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Soydal C, Demir B, Akkus Gunduz P, Baltacioglu MH, Araz M, Kuru Oz D, Kucuk NO. 68Ga DOTATATE PET/MR Imaging of Well-Differentiated Primary and Metastatic Liver Neuroendocrine Tumors: Unified Evaluation and Correlations of PET, DCE, DWI, and T2-weighted Images. Clin Nucl Med 2025:00003072-990000000-01756. [PMID: 40424605 DOI: 10.1097/rlu.0000000000005994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2025] [Accepted: 04/23/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE To evaluate the potential of integrated multiparametric 68Ga DOTATATE PET/MR imaging for assessing liver lesions of well-differentiated neuroendocrine tumors (NETs) and to identify imaging parameters predictive of primary tumor localization. PATIENTS AND METHODS This retrospective study involves patients with well-differentiated NETs who underwent 68Ga DOTATATE PET/MRI between September 2018 and November 2024. Inclusion criteria required histopathologically proven NETs with 68Ga DOTATATE-avid liver metastases and complete multiparametric MRI sequences. PET and MRI-derived variables, including SUVmax, ADCmin, T/L ratios, and tumor volume (log-transformed tumor volume: LOGVOL), were analyzed. Linear mixed-effects models and logistic regression analyses were performed to identify relationships between imaging features and tumor characteristics. ROC analyses were conducted to evaluate the accuracy of primary tumor origin predictions. RESULTS Of 43 imaging sessions, 14 patients (7 male, 7 female; median age 59 y) with 181 lesions met the inclusion criteria. SUVmax was significantly correlated with LOGVOL and contrast enhancement parameters (eg, WOliver). Linear mixed-effects models revealed that LOGVOL and WOliver were independent predictors of SUVmax. In the binomial regression analysis, tumor precontrast T1 intensity, T/Lart, and T/Lven were significant factors in differentiation between pancreatic and gastrointestinal (GIS) NET metastases, with pancreatic tumors demonstrating higher T/Lart and GIS tumors exhibiting higher T/Lven and T1 intensity. Logistic regression achieved an AUC of 0.911, with a sensitivity of 86% and specificity of 76%. CONCLUSION 68Ga DOTATATE PET/MRI effectively integrates metabolic and anatomical imaging for characterizing NET liver metastases. Parameters such as LOGVOL and WOliver independently predict SUVmax, while precontrast T1 intensity, T/Lart, and T/Lven assist in differentiating pancreatic from GIS NETs. These findings underscore the potential of 68Ga DOTATATE PET/MRI in personalized NET management and suggest avenues for further research to confirm these results.
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Affiliation(s)
- Cigdem Soydal
- Department of Nuclear Medicine, Ankara University Medical School, Ankara
| | - Burak Demir
- Department of Nuclear Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Şanliurfa
| | - Pinar Akkus Gunduz
- Department of Nuclear Medicine, Gülhane Training and Research Hospital, Ankara
| | | | - Mine Araz
- Department of Nuclear Medicine, Ankara University Medical School, Ankara
| | - Digdem Kuru Oz
- Department of Radiology, Ankara University Medical School, Ankara, Turkey
| | - Nuriye Ozlem Kucuk
- Department of Nuclear Medicine, Ankara University Medical School, Ankara
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Wang IE, SaTsu HA, Brooks AF, Werner RA, Rowe SP, Scott PJH, Viglianti BL. Molecular imaging of neuroendocrine tumors: Current applications and future trends. Diagn Interv Imaging 2025:S2211-5684(25)00103-2. [PMID: 40404554 DOI: 10.1016/j.diii.2025.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 04/30/2025] [Accepted: 05/15/2025] [Indexed: 05/24/2025]
Abstract
The prevalence of neuroendocrine neoplasms (NEN), which include neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC), has increasing during recent years. The approval of diagnostic single-photon emission computed tomography and positron emission tomography imaging agents for NEN is an important factor in pushing the development of additional agents using new targets to develop patient-specific, targeted, radiopharmaceuticals. Numerous NEN-specific targets exist, including somatostatin receptors, norepinephrine transport substrates, amino acid transport substrates, and glucagon-like peptide-1 receptor analogues, as well as non-specific targets, such as glucose metabolism. Additionally, there are targets that can be used in combination with current agents to further personalize NEN imaging. In well-differentiated gastroenteropancreatic NET, [68Ga]DOTATATE is the first line agent. In pheochromocytoma, paraganglioma, and neuroblastomas [131I]MIBG can also be considered for imaging. [18F]FDOPA is mainly used for midgut NETs but is second line if access to [68Ga]DOTATATE is difficult. In insulinomas, glucagon like peptide-1 receptor agents can be considered with [68Ga]DOTATATE. In medullary thyroid carcinomas, [18F]FDOPA is preferred with or without [68Ga]DOTATATE imaging. In poorly-differentiated NEN/NEC, non-specific agents such as [18F]Fluoro-2-deoxy-d-glucose and [68Ga]fibroblast activation protein inhibitor-04 can be used if somatostatin imaging is insufficient. Urokinase plasminogen activator receptor targeting has been used as a method for risk stratification and can be used in combination with [68Ga]DOTATATE. The use of somatostatin receptor antagonists, bombesin receptor 2, C-X-C motif chemokine receptor-4, and glucose-dependent insulinotropic polypeptide receptor agents are currently in development - with all of them requiring further studies to determine their potential utility. This review analyzes the current landscape of NEN imaging and discusses the emerging agents that can potentially contribute to NEN imaging in the future.
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Affiliation(s)
- Ivan E Wang
- Department of Radiology, University of Michigan, Ann Arbor MI 48109 USA
| | - Helen A SaTsu
- Department of Radiology, University of Michigan, Ann Arbor MI 48109 USA
| | - Allen F Brooks
- Department of Radiology, University of Michigan, Ann Arbor MI 48109 USA
| | - Rudolf A Werner
- Department of Nuclear Medicine, LMU University Hospital 80336 Munich, Germany
| | - Steven P Rowe
- Department of Radiology, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor MI 48109 USA
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Expert Panel on Neurological Imaging, Ivanidze J, Shih RY, Utukuri PS, Ajam AA, Auron M, Chang SM, Jordan JT, Kalnins A, Kuo PH, Ledbetter LN, Pannell JS, Pollock JM, Sheehan J, Soares BP, Soderlund KA, Wang LL, Burns J. ACR Appropriateness Criteria® Brain Tumors. J Am Coll Radiol 2025; 22:S108-S135. [PMID: 40409872 DOI: 10.1016/j.jacr.2025.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 02/24/2025] [Indexed: 05/25/2025]
Abstract
Brain tumors represent a complex and clinically diverse disease group, whose management is particularly dependent on neuroimaging given the wide range of differential diagnostic considerations and clinical scenarios. The introduction of advanced brain imaging tools into clinical practice makes it paramount for all treating physicians to recognize the range and understand the appropriate application of various conventional and advanced imaging modalities. The imaging recommendations for neuro-oncologic clinical scenarios involving screening in patients with increased genetic risk, screening in patients with systemic malignancy, pretreatment evaluation in patients with intra- and extraaxial brain tumors, posttreatment-surveillance in patients with known brain tumors after completion of therapy, and subsequent workup in the context of suspected radiographic progression are encompassed by this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Robert Y Shih
- Panel Chair, Uniformed Services University, Bethesda, Maryland
| | - Pallavi S Utukuri
- Panel Vice-Chair, Columbia University Medical Center, New York, New York
| | | | - Moises Auron
- Cleveland Clinic and Outcomes Research Consortium, Cleveland, Ohio; American College of Physicians
| | - Susan M Chang
- University of California, San Francisco, San Francisco, California; American Society of Clinical Oncology
| | - Justin T Jordan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; American Academy of Neurology
| | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | | | - Jason Sheehan
- University of Virginia, Charlottesville, Virginia; American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Bruno P Soares
- Stanford University School of Medicine, Stanford, California
| | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Liechty B, Kim S, Dobri G, Schwartz TH, Ivanidze J, Pisapia D. SSTR2 expression in neoplastic and normal anterior pituitary is impacted by age, sex, and hormonal status. J Neuropathol Exp Neurol 2025:nlaf034. [PMID: 40261909 DOI: 10.1093/jnen/nlaf034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2025] Open
Abstract
