Intra-Subject Heterogeneity of Lesion SUV on [68GA]Dotatate PET/MRI in Patients with Multiple Meningiomas: Implications for Tumor Biology and Clinical Management

Abstract

Purpose: Meningiomas are the most common primary intracranial neoplasms. While MRI remains the gold standard for the evaluation of meningiomas, it has significant limitations, including limited sensitivity and specificity for infiltrative or “en plaque” lesions, presence of osseous or parenchymal invasion, and in the context of postsurgical and postradiation change.1 Meningiomas overexpress SSTR2. [68Ga]DOTATATE is a PET radiotracer that binds to somatostatin receptor 2 (SSTR2) with high affinity.2,3 [68Ga]DOTATATE PET/CT and PET/MR have previously demonstrated substantial clinical benefit compared with MRI-alone.4–7 Previous [68Ga]DOTATATE PET/CT and PET/MR studies in patients with meningiomas have demonstrated no significant between WHO grade and standardized uptake value (SUV) or SUV ratio of lesion relative to superior sagittal sinus SUV, respectively.3,5 Furthermore, prior [68Ga]DOTATATE PET/CT and PET/MR studies in patients with meningiomas focused primarily on inter-subject variability and range of SUV,8 with the assumption that all lesions within the same subject exhibit similar behavior. It is common for patients to present with multiple meningiomas; patients also develop new lesions posttreatment, both in the resection/radiation bed as well as at discontiguous disease sites. The degree of intra-subject heterogeneity with respect to [68Ga]DOTATATE PET SUV is unknown. The purpose of our study was to assess the intra-subject heterogeneity of lesion SUV in patients with >5 meningiomas and evaluate the effect of WHO Grade on meningioma SUV and SUVR.