Comparison of diagnostic value of 68 Ga-DOTATOC PET/MRI and standalone MRI for the detection of intracranial meningiomas

Abstract

To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5–1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5–1.0 and 1.0–2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.

The Role of [68Ga]Ga-DOTA-SSTR PET Radiotracers in Brain Tumors: A Systematic Review of the Literature and Ongoing Clinical Trials

“…The initial search yielded 1606 published articles (PubMed: 803; Scopus: 673; Web of Science: 107; Cochrane: 23). A total of 63 studies were included with the a priori criteria: 25 were case reports and 38 were case series, categorized with levels of evidence IV and V, respectively [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ,…”

“…DOTATATE (54.5%) was utilized more frequently than DOTATOC (45.5%). In meningiomas, [ 68 Ga]Ga-DOTA-SSTR PET studies were implemented to: (1) evaluate intraosseous or infracranial extension [ 15 , 31 , 79 ]; (2) detect lesions difficult-to-identify on MRI [ 30 , 63 ]; (3) differentiate residual/recurrent tumor tissue versus non-tumor tissue [ 14 ], such as surgical scarring [ 38 ] or post-therapy changes [ 53 ]; (4) confirm the diagnosis of meningiomas (high tracer uptake) [ 35 , 71 , 72 ] and differentiate those from other pathologies with lower tracer uptakes, both tumoral [ 44 , 54 , 55 , 58 ] and non-tumoral [ 40 , 42 ]; (5) stage recurrent or systemic disease [ 34 , 50 , 56 ]; (6) quantify tracer uptake (SSTR2 expression) [ 61 , 62 , 77 ] and match/mismatch with FDG uptake (metabolic rate) [ 35 , 52 ]; (7) evaluate postoperative extent of resection [ 60 , 65 ]; (8) predict tumor growth [ 45 ]; and appraise the diagnostic accuracy of hybrid PET/MRI scans [ 13 , 37 , 63 ]. In pituitary adenomas, [ 68 Ga]Ga-DOTA-SSTR PET studies were utilized to confirm biologically active post-surgical residual tumor tissue in concomitance with FDG PET/CT studies [ 16 ], or for differential diagnosis with synchronous meningiomas [ 44 ].…”

“…Since the study by Henze et al [ 11 ] in 2001, [ 68 Ga]Ga-DOTA-SSTR PET studies have expanded beyond neuroendocrine neoplasms in neuro-oncology, primarily for meningiomas, with the goal to improve tumor detection, differentiation, and extent-of-infiltration. While most meningiomas are easily identifiable at standard MRIs by showing typical pathognomonic features, lesions with intraosseous extensions, invading the skull base, or adjacent to the falx cerebri, may pose some diagnostic challenges [ 63 , 93 , 94 , 95 ]. By selectively binding to SSTR, [ 68 Ga]Ga-DOTA-SSTR radiotracers allow for targeted uptake by SSTR-positive neoplasms and high tumor-to-background contrast, offering higher accuracy in evaluating the infracranial/transosseous extent of meningiomas infiltration and detection of synchronous lesions undetected by MRI studies [ 31 , 34 ].…”

Somatostatin Receptor Targeted PET-Imaging for Diagnosis, Radiotherapy Planning and Theranostics of Meningiomas: A Systematic Review of the Literature

“…In a recently published paper, Einhellig et al [ 35 ] performed a prospective head-to-head comparison between 68 Ga-DOTATOC PET/MRI versus standalone MRI in 57 patients harboring 112 meningiomas. Histology, as a reference standard, was available in 32 cases, while for the remaining 25, final diagnosis was made on the basis of clinical and imaging correlation.…”

Evaluating diagnostic accuracy and determining optimal diagnostic thresholds of different approaches to [68Ga]-DOTATATE PET/MRI analysis in patients with meningioma

“…Rachinger and colleagues demonstrated that standard MRI has sensitivity of 79% and specificity of 65% in distinguishing meningioma from tumor-free tissues 17 . Another group showed that MRI alone can achieve sensitivity of 95% and specificity 88% in the diagnosis of meningioma in a cohort of 57 patients, but noted that diagnostic accuracy diminishes in cases of small lesions (< 0.5 cm 3 ) and certain difficult locations such as skull base 6 . For transosseous growing meningiomas, MRI’s sensitivity was even lower at 54% 5 .…”