Pituitary neuroendocrine tumors (PitNETs) are among the most common tumors encountered in neurooncology. While the majority of PitNETs demonstrate indolent behavior, a subset of tumors demonstrates aggressive behavior, including invasion into surrounding structures. As traditional imaging has limited capacity to distinguish tumor from post-operative changes, better methods of tumor delineation are needed to guide management. Somatotroph adenomas are known to express high levels of SSTR2, and SSTR2-targeting PET imaging has shown clinical utility in the management of neuroendocrine tumors and meningiomas. In this retrospective study of archival PitNETs (n = 271) and autopsy controls (AC) (n = 20), we show that although significant differences in SSTR2 immunostaining are appreciable between adenoma subtypes and ACs, high-staining cases are encountered in all subtypes. In ACs, females demonstrated significantly stronger SSTR2 staining than males. Weak age-related trends towards increasing labelling in females and decreasing labelling in males were noted but these did not reach statistical significance. Decreasing age-related trends were seen in gonadotrophs in both sexes; this was statistically significant in females. Our findings suggest that SSTR2-targeting imaging modalities may assist clinical management of a subset of PitNETs and that these results may need to be interpreted with consideration of patient age and sex.
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Affiliation(s)
- Benjamin Liechty
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, NY, United States
| | - Sean Kim
- Division of Neuroradiology, Department of Radiology, Weill-Cornell Medical College, New York, NY, United States
| | - Georgiana Dobri
- Department of Neurological Surgery, Weill-Cornell Medical College, New York, NY, United States
- Department of Medicine, Weill-Cornell Medical College, New York, NY, United States
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill-Cornell Medical College, New York, NY, United States
| | - Jana Ivanidze
- Division of Neuroradiology, Department of Radiology, Weill-Cornell Medical College, New York, NY, United States
| | - David Pisapia
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, NY, United States
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Breen WG, Palmer JD, Johnson DR, Kim MM. The Role of PET/CT in Radiation Oncology for Central Nervous System Tumors. PET Clin 2025; 20:195-204. [PMID: 39915188 DOI: 10.1016/j.cpet.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2025]
Abstract
The investigation and application of PET modalities for the evaluation and treatment of patients with central nervous system (CNS) tumors continues to evolve, with anticipated increased uptake in the United States for both benign and malignant CNS tumors in the decade to come.
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Affiliation(s)
- William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Ivanidze J, Rosen K, Zgaljardic M, Lawrence JD, Forader BA, Konner M, Liechty B, Watson A, Pannullo SC, Green E, Knisely JPS, Karakatsanis NA, Nehmeh SA, Schwartz TH. Preoperative PET/MRI and radio-guided surgery using [Cu64]DOTATATE in meningioma: a feasibility study. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2025; 9:CASE24867. [PMID: 40127474 PMCID: PMC11933661 DOI: 10.3171/case24867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 01/22/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Meningiomas are the most common primary intracranial neoplasms. Gross-total resection, the primary treatment goal, is not achieved in up to 50% of patients, affecting progression-free and overall survival. The traditionally used intraoperative assessment of resection extent using the Simpson grade has recently been shown to be less accurate than postoperative MRI. Improving intraoperative resection extent delineation thus represents a paramount goal. Somatostatin receptor (SSTR)-targeted PET has improved meningioma management. [Cu64]DOTATATE is a clinically approved PET radiotracer that avidly binds to SSTR2 with properties similar to [Ga68]DOTATATE but with a significantly longer half-life of approximately 13 hours. OBSERVATIONS The authors assessed the feasibility of immediate preoperative [Cu64]DOTATATE PET/MRI and subsequent intraoperative tumor detection using a handheld gamma probe device typically used in sentinel node biopsy. They describe [Cu64]DOTATATE PET-guided surgical debulking of a meningioma and demonstrate the feasibility of intraoperative tumor detection using the gamma probe device, with activity 10 times higher than the background after exposing the tumor, decreasing by 50% after debulking. The authors further demonstrate 3-month clinical and PET/MRI outcomes, with accurate delineation of minimal residual viable tumor. LESSONS This pilot study for the first time demonstrates the feasibility of preoperative PET with in vivo radio-guided surgery in meningiomas, laying the foundation for larger-scale prospective trials. https://thejns.org/doi/10.3171/CASE24867.
