagnosis of optic nerve sheath meningioma (ONSM). Our objective was to report the use and results of 68Ga-DOTATOC PET in suspected ONSM. Twelve subjects who underwent 68Ga-DOTATOC PET for suspected ONSM in our department were retrospectively included. Standardised clinical and radiological data were collected. The PET examination results were classified as positive or negative, and lesion standardised uptake values (SUVmax) were recorded. 68Ga-DOTATOC PET confirmed positive uptake in six cases (SUVmax > 5), leading to ONSM diagnoses followed by radiation therapy in patients with vision loss. Six 68Ga-DOTATOC PET scans were considered negative (SUVmax < 5); these comprised one case of neurosarcoidosis, one cavernous malformation, and four uncertain diagnoses, leading to further investigation. 68Ga-DOTATOC PET was helpful in tumour volume delineation before radiation therapy, leading to a decrease in dose exposure. Noninvasive 68Ga-DOTATOC PET should be performed before treating nonhistologically proven meningiomas with radiotherapy or stereotactic radiosurgery, particularly in cases of uncertain diagnosis with MRI, which characterises most ONSM cases. PET SUVmax thresholds to distinguish meningioma from nonspecific uptake in other lesions need to be adapted to ONSM. 68Ga-DOTATOC PET improves the intraorbital lesion diagnostic approach and therefore impacts therapeutic management.
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Affiliation(s)
- Tatiana Horowitz
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, 13005 Marseille, France
| | - Betty Salgues
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, 13005 Marseille, France
| | - Laetitia Padovani
- Radiotherapy Department, APHM, Timone Hospital, 13005 Marseille, France
| | - Kaissar Farah
- Neurosurgery Department, INSERM, MMG, APHM, Timone Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Henry Dufour
- Neurosurgery Department, INSERM, MMG, APHM, Timone Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Olivier Chinot
- Neuro-Oncology Department, APHM, Timone Hospital, 13005 Marseille, France
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, 13005 Marseille, France
| | - Thomas Graillon
- Neurosurgery Department, INSERM, MMG, APHM, Timone Hospital, Aix-Marseille University, 13005 Marseille, France
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Horowitz T, Tabouret E, Graillon T, Salgues B, Chinot O, Verger A, Guedj E. Contribution of nuclear medicine to the diagnosis and management of primary brain tumours. Rev Neurol (Paris) 2023; 179:394-404. [PMID: 36934021 DOI: 10.1016/j.neurol.2023.03.002] [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: 02/18/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
Positron emission tomography (PET) is a powerful tool that can help physicians manage primary brain tumours at diagnosis and follow-up. In this context, PET imaging is used with three main types of radiotracers: 18F-FDG, amino acid radiotracers, and 68Ga conjugated to somatostatin receptor ligands (SSTRs). At initial diagnosis, 18F-FDG helps to characterize primary central nervous system (PCNS) lymphomas and high-grade gliomas, amino acid radiotracers are indicated for gliomas, and SSTR PET ligands are indicated for meningiomas. Such radiotracers provide information on tumour grade or type, assist in directing biopsies and help with treatment planning. During follow-up, in the presence of symptoms and/or MRI modifications, the differential diagnosis between tumour recurrence and post-therapeutic changes, in particular radiation necrosis, may be challenging, and there is strong interest in using PET to evaluate therapeutic toxicity. PET may also contribute to identifying specific complications, such as postradiation therapy encephalopathy, encephalitis associated with PCNS lymphoma, and stroke-like migraine after radiation therapy (SMART) syndrome associated with glioma recurrence and temporal epilepsy, originally illustrated in this review. This review summarizes the main contribution of PET to the diagnosis, management, and follow-up of brain tumours, specifically gliomas, meningiomas, and primary central nervous system lymphomas.
