Abstract
To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5–1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5–1.0 and 1.0–2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.
Highlights
Abbreviations PET Positron emission tomography magnetic resonance imaging (MRI) Magnetic resonance imaging DOTATOC DOTA-D Phe1-Tyr3-octreotide Ga/Ge Gallium/germanium peptide receptor radionuclide therapy (PRRT) Peptide receptor radionuclide therapy ultrashort echo time sequence (UTE) Ultra-short echo time TSE fs Turbo spin echo-weighted with fat saturation T1 FL2D T1-weighted Flash 2-dimensional SWI Susceptibility-weighted imaging DWI Diffusion-weighted imaging
Meningiomas can be identified on standard brain MRI, as they appear with isointensity to slight hypointensity on T1 and isointensity to slight hyperintensity on T2 images relative to grey matter[10]
The aim of our study was to evaluate the diagnostic performance of standard MRI imaging in comparison to hybrid imaging with positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas
Summary
Abbreviations PET Positron emission tomography MRI Magnetic resonance imaging DOTATOC DOTA-D Phe1-Tyr3-octreotide Ga/Ge Gallium/germanium PRRT Peptide receptor radionuclide therapy UTE Ultra-short echo time TSE fs Turbo spin echo-weighted with fat saturation T1 FL2D T1-weighted Flash 2-dimensional SWI Susceptibility-weighted imaging DWI Diffusion-weighted imaging. Besides and additional to neurosurgical resection, other therapy strategies such as radiotherapy (radiosurgery and external fractionated radiotherapy)[5] or peptide receptor radionuclide therapy (PRRT) exist. Meningiomas can be identified on standard brain MRI, as they appear with isointensity to slight hypointensity on T1 and isointensity to slight hyperintensity on T2 images relative to grey matter[10]. Additional features such as homogenous contrast medium uptake or typical MR-signs (dural tail sign, broad-based dural attachment, displacement of grey matter, displaced subarachnoidal space, calcifications or CSF leakage) are helpful for a reliable diagnosis[11]. Differentiation between viable tumor from scar tissue or post-therapeutic changes by MRI alone- after radiotherapy can be challenging
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