Article

Positron emission tomography imaging of meningioma in clinical practice: review of literature and future directions.

Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany.
Neurosurgery (Impact Factor: 2.53). 04/2012; 70(4):1033-41; discussion 1042. DOI: 10.1227/NEU.0b013e31823bcd87
Source: PubMed

ABSTRACT Meningiomas represent about 20% of intracranial tumors and are the most frequent nonglial primary brain tumors. Diagnosis is based on computed tomography (CT) and magnetic resonance imaging (MRI). Mainstays of therapy are surgery and radiotherapy. Adjuvant chemotherapy is tested in clinical trials of phase II. Patients are followed clinically by imaging. However, classical imaging modalities such as CT and MRI have limitations. Hence, we need supplementary imaging tools. Molecular imaging modalities, especially positron emission tomography (PET), represent promising new instruments that are able to characterize specific metabolic features. So far, these modalities have only been part of limited study protocols, and their impact on clinical routine management is still under investigation. It may be expected that their extended use will provide new aspects about meningioma imaging and biology. In the present article, we summarize PET imaging for meningiomas based on a thorough review of the literature. We discuss and illustrate the potential role of PET imaging in the clinical management of meningiomas. Finally, we indicate current limitations and outline directions for future research.

0 Bookmarks
 · 
150 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Imaging with positron emission tomography (PET) and (68)Ga-DOTA peptides is a promising method in intracranial meningiomas. Especially in recurrent meningioma discrimination between scar tissue and recurrent tumor tissue in magnetic resonance imaging (MRI) is often difficult. We report the first case of (68)Ga-DOTATATE-PET/computed tomography (PET/CT) imaging in recurrent spinal meningioma. A 64-year-old Caucasian female patient was referred to our department with the second recurrence of thoracic meningothelial meningioma. In MRI, it remained unclear if the multiple enhancements seen represented scar tissue or vital tumor. We offered (68)Ga-DOTATATE-PET/CT imaging in order to evaluate the best strategy. (68)Ga-DOTATATE-PET/CT imaging revealed strong tracer uptake in parts of the lesions. The pattern did distinctly differ from MRI enhancement. Multiple biopsies were performed in the PET-positive and PET-negative regions. Histological results confirmed the prediction of (68)Ga-DOTATATE-PET with vital tumor in PET-positive regions and scar tissue in PET-negative regions. Differentiating scar tissue from tumor can be challenging in recurrent spinal meningioma with MRI alone. In the presented case, (68)Ga-DOTATATE-PET imaging was able to differentiate noninvasively between tumor and scar.
    Journal of craniovertebral junction and spine 01/2014; 5(1):44-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Magnetresonanztomographie (MRT) ist die Methode der Wahl zur Diagnosestellung von Keilbeinflügelmeningeomen. Die enge Lagebeziehung insbesondere an der Schädelbasis zu Gefäß- und nervalen Strukturen lassen sich mit der MRT am besten beurteilen. Bei typischer Konfiguration und Ausdehnung kann die Diagnose eines Meningeoms prima vista gestellt werden. Auch für die Verlaufskontrollen von therapierten und asymptomatischen Meningeomen ist die MRT das bildgebende Standardverfahren. In der präoperativen Abklärung ist die Computertomographie (CT) ein komplementäres Untersuchungsverfahren, das die Ausdehnung und Art der Knochenbeteiligung präziser darstellen kann. Auch ist diese zusätzliche Information zur Abgrenzung von Differenzialdiagnosen wie Metastasen, Sarkom und primären Knochenveränderungen wie der fibrösen Dysplasie oder Morbus Paget nötig. Die PET-CT und neu auch die PET-MRT sind ergänzende Untersuchungsverfahren u. a. zur Tumorvolumenplanung vor einer geplanten Strahlentherapie und aufgrund der selektiven Bindung der Meningeome an den Tracer DOTATOC hilfreich bei der Diagnosestellung von atypischen Meningeomen. Die konventionelle Angiographie hingegen kommt nur noch in Ausnahmefällen präoperativ zum Einsatz.
    Der Ophthalmologe 05/2013; 110(5). · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Metabolic imaging technologies such as 5-aminolevulinic acid (ALA) fluorescence-guided resection and positron-emission tomography (PET) imaging have improved glioma surgery within the last decade. At present, these tools are not routinely used in meningioma surgery. Objective We present a case of a complex-shaped, recurrent skull base meningioma where 5-ALA fluorescence-guidance and (18)F-fluoroethyltyrosine (FET)-PET-imaging facilitated surgical resection. Material and Methods The patient underwent surgery via a combined transcranial/transnasal endoscopic approach. What was original is that both the microscope and the endoscope were equipped for 5-ALA fluorescence-guided surgery, respectively. Furthermore, preoperative FET-PET imaging was fused with computed tomography (CT) and magnetic resonance imaging (MRI) data for intraoperative navigation. The case richly illustrated the performance of the different modalities. Conclusions Metabolic imaging tools such as 5-ALA fluorescence-guided resection and navigated FET-PET were helpful for the resection of this complex-shaped, recurrent skull base meningioma. 5-ALA fluorescence was useful to dissect the adherent interface between tumor and brain. Furthermore, it helped to delineate tumor margins in the nasal cavity. FET-PET improved the assessment of bony and dural infiltration. We hypothesize that these imaging technologies may reduce recurrence rates through better visualization of tumor tissue that might be left unintentionally. This has to be verified in larger, prospective trials.
    Journal of neurological surgery. Part B, Skull base. 08/2013; 74(4):211-6.