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Affiliation(s)
- T Horowitz
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - E Tabouret
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France; Team 8 GlioME, CNRS 7051, Inst. neurophysiopathol, Aix-Marseille university, Marseille, France
| | - T Graillon
- Inserm, MMG, neurosurgery department, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - B Salgues
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - O Chinot
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France
| | - A Verger
- IADI, Inserm, UMR 1254, department of nuclear medicine & nancyclotep imaging platform, université de Lorraine, CHRU-Nancy, Nancy, France
| | - E Guedj
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France.
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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.
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Ivanidze J, Roytman M, Skafida M, Kim S, Glynn S, Osborne JR, Pannullo SC, Nehmeh S, Ramakrishna R, Schwartz TH, Knisely JPS, Lin E, Karakatsanis NA. Dynamic 68Ga-DOTATATE PET/MRI in the Diagnosis and Management of Intracranial Meningiomas. Radiol Imaging Cancer 2022; 4:e210067. [PMID: 35275019 DOI: 10.1148/rycan.210067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose To evaluate dynamic gallium 68 (68Ga) tetraazacyclododecane tetraacetic acid octreotate (DOTATATE) brain PET/MRI as an adjunct modality in meningioma, enabling multiparametric standardized uptake value (SUV) and Patlak net binding rate constant (Ki) imaging, and to optimize static acquisition period. Materials and Methods In this prospective study (ClinicalTrials.gov no. NCT04081701, DOMINO-START), 68Ga-DOTATATE PET/MRI-derived time-activity curves (TACs) were measured in 84 volumes of interest in 19 participants (mean age, 63 years; range, 36-89 years; 13 women; 2019-2021) with meningiomas. Region- and voxel-specific Ki were determined using Patlak analysis with a validated population-based reference tissue TAC model built from an independent data set of nine participants. Mean and maximum absolute and relative-to-superior-sagittal-sinus SUVs were extracted from the entire 50 minutes (SUV50) and last 10 minutes (SUV10) of acquisition. SUV versus Ki Spearman correlation, SUV and Ki meningioma versus posttreatment-change Mann-Whitney U tests, and SUV50 versus SUV10 Wilcoxon matched-pairs signed rank tests were performed. Results Absolute and relative maximum SUV50 demonstrated a strong positive correlation with Patlak Ki in meningioma (r = 0.82, P < .001 and r = 0.85, P < .001, respectively) and posttreatment-change lesions (r = 0.88, P = .007 and r = 0.83, P = .02, respectively). Patlak Ki images yielded higher lesion contrast by mitigating nonspecific background signal. All SUV50 and SUV10 metrics differed between meningioma and posttreatment-change regions (P < .001). Within the meningioma group, SUV10 attained higher mean scores than SUV50 (P < .001). Conclusion Combined SUV and Patlak K i 68Ga-DOTATATE PET/MRI enabled multiparametric evaluation of meningioma, offering the potential to enhance lesion contrast with Ki imaging and optimize the SUV measurement postinjection window. Keywords: Molecular Imaging-Clinical Translation, Neuro-Oncology, PET/MRI, Dynamic, Patlak ClinicalTrials.gov registration no. NCT04081701 © RSNA, 2022.