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Affiliation(s)
- Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Kate Rosen
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | | | - Jesse D. Lawrence
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Beth Ann Forader
- Ambulatory Surgery, NewYork-Presbyterian Hospital, New York, New York
| | - Marcus Konner
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Benjamin Liechty
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Alexis Watson
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Susan C. Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Elizabeth Green
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | | | | | - Sadek A. Nehmeh
- Department of Radiology, Weill Cornell Medicine, New York, New York
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Albert NL, Preusser M, Traub-Weidinger T, Tolboom N, Law I, Palmer JD, Guedj E, Furtner J, Fraioli F, Huang RY, Johnson DR, Deroose CM, Herrmann K, Vogelbaum M, Chang S, Tonn JC, Weller M, Wen PY, van den Bent MJ, Verger A, Ivanidze J, Galldiks N. Joint EANM/EANO/RANO/SNMMI practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor ligands: version 1.0. Eur J Nucl Med Mol Imaging 2024; 51:3662-3679. [PMID: 38898354 PMCID: PMC11445317 DOI: 10.1007/s00259-024-06783-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To provide practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor (SSTR) ligands. METHODS This joint practice guideline/procedure standard was collaboratively developed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the PET task force of the Response Assessment in Neurooncology Working Group (PET/RANO). RESULTS Positron emission tomography (PET) using somatostatin receptor (SSTR) ligands can detect meningioma tissue with high sensitivity and specificity and may provide clinically relevant information beyond that obtained from structural magnetic resonance imaging (MRI) or computed tomography (CT) imaging alone. SSTR-directed PET imaging can be particularly useful for differential diagnosis, delineation of meningioma extent, detection of osseous involvement, and the differentiation between posttherapeutic scar tissue and tumour recurrence. Moreover, SSTR-peptide receptor radionuclide therapy (PRRT) is an emerging investigational treatment approach for meningioma. CONCLUSION These practice guidelines will define procedure standards for the application of PET imaging in patients with meningiomas and related SSTR-targeted PRRTs in routine practice and clinical trials and will help to harmonize data acquisition and interpretation across centers, facilitate comparability of studies, and to collect larger databases. The current document provides additional information to the evidence-based recommendations from the PET/RANO Working Group regarding the utilization of PET imaging in meningiomas Galldiks (Neuro Oncol. 2017;19(12):1576-87). The information provided should be considered in the context of local conditions and regulations.
