• Jana Ivanidze, Michelle Roytman, Eaton Lin, Rajiv S Magge, David J Pisapia, Benjamin Liechty, Nicolas Karakatsanis, Rohan Ramakrishna, Jonathan Knisely, Theodore H Schwartz, Joseph R Osborne, and Susan C Pannullo.
• Department of Diagnostic Radiology, Weill Cornell Medicine, New York, NY.
• J Neuroimaging. 2019 Sep 1; 29 (5): 650-656.

Background And PurposeMeningiomas are the most common primary intracranial tumors, typically treated with surgery and adjuvant radiation in cases of subtotal resection and/or higher histopathologic grade. Contrast-enhanced magnetic resonance imaging (MRI) is the gold standard for postoperative assessment and adjuvant treatment planning. However, MRI can have limited accuracy particularly in the presence of posttreatment change. [68Ga]-DOTATATE is a Positron Emission Tomography (PET) radiotracer targeting somatostatin receptor 2A (SSTR2A). SSTR2A is a reliable biomarker of meningiomas. We report a consecutive case series of 20 patients evaluated with [68Ga]-DOTATATE PET/MRI, propose a novel approach to quantitative analysis, and discuss clinical implications.MethodsWe present a consecutive case series of 20 patients with clinically suspected or pathology-proven meningioma evaluated between July 2018 and February 2019. [68Ga]-DOTATATE PET/MRI was obtained in order to confirm the diagnosis or determine tumor recurrence/progression to help guide surgical and/or radiation therapy management in cases in which MRI findings were indeterminate or equivocal.ResultsSeventeen (85%) patients had undergone prior surgery and 11 (55%) underwent adjuvant radiation therapy. In 17 patients [68Ga]-DOTATATE confirmed the presence of recurrent meningioma. A total of 49 meningiomas were identified (median: 2 meningiomas/patient, range 0-14). There was excellent differentiation between meningioma and posttreatment change based on our approach of target lesion/superior sagittal sinus maximum standardized uptake values ratio (16.6 vs. 1.6, P < .0001).Conclusions[68Ga]-DOTATATE PET/MRI is a promising tool in the assessment of both treatment naïve and resected/irradiated meningiomas, allowing improved diagnosis and extent of disease evaluation. Future prospective studies are needed to determine utility of [68Ga]-DOTATATE PET/MRI in treatment response assessment.© 2019 by the American Society of Neuroimaging.

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