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Affiliation(s)
- Jana Ivanidze
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Michelle Roytman
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Myrto Skafida
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Sean Kim
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Shannon Glynn
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Joseph R Osborne
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Susan C Pannullo
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Sadek Nehmeh
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Rohan Ramakrishna
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Theodore H Schwartz
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Jonathan P S Knisely
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Eaton Lin
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Nicolas A Karakatsanis
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
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Pelak MJ, Flechl B, Mumot M, Galalae R, Tubin S, Hug E, Lütgendorf-Caucig C. The Value of SSTR2 Receptor-Targeted PET/CT in Proton Irradiation of Grade I Meningioma. Cancers (Basel) 2021; 13:4707. [PMID: 34572933 PMCID: PMC8469658 DOI: 10.3390/cancers13184707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/04/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Grade I meningioma is the most common intracranial tumor in adults. The standard imaging for its radiation treatment planning is MRI, and [68Ga]1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-conjugated PET/CT can further improve delineation. We investigated the impact of PET/CT on interobserver variability in identifying the tumor in 30 anonymized patients. Four radiation oncologists independently contoured residual tumor volume, first using only MRI and subsequently with the addition of PET/CT. Conformity indices (CIs) were calculated between common volumes, observer pairs and compared to the volumes previously used. Overall, 29/30 tumors (96.6%) showed [68Ga]Ga-DOTA avidity. With help of PET/CT, the participants identified six cases with new lesions not recognized in MRI, including two where new findings would critically alter the target volume used for radiation. The PET/CT-aided series demonstrated superior conformity, as compared to MRI-only between observer pairs (median CI = 0.58 vs. 0.49; p = 0.002), common volumes (CI = 0.34; vs. 0.29; p = 0.002) and matched better the reference volumes actually used for patient treatment (CI = 0.55 vs. 0.39; p = 0.008). Cis in the PET/CT-aided series were lower for meningiomas outside of the skull base (0.2 vs. 0.44; p = 0.03). We conclude that SSTR2 receptor-targeted PET/CT is a valuable tool for planning particle therapy of incompletely resected meningioma. It serves both as a workup procedure and an aid for delineation process that reduces the likelihood of marginal misses.
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Affiliation(s)
- Maciej J. Pelak
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
| | - Birgit Flechl
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
| | - Marta Mumot
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
| | - Razvan Galalae
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
- Medizinische Fakultät, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany
| | - Slavisa Tubin
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
| | - Eugen Hug
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
| | - Carola Lütgendorf-Caucig
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (B.F.); (M.M.); (R.G.); (S.T.); (E.H.); (C.L.-C.)
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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9
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68Ga-DOTATOC PET/CT Follow Up after Single or Hypofractionated Gamma Knife ICON Radiosurgery for Meningioma Patients. Brain Sci 2021; 11:brainsci11030375. [PMID: 33804251 PMCID: PMC8001061 DOI: 10.3390/brainsci11030375] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
68Ga-DOTATOC represents a useful tool in tumor contouring for radiosurgery planning. We present a case series of patients affected by meningiomas on who we performed 68Ga-DOTATOC positron emission tomography (PET)/CT pre-operatively, a subgroup of which also underwent a post-operative 68Ga-DOTATOC PET/CT to evaluate the standardized uptake value (SUV) modification after Gamma Knife ICON treatment in single or hypofractionated fractions. Twenty patients were enrolled/included in this study: ten females and ten males. The median age was 52 years (range 33-80). The median tumor diameter was 3.68 cm (range 0.12-22.26 cm), and the median pre-radiotherapy maximum SUV value was 11 (range 2.3-92). The average of the relative percentage changes between SUVs at baseline and follow up was -6%, ranging from -41% to 56%. The SUV was reduced in seven out of 12 patients (58%), stable in two out of 12 (17%), and increased in three out of 12 (25%), suggesting a biological response of the tumor to the Gamma Knife treatment in most of the cases. 68Ga-DOTATOC-PET represents a valuable tool in assessing the meningioma diagnosis for primary radiosurgery; it is also promising for follow-up assessment.