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Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, LMU Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Diagnostic and Therapeutic Nuclear Medicine, Clinic Donaustadt, Vienna Health Care Group, Vienna, Austria
| | - Nelleke Tolboom
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, Netherlands
- Division Imaging & Oncology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric Guedj
- Institut Fresnel, Nuclear Medicine Department, APHM, CNRS, Timone Hospital, CERIMED, Aix Marseille Univ, Marseille, France
| | - Julia Furtner
- Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK) - University Hospital Essen, Essen, Germany
| | | | - Susan Chang
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy and IADI INSERM UMR 1254, Université de Lorraine, Nancy, France
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
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Ivanidze J, Chang SJ, Haghdel A, Kim JT, Roy Choudhury A, Wu A, Ramakrishna R, Schwartz TH, Cisse B, Stieg P, Muller L, Osborne JR, Magge RS, Karakatsanis NA, Roytman M, Lin E, Pannullo SC, Palmer JD, Knisely JPS. [Ga68] DOTATATE PET/MRI-guided radiosurgical treatment planning and response assessment in meningiomas. Neuro Oncol 2024; 26:1526-1535. [PMID: 38553990 PMCID: PMC11300004 DOI: 10.1093/neuonc/noae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Our purpose was to determine the utility of [68Ga]-DOTATATE PET/MRI in meningioma response assessment following radiosurgery. METHODS Patients with meningioma prospectively underwent postoperative DOTATATE PET/MRI. Co-registered PET and gadolinium-enhanced T1-weighted MRI were employed for radiosurgery planning. Follow-up DOTATATE PET/MRI was performed at 6-12 months post-radiosurgery. Maximum absolute standardized uptake value (SUV) and SUV ratio (SUVRSSS) referencing superior sagittal sinus (SSS) blood pool were obtained. Size change was determined by Response Assessment in Neuro-Oncology (RANO) criteria. Association of SUVRSSS change magnitude and progression-free survival (PFS) was evaluated using Cox regression. RESULTS Twenty-seven patients with 64 tumors (26% World Health Organization [WHO]-1, 41% WHO-2, 26% WHO-3, and 7% WHO-unknown) were prospectively followed post stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT; mean dose: 30 Gy, modal dose 35 Gy, mean of 5 fractions). Post-irradiation SUV and SUVRSSS decreased by 37.4% and 44.4%, respectively (P < .0001). Size product decreased by 8.9%, thus failing to reach the 25% significance threshold as determined by RANO guidelines. Mean follow-up time was 26 months (range: 6-44). Overall mean PFS was 83% and 100%/100%/54% in WHO-1/-2/-3 subcohorts, respectively, at 34 months. At maximum follow-up (42-44 months), PFS was 100%/83%/54% in WHO-1/-2/-3 subcohorts, respectively. Cox regression analyses revealed a hazard ratio of 0.48 for 10-unit reduction in SUVRSSS in the SRS cohort. CONCLUSIONS DOTATATE PET SUV and SUVRSSS demonstrated marked, significant decrease post-radiosurgery. Lesion size decrease was statistically significant; however, it was not clinically significant by RANO criteria. DOTATATE PET/MR thus represents a promising imaging biomarker for response assessment in meningiomas treated with radiosurgery. CLINICALTRIALS.GOV IDENTIFIER NCT04081701.
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Affiliation(s)
- Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Se Jung Chang
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Arsalan Haghdel
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Joon Tae Kim
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Arindam Roy Choudhury
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alan Wu
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Babacar Cisse
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Leland Muller
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Rajiv S Magge
- Brain Tumor Center, Weill Cornell Medicine, New York, New York, USA
| | | | - Michelle Roytman
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
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Nabavizadeh A, Galldiks N, Veronesi M, Lohmann P, McConathy JE, Johnson DR, Aboian MS, Barajas RF, Ivanidze J. Introducing the American Society of Neuroradiology PET-Guided Diagnosis and Management in Neuro-Oncology Study Group. AJNR Am J Neuroradiol 2024; 45:535-536. [PMID: 38548306 PMCID: PMC11288530 DOI: 10.3174/ajnr.a8243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
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10
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Perlow HK, Nalin AP, Handley D, Gokun Y, Blakaj DM, Beyer SJ, Thomas EM, Raval RR, Boulter D, Kleefisch C, Bovi J, Chen WC, Braunstein SE, Raleigh DR, Knisely JPS, Ivanidze J, Palmer JD. A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation Into Treatment Planning of Intracranial Meningiomas. Int J Radiat Oncol Biol Phys 2024; 118:979-985. [PMID: 37871886 DOI: 10.1016/j.ijrobp.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that 68Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy. METHODS AND MATERIALS A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a 68Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion. RESULTS Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation. CONCLUSIONS This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used 68Ga-DOTATATE PET-guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.
