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Year : 2020  |  Volume : 35  |  Issue : 3  |  Page : 264-266  

Multifocal meningioma recurrence detected on Ga68-DOTANOC scan


1 Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Nuclear Medicine and PET/CT, Platinum Imaging Centre, New Delhi, India

Date of Submission04-Feb-2020
Date of Acceptance09-Mar-2020
Date of Web Publication01-Jul-2020

Correspondence Address:
Dr. Nitin Gupta
Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_19_20

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   Abstract 


Meningiomas arise from meningothelial cells of the arachnoid membranes. They are classified into three grades according to the WHO criteria, Grade I (Benign), Grade II (atypical), and Grade III (anaplastic). Radiological and structural imaging computed tomography (CT) and magnetic resonance imaging are done routinely for defining the location, extent, and follow-up. However, these imaging techniques have their limitations. Since meningiomas have overexpression of somatostatin receptor 2, DOTANOC positron-emission tomography (PET)/CT scan is suggested for their delineation and distinguish postradiotherapy necrosis from recurrence. Here, we present a case where DOTANOC PET/CT scan helped in confirming recurrence postsurgery and radiotherapy.

Keywords: Ga-68 DOTANOC scan, meningioma, recurrence


How to cite this article:
Gupta N, Khare A. Multifocal meningioma recurrence detected on Ga68-DOTANOC scan. Indian J Nucl Med 2020;35:264-6

How to cite this URL:
Gupta N, Khare A. Multifocal meningioma recurrence detected on Ga68-DOTANOC scan. Indian J Nucl Med [serial online] 2020 [cited 2020 Aug 10];35:264-6. Available from: http://www.ijnm.in/text.asp?2020/35/3/264/288454




   Description Top


A 31-year-old male, histopathologically proven case of atypical Meningioma, WHO Grade II, with Ki-67 proliferation index 7%–8%, who underwent left fronto-parietal crossing middle craniotomy with excision of tumor and radiotherapy, 1 year back, presented with bilateral lower limbs weakness for 10–12 days. Magnetic resonance imaging (MRI) brain findings were equivocal in differentiating recurrence from necrosis. Whole-body DOTANOC positron-emission tomography-computed tomography (PET-CT) scan was advised in view of suspicion of recurrence. The maximum intensity projection (MIP) image of the brain [Figure 1]a revealed abnormal increased DOTANOC uptake in midline and MIP of the whole body [Figure 1]b showed no site of any other abnormal DOTANOC uptake. Further PET, CT, and fused PET/CT axial [Figure 1]c, [Figure 1]d, [Figure 1]e, coronal [Figure 1]f, [Figure 1]g, [Figure 1]h, and sagittal images [Figure 1]i, [Figure 1]j, [Figure 1]k revealed DOTANOC-avid multifocal enhancing plaque-like dural-based lesions of varying sizes in the left frontoparietal, left parieto-occipital, and left inferior parietal regions. Subsequent surgical resection and pathology report confirmed meningioma recurrence with WHO Grade II.
Figure 1: Maximum intensity projection image of the brain (a) showing DOTANOC uptake in midline and maximum intensity projection of the whole body (b) showing physiological DOTANOC distribution. Positron emission tomography, computed tomography and fused axial, coronal and sagittal images (c-k) suggestive of DOTANOC avid plaque-like dural-based lesions in left fronto-parietal, left parieto-occipital, and left inferior parietal regions

