Positron emission tomography for intracranial meningioma [Neurosurgery Wiki]

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====== Positron emission tomography for intracranial meningioma ======
[[MET]] [[PET/CT]] showed a high [[sensitivity]] compared with [[FDG]] [[PET/CT]] for detection of newly diagnosed [[WHO grade]]s I and II [[intracranial meningioma]]s. Both FDG and MET uptake were found to be useful for evaluating tumor proliferation in meningiomas
((Mitamura K, Yamamoto Y, Norikane T, Hatakeyama T, Okada M, Nishiyama Y.
Correlation of (18)F-FDG and (11)C-methionine uptake on PET/CT with Ki-67
immunohistochemistry in newly diagnosed intracranial meningiomas. Ann Nucl Med.
2018 Jul 21. doi: 10.1007/s12149-018-1284-6. [Epub ahead of print] PubMed PMID:
30032455.
)).

Although [[positron emission tomography]] has not been routinely used in the diagnostic workup and follow-up of patients with [[meningioma]]s, it can be useful in cases of [[skull base meningioma]]s that are frequently difficult to visualize by using standard CT and MR imaging techniques
((Rockhill J, Mrugala M, Chamberlain MC. Intracranial meningiomas: an overview
of diagnosis and treatment. Neurosurg Focus. 2007;23(4):E1. Review. PubMed PMID: 
17961033.)).

Primary intracranial meningioma is typically reported as having low [[FDG]] uptake, because glucose metabolism in meningioma is similar to that of surrounding tissue
((Kaminski JM, Movsas B, King E, Yang C, Kronz JD, Alli PM, et al. [[Metastatic meningioma]] to the lung with multiple pleural metastases. Am J Clin Oncol 2001;24:579–82)).

There have been a few isolated reports describing the imaging features of [[metastatic meningioma]] on FDG-PET imaging. Ghodsian et al., described a moderately hypermetabolic sacral metastatic mass by FDG-PET/CT. This was a Grade III malignant meningioma on histology
((Ghodsian M, Obrzut SL, Hyde CC, Watts WJ, Schiepers C. Evaluation of [[metastatic meningioma]] with 2-deoxy-2-[18F] fluoro-d-glucose PET/CT. Clin Nucl Med 2005;30:717–20)).

Meirelles et al., described a pulmonary meningioma that manifested as a solitary pulmonary nodule and had very high metabolic activity on PET scan. The current case also showed avid uptake of FDG; the SUV was >7 in each pulmonary lesion. The uptake was more avid in the periphery and slightly less in the centre of both lesions, corresponding to the central areas of low density on CT. It was useful to note that there were no other foci of abnormal FDG uptake elsewhere to suggest other metastases. It is reassuring to note that 10 months after the PET/CT with clinical follow-up, the patient remains asymptomatic with no evidence of local or distant spread. The diagnosis of pulmonary [[metastatic meningioma]] was confirmed histologically by CT-guided percutaneous biopsy, which has been previously reported
((Brennan C, O'Connor OJ, O'Regan KN, Keohane C, Dineen J, Hinchion J, Sweeney
B, Maher MM. [[Metastatic meningioma]]: positron emission tomography CT imaging
findings. Br J Radiol. 2010 Dec;83(996):e259-62. doi: 10.1259/bjr/11276652.
PubMed PMID: 21088084; PubMed Central PMCID: PMC3473618.
)).
----
In [[2007]], Rutten et al., described the combination of [[CT]] and [[MRI]] as limited in the [[diagnosis]] of local [[skull]] involvement from adjacent [[intracranial meningioma]]. In their [[study]], the authors demonstrated that [[skull base tumor]]s could be clearly visualised with [[18F]]-[[tyrosine]] [[PET]], even after [[radiation therapy]]
((Rutten I, Cabay JE, Withofs N, Lemaire C, Aerts J, Baart V, et al.: PET/CT of skull base meningiomas using 2–18F-fluoro-L-tyro-sine: initial report. J Nucl Med 48:720–5, 2007))
((Conti PS, Cham DK, editors. Singapore: Springer; 2005. PET/CT: a case based approach book.)).

Meningiomas are also known to have high somatostatin receptor density allowing for the potential use of octreotide brain scintigraphy to help delineate extent of disease. This may be particularly useful in distinguishing residual tumor from postoperative scarring in subtotally resected/recurrent tumors
((Klutmann S, Bohuslavizki KH, Brenner W, Behnke A, Tietje N, Kröger S, et al.: Somatostatin receptor scintigraphy in postsurgical follow-up examinations of meningioma. J Nucl Med 39:1913–1917, 1998)).

===== 68Ga-DOTATATE PET for meningioma diagnosis =====
[[68Ga-DOTATATE PET for meningioma diagnosis]]

===== References =====