Case Studies: Meningioma

Meningiomas have a high density of somatostatin tracer receptor expression and hence accumulate DOTATATE. Positron imaging with radiolabelled synthetic somatostatin receptor analogues such as Ga-68 DOTATATE is an established modality for diagnosis and target volume delineation of intracranial meningiomas prior to any surgical intervention or radiotherapy planning. In the following cases, additional meningiomatous foci were identified on DOTATATE PET/MRI thus having a significant overall impact on treatment planning and further management.

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Case 1: Meningioma – Ga-68 DOTATATE PET/MRI

Case History:

A 49-year old female with suspected meningioma. Ga-68 DOTATATE PET/MRI was done for further assessment.

Findings:

Coronal T1W (A) and Coronal PET/MR fused image (B) reveals a solitary DOTATATE positive enhancing extra-axial mass lesion in relation to the left cavernous sinus.

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Case 2: Meningioma – Ga-68 DOTATATE PET/MRI

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Case History:

Clinical Profile: A 46-year old female with suspected meningioma. Ga-68 DOTATATE PET/MRI was done for further assessment.

Findings:

Axial T1W (A) and Axial PET/MRI fused image (B) reveals a solitary DOTATATE positive enhancing extra axial dural based mass lesion in relation to the falx: Falx meningioma.

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Case 3: Meningioma – Ga-68 DOTATATE PET/MRI

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Case History:

A 24-year old male, Operated case of left parietal meningioma. Ga-68 DOTATATE PET MRI was done for further assessment

Findings:

Sagittal PET/MR fused (A), T1W (B) images reveal post-op changes and DOTATATE positive residual meningioma along the post-op cavity margins.

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Case 4: Meningioma – Ga-68 DOTATATE PET/MRI

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Case History:

A 53-year old female operated for olfactory meningioma.Ga-68 DOTATATE PET/MRI was done for further assessment.

Findings:

PET/MR fused axial images (A, B, C) at different levels reveal multiple DOTATATE positive bilateral residual predominantly extra-axial enhancing dural based lesions in the left parietal region, left posterior parietal parasagittal region, bilateral temporal regions, left petrous and left CP angle cistern region. In addition, diffuse nodular dural thickening is seen throughout the dural lining with mild diffuse SSR tracer uptake

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Case 5: Meningioma – Ga-68 DOTATATE PET/MRI

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Case History:

A 50-year old female operated in 2010.Ga-68 DOTATATE PET/MR was done.

Findings:

PET/MR fused coronal image (A)and Coronal T1W (B) reveals a DOTATATE avid enhancing left high parietal parasagittal meningioma abutting the superior sagittal sinus.

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Case 6: Meningioma – Ga-68 DOTATATE PET/MRI

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Case History:

A 58-year old female operated for meningioma in 2001. Ga-68 DOTATATE PET/MRI was done for suspected recurrence.

Findings:

Coronal post-contrast T1W (A) and PET MR fused coronal image (B) reveal a DOTATATE positive enhancing dural based lesion at the previously operated site: recurrent meningioma. Axial post-contrast T1 ( C), PET MR fused image axial (D) and coronal (E) reveal another discrete subcentimeter size focal enhancing lesion with Ga 68 DOTATATE uptake in the left suprasellar region.

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Key message:

1. Positron imaging with radiolabelled synthetic somatostatin receptor analogues such as Ga-68 DOTATATE is an established modality for diagnosis and target volume delineation of intracranial meningiomas prior to any surgical intervention or radiotherapy planning.

3. Simultaneous PET/MRI brings the potentiality of MR and PET together in a single study and likely to impact management further.

2. The case studies described above demonstrate the Ga-68 DOTATATE positivity of meningiomas. Additional foci were

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Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).

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Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.

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