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Meningiomas account for 20%–30% of all primary intracranial neoplasms and are the most common intracranial tumors in adults.[1] The high-grade meningiomas (WHO Grade II and III) show significantly more aggressive behavior and poor prognosis as compared to low-grade meningiomas.[2] Molecular imaging, PET/CT scan can characterize specific metabolic and cellular information, which may help in management as compared to details provided by structural magnetic resonance or CT imaging alone. These structural imaging techniques have limitations in delineating meningiomas, particularly at the skull base, bony involvement, and tumors with complex geometry and in suspected recurrence to distinguish viable tumor from scar tissue.[3] 18F-fluorodeoxyglucose is the most commonly used tracer in PET/CT scans. However, there are several limitations in its use in meningioma, as they are slow-growing tumors, and their glucose metabolism might be only moderately elevated [4] and due to low tumor-to-background ratio.[5] Somatostatin receptors (SSTRs) are expressed in the normal leptomeninges and are overexpressed in meningiomas.[6] The major receptor subtype overexpressed is SSTR 2. Their overexpression in meningiomas increases with tumor grade.[7] The overexpression of these receptors is used in 68Ga-DOTA-peptide PET/CT in meningioma for imaging and as well for therapy purposes.

The literature review describes SSTR expression and various DOTANOC positive meningioma,[8],[9] detecting recurrence pattern on DOTA PET/CT scan,[10],[11] predicting tumor growth.[12] The one limitation of the 68Ga-DOTANOC scan is the parasellar region because of the pituitary gland expressing SSTR2. 68Ga-DOTANOC also allows the detection of additional lesions in patients with multiple meningiomas, for adequate delineation of meningiomas for radiation treatment [13] may strongly complement anatomical data from MRI and CT and improve target volume definition, especially in cases with complex meningioma, recurrent disease after the surgery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 2016;17:e383-91.  Back to cited text no. 3
    
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Di Chiro G, Hatazawa J, Katz DA, Rizzoli HV, De Michele DJ. Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: A PET study. Radiology 1987;164:521-6.  Back to cited text no. 4
    
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Liu RS, Chang CP, Guo WY, Pan DH, Ho DM, Chang CW, et al. 1-11C-acetate versus 18F-FDG PET in detection of meningioma and monitoring the effect of gamma-knife radiosurgery. J Nucl Med 2010;51:883-91.  Back to cited text no. 5
    
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Reubi JC, Maurer R, Klijn JG, Stefanko SZ, Foekens JA, Blaauw G, et al. High incidence of somatostatin receptors in human meningiomas: Biochemical characterization. J Clin Endocrinol Metab 1986;63:433-8.  Back to cited text no. 6
    
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Unterrainer M, Ruf V, Ilhan H, Vettermann FJ, Cyran CC, Niyazi M, et al. 68Ga-DOTATOC PET/CT differentiates meningioma from dural metastases. Clin Nucl Med 2019;44:412-3.  Back to cited text no. 8
    
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Galldiks N, Albert NL, Sommerauer M, Grosu AL, Ganswindt U, Law I, et al. PET imaging in patients with meningioma-report of the RANO/PET Group. Neuro Oncol 2017;19:1576-87.  Back to cited text no. 9
    
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Pelak MJ, d'Amico A. The prognostic value of pretreatment gallium-68 DOTATATE positron emission tomography/computed tomography in irradiated non-benign meningioma. Indian J Nucl Med 2019;34:278-83.  Back to cited text no. 10
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11.
Rachinger W, Stoecklein VM, Terpolilli NA, Haug AR, Ertl L, Pöschl J, et al. Increased 68Ga-DOTATATE uptake in PET imaging discriminates meningioma and tumor-free tissue. J Nucl Med 2015;56:347-53.  Back to cited text no. 11
    
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Sommerauer M, Burkhardt JK, Frontzek K, Rushing E, Buck A, Krayenbuehl N, et al. 68Gallium-DOTATATE PET in meningioma: A reliable predictor of tumor growth rate? Neuro Oncol 2016;18:1021-7.  Back to cited text no. 12
    
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Nyuyki F, Plotkin M, Graf R, Michel R, Steffen I, Denecke T, et al. Potential impact of (68) Ga-DOTATOC PET/CT on stereotactic radiotherapy planning of meningiomas. Eur J Nucl Med Mol Imaging 2010;37:310-8.  Back to cited text no. 13
    


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