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10
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Decazes P, Hinault P, Veresezan O, Thureau S, Gouel P, Vera P. Trimodality PET/CT/MRI and Radiotherapy: A Mini-Review. Front Oncol 2021; 10:614008. [PMID: 33614497 PMCID: PMC7890017 DOI: 10.3389/fonc.2020.614008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Computed tomography (CT) has revolutionized external radiotherapy by making it possible to visualize and segment the tumors and the organs at risk in a three-dimensional way. However, if CT is a now a standard, it presents some limitations, notably concerning tumor characterization and delineation. Its association with functional and anatomical images, that are positron emission tomography (PET) and magnetic resonance imaging (MRI), surpasses its limits. This association can be in the form of a trimodality PET/CT/MRI. The objective of this mini-review is to describe the process of performing this PET/CT/MRI trimodality for radiotherapy and its potential clinical applications. Trimodality can be performed in two ways, either a PET/MRI fused to a planning CT (possibly with a pseudo-CT generated from the MRI for the planning), or a PET/CT fused to an MRI and then registered to a planning CT (possibly the CT of PET/CT if calibrated for radiotherapy). These examinations should be performed in the treatment position, and in the second case, a patient transfer system can be used between the PET/CT and MRI to limit movement. If trimodality requires adapted equipment, notably compatible MRI equipment with high-performance dedicated coils, it allows the advantages of the three techniques to be combined with a synergistic effect while limiting their disadvantages when carried out separately. Trimodality is already possible in clinical routine and can have a high clinical impact and good inter-observer agreement, notably for head and neck cancers, brain tumor, prostate cancer, cervical cancer.
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Affiliation(s)
- Pierre Decazes
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Ovidiu Veresezan
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Sébastien Thureau
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Pierrick Gouel
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
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11
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Mahase SS, Roth O'Brien DA, No D, Roytman M, Skafida ME, Lin E, Karakatsanis NA, Osborne JR, Brandmaier A, Pannullo SC, Ramakrishna R, Stieg PE, Knisely JPS, Ivanidze J. [ 68Ga]-DOTATATE PET/MRI as an adjunct imaging modality for radiation treatment planning of meningiomas. Neurooncol Adv 2021; 3:vdab012. [PMID: 33738446 PMCID: PMC7954102 DOI: 10.1093/noajnl/vdab012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Meningiomas express high levels of somatostatin receptor 2 (SSTR2). SSTR2-targeted PET imaging with [68Ga]-DOTATATE can aid with distinguishing residual meningioma from reactive changes in the postoperative setting. We present initial dosimetric analyses, acute events, and local control data utilizing [68Ga]-DOTATATE PET/MRI-assisted target delineation for prospectively-treated intermediate-risk meningiomas. Methods Twenty-nine patients underwent DOTATATE PET/MRI meningioma evaluation in 2019. Eight patients with 9 postoperative meningiomas met RTOG 0539 intermediate-risk criteria (recurrent WHO grade I, 1/9; WHO grade II, 8/9). Target volumes were created using DOTATATE PET/MRI to determine residual disease and received a nominal dose of 35.0 Gy over 5 fractions. For comparison, cases were recontoured and planned with MRI alone per RTOG 0539 guidelines. Mean and maximum equivalent 2 Gy doses were generated for target volumes and organs at risk (OAR) within 1 cm of the PTV and compared using Wilcoxon matched pairs signed rank test. Results DOTATATE PET/MRI-guided planning significantly reduced mean PTV (11.12 cm3 compared to 71.39 cm3 based on MRI alone, P < .05) and mean and max dose to the whole brain, optic nerves, and scalp. PET/MRI plans resulted in at least 50% reduction of mean and max doses to the lens, eyes, chiasm, cochlea, brainstem, and hippocampi. One patient experienced focal alopecia. There were no local recurrences at 6 months. Conclusion Incorporating DOTATATE-PET/MRI for postoperative target delineation in patients with intermediate-risk intracranial meningiomas results in PTV reduction and decreased OAR dose. Our findings warrant larger studies evaluating DOTATATE-PET/MRI in the radiotherapeutic planning of postoperative meningiomas.