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Affiliation(s)
- Haley K Perlow
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ansel P Nalin
- Ohio State University College of Medicine, Columbus, Ohio
| | - Demond Handley
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Yevgeniya Gokun
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha J Beyer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Evan M Thomas
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raju R Raval
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Boulter
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William C Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - David R Raleigh
- Department of Radiation Oncology, University of California, San Francisco, California; Departments of Radiation Oncology, Neurological Surgery, and Pathology, University of California, San Francisco, California
| | | | - Jana Ivanidze
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio.
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11
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Rodriguez J, Martinez G, Mahase S, Roytman M, Haghdel A, Kim S, Madera G, Magge R, Pan P, Ramakrishna R, Schwartz TH, Pannullo SC, Osborne JR, Lin E, Knisely JPS, Sanelli PC, Ivanidze J. Cost-Effectiveness Analysis of 68Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma. AJNR Am J Neuroradiol 2023; 44:783-791. [PMID: 37290818 PMCID: PMC10337622 DOI: 10.3174/ajnr.a7901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/07/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium 68Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating 68Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, 68Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of 68Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma. MATERIALS AND METHODS We developed a decision-analytical model based on both recommended guidelines on meningioma management and our institutional experience. Markov models were implemented to estimate quality-adjusted life-years (QALY). Cost-effectiveness analyses with willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were performed from a societal perspective. Sensitivity analyses were conducted to validate the results. Model input values were based on published literature. RESULTS The cost-effectiveness results demonstrated that 68Ga-DOTATATE PET/MR imaging yields higher QALY (5.47 versus 5.05) at a higher cost ($404,260 versus $395,535) compared with MR imaging alone. The incremental cost-effectiveness ratio analysis determined that 68Ga-DOTATATE PET/MR imaging is cost-effective at a willingness to pay of $50,000/QALY and $100,000/QALY. Furthermore, sensitivity analyses showed that 68Ga-DOTATATE PET/MR imaging is cost-effective at $50,000/QALY ($100,000/QALY) for specificity and sensitivity values above 76% (58%) and 53% (44%), respectively. CONCLUSIONS 68Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of 68Ga-DOTATATE PET/MR imaging could be attained in clinical practice.
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Affiliation(s)
- J Rodriguez
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - G Martinez
- Siemens Healthineers (G. Martinez), Malvern, Pennsylvania
- Imaging Clinical Effectiveness and Outcomes Research Program (G. Martinez, P.C.S.), Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - S Mahase
- Department of Radiation Oncology (S.M.), Penn State Health, Mechanicsburg, Pennsylvania
| | - M Roytman
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - A Haghdel
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - S Kim
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - G Madera
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | | | - P Pan
- Department of Neurology (P.P.), Columbia University Medical Center, New York, New York
| | - R Ramakrishna
- Department of Neurological Surgery (R.R., T.H.S., S.C.P.)
| | - T H Schwartz
- Department of Neurological Surgery (R.R., T.H.S., S.C.P.)
| | - S C Pannullo
- Department of Neurological Surgery (R.R., T.H.S., S.C.P.)
- Meinig School of Biomedical Engineering (S.C.P.), Cornell University, Ithaca, New York
| | - J R Osborne
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - E Lin
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
| | - J P S Knisely
- Department of Radiation Oncology (J.P.S.K.), Weill Cornell Medicine, New York, New York
| | - P C Sanelli
- Department of Radiology (P.C.S.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Imaging Clinical Effectiveness and Outcomes Research Program (G. Martinez, P.C.S.), Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - J Ivanidze
- From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.)
