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LETTER TO THE EDITOR
Year : 2017  |  Volume : 32  |  Issue : 2  |  Page : 164  

68Ga-DOTA-D Phe1-Tyr3-octreotide (DOTATOC)-PET/CT in a suspected case of recurrent meningioma


1 Department of Nuclear Medicine, Action Cancer Hospital, Paschim Vihar, New Delhi, India
2 Department of Radiology, Action Cancer Hospital, Paschim Vihar, New Delhi, India

Date of Web Publication16-Mar-2017

Correspondence Address:
Sachin Jain
Department of Nuclear Medicine and PET/CT Action Cancer Hospital, A4, Paschim VIhar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.202241

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How to cite this article:
Jain S, Gupta A, Jain A. 68Ga-DOTA-D Phe1-Tyr3-octreotide (DOTATOC)-PET/CT in a suspected case of recurrent meningioma. Indian J Nucl Med 2017;32:164

How to cite this URL:
Jain S, Gupta A, Jain A. 68Ga-DOTA-D Phe1-Tyr3-octreotide (DOTATOC)-PET/CT in a suspected case of recurrent meningioma. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 15];32:164. Available from: http://www.ijnm.in/text.asp?2017/32/2/164/202241

Sir,

We present a case of 45-year-old female who presented with headache for last 1 month. She was a follow-up case of left frontal meningioma that was operated 4 years back. CEMRI of the brain suggested post-surgical changes with no obvious enhancing residual/recurrent lesion. The patient was then referred for 68 Ga DOTANOC PET/CT to rule out recurrent disease. PET/CT revealed a focus of somatostatin receptor expressing lesion in the left frontal region at the post-operative site suggesting recurrent disease.

Meningioma is the most common non-glial brain tumor. It arises from the cap cells of the arachnoid membrane. However, 90% of meningiomas are benign. Surgery often with adjuvant radiotherapy is the usual treatment.[1] MRI is the imaging method of choice for diagnosis and radiotherapy planning. Somatostatin receptors (SSTR) are present in normal leptomeninges[2] and have been shown to be over expressed in meningiomas.[3] The major receptor subtype over expressed is SSTR 2.[4] This fact has been exploited for SSTR scintigraphy (SRS) and more recently for 68Ga-DOTA-peptide PET/CT in meningioma. Even after complete removal, meningiomas tend to recur in 10% to 32% of the cases within 10 years.[5],[6] MRI fails to differentiate between post-therapy radiation necrosis and recurrent disease in majority of the cases. Recurrent brain tumors are typically characterized by intravenous contrast enhancement, mass effect, and associated vasogenic edema. However, treatment necrosis also presents with similar characteristics, making it difficult to reliably distinguish from tumor recurrence. Because of the high tumor to background ratio and expression of the somatostatin receptor by the tumor, 68Ga-DOTA-peptide PET/CT helps in differentiation between the post-operative scar and recurrent disease in meningioma. It also helps in selection of patients for somatostatin-based analog-based therapies.

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   References Top

1.
Stafford SL, Perry A, Suman VJ, Meyer FB, Scheithauer BW, Lohse CM. Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998;73:936-42.  Back to cited text no. 1
    
2.
Reubi JC, Maurer R, Lamberts SWJ. Somatostatin binding sites in human leptomeninx. Neurosci Lett 1986;70:183-6.  Back to cited text no. 2
    
3.
Reubi JC, Maurer R, Klijn JGM, Stefanko SZ, Foekens JA, Blaauw G. High incidence of somatostatin receptors in human meningiomas: biochemical characterization. J Clin Endocrinol Metab 1986;63:433-8.  Back to cited text no. 3
    
4.
Barresi V, Alafaci C, Salpietro F, Tuccari G. Sstr2A immunohistochemical expression in human meningiomas: Is there a correlation with the histological grade, proliferation or microvessel density? Oncol Rep 2008;20:485-92.  Back to cited text no. 4
    
5.
Adegbite AB, Khan MI, Paine KWE, Tan LK. The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 1983;58:51-6.  Back to cited text no. 5
    
6.
Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985;62:18-24.  Back to cited text no. 6
    




 

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