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Affiliation(s)
- Sean S Mahase
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Diana A Roth O'Brien
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Diana No
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Roytman
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Myrto E Skafida
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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12
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Image-Guided Multisession Radiosurgery of Skull Base Meningiomas. Cancers (Basel) 2020; 12:cancers12123569. [PMID: 33260363 PMCID: PMC7761100 DOI: 10.3390/cancers12123569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Stereotactic radiosurgery has changed the landscape of treatment for skull base meningiomas. Lesions encasing or compressing radiosensitive structures are considered not suitable for single session stereotactic radiosurgery because of the high risk of side effects. Multisession stereotactic radiosurgery can reduce these risks, allowing for normal tissue repair between fractions, while delivering a high dose per fraction. The aim of this study is to validate the role of multi-session stereotactic radiosurgery in the treatment of skull base meningiomas, through a retrospective analysis of 156 patients affected by skull base meningioma, treated at the University of Messina between 2008 and 2018. Our study suggests that multisession stereotactic radiosurgery represents a safe and effective profile in the treatment of skull base meningioma, providing a satisfactory local control and a low toxicity rate, together with patient comfort from a frameless procedure. Abstract Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.
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13
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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.
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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
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14
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Huang RY, Bi WL, Griffith B, Kaufmann TJ, la Fougère C, Schmidt NO, Tonn JC, Vogelbaum MA, Wen PY, Aldape K, Nassiri F, Zadeh G, Dunn IF. Imaging and diagnostic advances for intracranial meningiomas. Neuro Oncol 2020; 21:i44-i61. [PMID: 30649491 DOI: 10.1093/neuonc/noy143] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The archetypal imaging characteristics of meningiomas are among the most stereotypic of all central nervous system (CNS) tumors. In the era of plain film and ventriculography, imaging was only performed if a mass was suspected, and their results were more suggestive than definitive. Following more than a century of technological development, we can now rely on imaging to non-invasively diagnose meningioma with great confidence and precisely delineate the locations of these tumors relative to their surrounding structures to inform treatment planning. Asymptomatic meningiomas may be identified and their growth monitored over time; moreover, imaging routinely serves as an essential tool to survey tumor burden at various stages during the course of treatment, thereby providing guidance on their effectiveness or the need for further intervention. Modern radiological techniques are expanding the power of imaging from tumor detection and monitoring to include extraction of biologic information from advanced analysis of radiological parameters. These contemporary approaches have led to promising attempts to predict tumor grade and, in turn, contribute prognostic data. In this supplement article, we review important current and future aspects of imaging in the diagnosis and management of meningioma, including conventional and advanced imaging techniques using CT, MRI, and nuclear medicine.
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Affiliation(s)
- Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Christian la Fougère
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tubingen, Tubingen, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
| | - Jöerg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth Aldape
- Department of Laboratory Pathology, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Ian F Dunn
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Shimanskiy VN, Karnaukhov VV, Galkin MV, Tanyashin SV, Golanov AV, Poshataev VK, Shevchenko KV. [Treatment of petroclival meningiomas: current state of the problem]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:78-89. [PMID: 32031171 DOI: 10.17116/neiro20198306178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.
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Affiliation(s)
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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16
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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.
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Alfredo C, Carolin S, Güliz A, Anne K, Antonio P, Alberto C, Stefano P, Antonino G, Harun B, Markus K, Franziska M, Phuong N, Franziska L, Peter V, Volker B, David K. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis. Radiat Oncol 2019; 14:201. [PMID: 31718650 PMCID: PMC6852939 DOI: 10.1186/s13014-019-1397-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background This retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy (nFSRT) to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas. Methods Overall, 341 patients across three centers were treated with either nFSRT or CK-hFSRT for skull base meningioma. Treatment planning was based on computed tomography (CT) and magnetic resonance imaging (MRI) following institutional guidelines. Most nFSRT patients received 33 × 1.8 Gy, and most CK-hFSRT patients received 5 × 5 Gy. The median follow-up time was 36 months (range: 1–232 months). Results In the CK-hFSRT group, the 1-, 3-, and 10-year local control (LC) rates were 99.4, 96.8, and 80.3%, respectively. In the nFSRT group, the 1-, 3-, and 10-year LC rates were 100, 99, and 79.1%, respectively. There were no significant differences in LC rates between the nFSRT and CK-hFSRT groups (p = 0.56, hazard ratio = 0.76, 95% confidence interval, 0.3–1.9). In the CK-hFSRT group, only one case (0.49%) of severe toxicity (CTCAE 4.0 ≥ 3) was observed. In the nFSRT group, three cases (2.1%) of grade III toxicity were observed. Conclusion This analysis of pooled data from three centers showed excellent LC and low side effect rates for patients treated with CK-hFSRT or nFSRT. The efficacy, safety, and convenience of a shortened treatment period provide a compelling case for the use of CK-hFSRT in patients with moderate size skull base meningioma and provided that OAR constraints are met.