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12
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Clinical Management of Supratentorial Non-Skull Base Meningiomas. Cancers (Basel) 2022; 14:cancers14235887. [PMID: 36497370 PMCID: PMC9737260 DOI: 10.3390/cancers14235887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
Supratentorial non-skull base meningiomas are the most common primary central nervous system tumor subtype. An understanding of their pathophysiology, imaging characteristics, and clinical management options will prove of substantial value to the multi-disciplinary team which may be involved in their care. Extensive review of the broad literature on the topic is conducted. Narrowing the scope to meningiomas located in the supratentorial non-skull base anatomic location highlights nuances specific to this tumor subtype. Advances in our understanding of the natural history of the disease and how findings from both molecular pathology and neuroimaging have impacted our understanding are discussed. Clinical management and the rationale underlying specific approaches including observation, surgery, radiation, and investigational systemic therapies is covered in detail. Future directions for probable advances in the near and intermediate term are reviewed.
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13
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Meißner AK, von Spreckelsen N, Al Shughri A, Brunn A, Fuertjes G, Schlamann M, Schmidt M, Dietlein M, Rueß D, Ruge MI, Galldiks N, Goldbrunner R. Case report: Use of 68Ga-DOTATATE-PET for treatment guidance in complex meningioma disease. Front Oncol 2022; 12:1017339. [PMID: 36313670 PMCID: PMC9596965 DOI: 10.3389/fonc.2022.1017339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Currently, contrast-enhanced MRI is the method of choice for treatment planning and follow-up in patients with meningioma. However, positron emission tomography (PET) imaging of somatostatin receptor subtype 2 (SSTR2) expression using 68Ga-DOTATATE may provide a higher sensitivity for meningioma detection, especially in cases with complex anatomy or in the recurrent setting. Here, we report on a patient with a multilocal recurrent atypical meningioma, in which 68Ga-DOTATATE PET was considerably helpful for treatment guidance and decision-making.
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Affiliation(s)
- Anna-Katharina Meißner
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Anna-Katharina Meißner,
| | - Niklas von Spreckelsen
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Abdulkader Al Shughri
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gina Fuertjes
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
| | - Matthias Schmidt
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Rueß
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian I. Ruge
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
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14
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Thuillier P, Bourhis D, Pavoine M, Metges JP, Le Pennec R, Schick U, Blanc-Béguin F, Hennebicq S, Salaun PY, Kerlan V, Karakatsanis NA, Abgral R. Population-based input function (PBIF) applied to dynamic whole-body 68Ga-DOTATOC-PET/CT acquisition. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 2:941848. [PMID: 39390995 PMCID: PMC11464975 DOI: 10.3389/fnume.2022.941848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/29/2022] [Indexed: 10/12/2024]
Abstract
Rational To validate a population-based input function (PBIF) model that alleviates the need for scanning since injection time in dynamic whole-body (WBdyn) PET. Methods Thirty-seven patients with suspected/known well-differentiated neuroendocrine tumors were included (GAPETNET trial NTC03576040). All WBdyn 68Ga-DOTATOC-PET/CT acquisitions were performed on a digital PET system (one heart-centered 6 min-step followed by nine WB-passes). The PBIF model was built from 20 image-derived input functions (IDIFs) obtained from a respective number of patients' WBdyn exams using an automated left-ventricle segmentation tool. All IDIF peaks were aligned to the median time-to-peak, normalized to patient weight and administrated activity, and then fitted to an exponential model function. PBIF was then applied to 17 independent patient studies by scaling it to match the respective IDIF section at 20-55 min post-injection time windows corresponding to WB-passes 3-7. The ratio of area under the curves (AUCs) of IDIFs and PBIF3-7 were compared using a Bland-Altman analysis (mean bias ± SD). The Patlak-estimated mean Ki for physiological uptake (Ki-liver and Ki-spleen) and tumor lesions (Ki-tumor) using either IDIF or PBIF were also compared. Results The mean AUC ratio (PBIF/IDIF) was 0.98 ± 0.06. The mean Ki bias between PBIF3-7 and IDIF was -2.6 ± 6.2% (confidence interval, CI: -5.8; 0.6). For Ki-spleen and Ki-tumor, low relative bias with low SD were found [4.65 ± 7.59% (CI: 0.26; 9.03) and 3.70 ± 8.29% (CI: -1.09; 8.49) respectively]. For Ki-liver analysis, relative bias and SD were slightly higher [7.43 ± 13.13% (CI: -0.15; 15.01)]. Conclusion Our study showed that the PBIF approach allows for reduction in WBdyn DOTATOC-PET/CT acquisition times with a minimum gain of 20 min.
