The role of 111indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas.
OBJECTIVE
Meningiomas are common brain tumors with somatostatin receptors that bind octreotide. We report the use of (111)indium-octreotide brain scintigraphy (OBS) for the non-invasive differentiation of meningiomas from other cranial dural-based pathology.


METHODS
A retrospective analysis of our experience with OBS for non-invasive identification of meningiomas was performed. Two neuroradiologists, blinded to clinical data, utilized a standardized grading scheme to define the uptake of octreotide at 6 and 24 h post-administration. The correlation between (18) F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) scans, and octreotide uptake was assessed.


RESULTS
The cohort consisted of 50 patients having a mean age of 62.4 years and a median follow-up time of 24 months. Management consisted of biopsy (n = 4); resection (n = 10); observation (n = 16); radiosurgery (n = 21); and external beam radiotherapy (n = 3). OBS was correlated with MRI (n = 50); FDG-PET brain studies (n = 38); histology (n = 14), and angiography (n = 1). In cases where definitive diagnosis could be made, the sensitivity, specificity, positive and negative predictor values for OBS alone were 100; 50; 75; and 100, respectively. OBS provided false positive data in 3 patients (metastasis, chronic inflammation, lymphoma). Use of OBS with MRI to differentiate meningiomas from other lesions was highly significant (P < 0.001). FDG-PET correctly identified malignant pathology with 100% sensitivity and specificity.


CONCLUSIONS
OBS may increase the diagnostic specificity of conventional MRI when differentiating meningioma from other dural-based pathologies, while the addition of FDG-PET differentiates benign from malignant lesions.
Nathoo
Narendra
N
Department of Neurosurgery, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Ugokwe
Kene
K
Chang
Albert S
AS
Li
Liang
L
Ross
Jeffrey
J
Suh
John H
JH
Vogelbaum
Michael A
MA
Barnett
Gene H
GH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007205:Indium Radioisotopes; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin / Q000378:metabolism; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology*
D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C094279:indium-111-octreotide; D019788:Fluorodeoxyglucose F18; D015282:Octreotide