title: Increased 68Ga-DOTATATE uptake in PET imaging discriminates meningioma and tumor-free tissue.
abstract: Meningiomas are known to express somatostatin receptor 2 (SSTR2). PET using the SSTR2 analog (68)Ga-DOTATATE has recently been introduced for imaging of meningiomas. However, a systematic correlation between (68)Ga-DOTATATE uptake, SSTR2 expression, and histology (including tumor-free scar tissue) is still lacking. For elucidation, we conducted this prospective study.
  
  
  METHODS
  Twenty-one adult patients with primary (n = 12) or recurrent (n = 9) meningiomas were prospectively enrolled. Preoperative MR imaging and (68)Ga-DOTATATE PET scans were fused and used for a spatially precise neuronavigated tissue-sampling procedure during tumor resection. Histopathologic diagnosis included immunohistochemical determination of SSTR2 expression. At each individual sampling site, the maximum standardized uptake value (SUVmax) of (68)Ga-DOTATATE was correlated with MR imaging findings, histology, and semiquantitative SSTR2 expression.
  
  
  RESULTS
  One hundred fifteen samples (81 tumor, 34 tumor-free) were obtained. There was a significant positive correlation between SUVmax and SSTR2 expression. Receiver-operating characteristic analysis revealed a threshold of 2.3 for SUVmax to discriminate between tumor and nontumoral tissue. Regarding the detection of tumor tissue, PET imaging showed a higher sensitivity (90% vs. 79%; P = 0.049), with specificity and positive predictive values similar to MR imaging, for both de novo and recurrent tumors.
  
  
  CONCLUSIONS
  (68)Ga-DOTATATE uptake correlates with SSTR2 expression and offers high diagnostic accuracy to delineate meningioma from tumor-free tissue even in recurrent tumors after previous therapy. Our findings substantiate an important role for (68)Ga-DOTATATE PET in meningioma management.
authors: Department of Neurosurgery, University of Munich, Munich, Germany walter.rachinger@med.uni-muenchen.de.
authors: Walter
authors: W
authors: Rachinger
authors: Department of Neurosurgery, University of Munich, Munich, Germany.
authors: Veit M
authors: VM
authors: Stoecklein
authors: Department of Neurosurgery, University of Munich, Munich, Germany.
authors: Nicole A
authors: NA
authors: Terpolilli
authors: Department of Nuclear Medicine, University of Munich, Munich, Germany Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria.
authors: Alexander R
authors: AR
authors: Haug
authors: Department of Neuroradiology, University of Munich, Munich, Germany; and.
authors: Lorenz
authors: L
authors: Ertl
authors: Center for Neuropathology and Prion Research, University of Munich, Munich, Germany.
authors: Julia
authors: J
authors: Pöschl
authors: Center for Neuropathology and Prion Research, University of Munich, Munich, Germany.
authors: Ulrich
authors: U
authors: Schüller
authors: Department of Neurosurgery, University of Munich, Munich, Germany.
authors: Christian
authors: C
authors: Schichor
authors: Department of Neurosurgery, University of Munich, Munich, Germany.
authors: Niklas
authors: N
authors: Thon
authors: Department of Neurosurgery, University of Munich, Munich, Germany.
authors: Jörg-Christian
authors: JC
authors: Tonn
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000378:metabolism; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D009942:Organometallic Compounds / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012372:ROC Curve; D017481:Receptors, Somatostatin / Q000378:metabolism; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D009942:Organometallic Compounds; D017481:Receptors, Somatostatin; C513399:gallium Ga 68 dotatate; C093733:somatostatin receptor 2
keywords: DOTATATE; PET; imaging; meningioma; neuronavigation; somatostatin receptor