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Affiliation(s)
- Conti Alfredo
- Department of Neurosurgery, University of Bologna, Bologna, Italy.,Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Senger Carolin
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Acker Güliz
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), 10178, Berlin, Germany
| | - Kluge Anne
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Cacciola Alberto
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | | | - Germanò Antonino
- Department of Neurosurgery, University of Bologna, Bologna, Italy
| | - Badakhshi Harun
- Ernst von Bergmann Medical Center, Department of Radiation Oncology, Potsdam, Germany
| | - Kufeld Markus
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Meinert Franziska
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nguyen Phuong
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Loebel Franziska
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Vajkoczy Peter
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Budach Volker
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kaul David
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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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.
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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.
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Abstract
Delineating the gross tumor volume (GTV) is a core task within radiation treatment planning. GTVs must be precisely defined irrespective of the region involved, but even more so in a sensitive area such as the brain. As precision medicine cannot exist without precision imaging, the current article aims to discuss the various imaging modalities employed in the radiation treatment planning of brain tumors.Gliomas, meningiomas, and paragangliomas are some of the most challenging tumors and the advancement in diagnostic imaging can significantly contribute to their delineation. For gliomas, irradiation based on multiparametric magnetic resonance imaging (MRI) and amino-acid positron emission tomography (PET)/computed tomography (CT) may have a higher sensitivity and specificity, which could lead to a better sparing of organs at risk and help distinguish between tumor, edema, and radiogenic alterations. Meningiomas and paragangliomas are often associated with a good prognosis. Therefore, GTV delineation according to MRI and somatostatin receptor ligand-PET/CT plays an essential role in sparing sensitive structures and maintaining a good quality of life for these patients.The combination of multiparametric MRI and PET/CT (possibly in the form of PET/MRI) presently appears to be the optimal approach for target volume delineation. The comparative efficacy of these imaging modalities has to be further evaluated in prospective trials.
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Ivanidze J, Roytman M, Lin E, Magge RS, Pisapia DJ, Liechty B, Karakatsanis N, Ramakrishna R, Knisely J, Schwartz TH, Osborne JR, Pannullo SC. Gallium‐68 DOTATATE PET in the Evaluation of Intracranial Meningiomas. J Neuroimaging 2019; 29:650-656. [DOI: 10.1111/jon.12632] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jana Ivanidze
- Department of Diagnostic RadiologyWeill Cornell Medicine New York NY
| | - Michelle Roytman
- Department of Diagnostic RadiologyWeill Cornell Medicine New York NY
| | - Eaton Lin
- Department of Diagnostic RadiologyWeill Cornell Medicine New York NY
| | - Rajiv S. Magge
- Department of Neuro‐OncologyWeill Cornell Medicine New York NY
| | | | | | | | - Rohan Ramakrishna
- Department of Neurological SurgeryWeill Cornell Medicine New York NY
| | - Jonathan Knisely
- Department of Radiation OncologyWeill Cornell Medicine New York NY
| | | | - Joseph R. Osborne
- Department of Diagnostic RadiologyWeill Cornell Medicine New York NY
| | - Susan C. Pannullo
- Department of Neurological SurgeryWeill Cornell Medicine New York NY
- Department of Radiation OncologyWeill Cornell Medicine New York NY
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