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Affiliation(s)
- Philippe Thuillier
- Department of Endocrinology, University Hospital of Brest, Brest, France
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
| | - David Bourhis
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Mathieu Pavoine
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
| | | | - Romain Le Pennec
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Ulrike Schick
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Frédérique Blanc-Béguin
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Simon Hennebicq
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Pierre-Yves Salaun
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Véronique Kerlan
- Department of Endocrinology, University Hospital of Brest, Brest, France
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
| | - Nicolas A. Karakatsanis
- Department of Radiology, Weil Cornell Medical College of Cornell University, New York, NY, United States
| | - Ronan Abgral
- UMR 1304 Inserm GETBO, University Hospital of Brest, Brest, France
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
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15
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Evaluating diagnostic accuracy and determining optimal diagnostic thresholds of different approaches to [ 68Ga]-DOTATATE PET/MRI analysis in patients with meningioma. Sci Rep 2022; 12:9256. [PMID: 35661809 PMCID: PMC9166786 DOI: 10.1038/s41598-022-13467-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple approaches with [68Ga]-DOTATATE, a somatostatin analog PET radiotracer, have demonstrated clinical utility in evaluation of meningioma but have not been compared directly. Our purpose was to compare diagnostic performance of different approaches to quantitative brain [68Ga]-DOTATATE PET/MRI analysis in patients with suspected meningioma recurrence and to establish the optimal diagnostic threshold for each method. Patients with suspected meningioma were imaged prospectively with [68Ga]-DOTATATE brain PET/MRI. Lesions were classified as meningiomas and post-treatment change (PTC), using follow-up pathology and MRI as reference standard. Lesions were reclassified using the following methods: absolute maximum SUV threshold (SUV), SUV ratio (SUVR) to superior sagittal sinus (SSS) (SUVRsss), SUVR to the pituitary gland (SUVRpit), and SUVR to the normal brain parenchyma (SUVRnorm). Diagnostic performance of the four methods was compared using contingency tables and McNemar’s test. Previously published pre-determined thresholds were assessed where applicable. The optimal thresholds for each method were identified using Youden’s J statistics. 166 meningiomas and 41 PTC lesions were identified across 62 patients. SUV, SUVRsss, SUVRpit, and SUVRnorm of meningioma were significantly higher than those of PTC (P < 0.0001). The optimal thresholds for SUV, SUVRsss, SUVRpit, and SUVRnorm were 4.7, 3.2, 0.3, and 62.6, respectively. At the optimal thresholds, SUV had the highest specificity (97.6%) and SUVRsss had the highest sensitivity (86.1%). An ROC analysis of SUV, SUVRsss, SUVRpit, and SUVRnorm revealed AUC of 0.932, 0.910, 0.915, and 0.800, respectively (P < 0.0001). Developing a diagnostic threshold is key to wider clinical translation of [68Ga]-DOTATATE PET/MRI in meningioma evaluation. We found that the SUVRsss method may have the most robust combination of sensitivity and specificity in the diagnosis of meningioma in the post-treatment setting, with the optimal threshold of 3.2. Future studies validating our findings in different patient populations are needed to continue optimizing the diagnostic performance of [68Ga]-DOTATATE PET/MRI in meningioma patients. Trial registration: ClinicalTrials.gov Identifier: NCT04081701. Registered 9 September 2019. https://clinicaltrials.gov/ct2/show/NCT04081701.
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