Intraindividual comparison of selective intraarterial
                    versus systemic intravenous 68Ga-DOTATATE PET/CT in patients with
                    inoperable meningioma

Abstract Aim Here we describe the results of superselective intraarterial application of diagnostic Ga-68-DOTA0,Tyr3-octreotate (Ga-68-DOTATATE) in a series of patients with inoperable WHO grade II meningiomas which were no longer amenable to radiotherapy. Methods Four patients with inoperable WHO grade II meningioma underwent systemic venous infusion of Ga-68-DOTATATE followed by PET/CT. Ga-68-DOTATATE application was repeated intraarterially via transfemoral catheterization of vessels supplying the meningioma and another PET/CT was performed. Results Selective arterial infusion of Ga-68-DOTATATE increased the median value for the maximum standardized uptake value (SUV) by 2.6-fold (median venous: 7.1, median arterial: 21.6; range 2.0–5.0) and the median value for mean SUV by 2.7-fold (median venous: 4.3, median arterial: 11.2; range 1.6–5.6) compared to systemic intravenous infusion. Arterial application was well tolerated by all patients without complications. When compared to liver uptake, intravenous tracer uptake was insufficient for PRRT, whereas tracer uptake after superselective intraarterial tracer injection was sufficient to allow for peptide receptor radionuclide therapy (PRRT) in all patients. Conclusion Insufficient tracer uptake in meningiomas after intravenous application of Ga-68-DOTATATE may be safely increased by a factor of 2–5 using transfemoral selective intraarterial tracer application.

Download Full-text

Photopenic defects on O-(2-[18F]-fluoroethyl)-L-tyrosine PET: clinical relevance in glioma patients

Neuro-Oncology ◽

10.1093/neuonc/noz083 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1331-1338 ◽

Cited By ~ 10

Author(s):

Norbert Galldiks ◽

Marcus Unterrainer ◽

Natalie Judov ◽

Gabriele Stoffels ◽

Marion Rapp ◽

...

Keyword(s):

Standardized Uptake Value ◽

Progression Free Survival ◽

Tracer Uptake ◽

World Health ◽

Diffuse Astrocytoma ◽

Who Grade ◽

Fet Pet ◽

Fluid Attenuated Inversion Recovery ◽

Grade Ii ◽

Health Organization

Abstract Background O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET has a sensitivity of more than 90% to detect gliomas. In the remaining small fraction of gliomas without increased tracer uptake, some tumors even show photopenic defects whose clinical significance is unclear. Methods Glioma patients with a negative FET PET scan prior to neuropathological confirmation were identified retrospectively. Gliomas were rated visually as (i) having indifferent FET uptake or (ii) photopenic, if FET uptake was below background activity. FET uptake in the area of signal hyperintensity on the T2/fluid attenuated inversion recovery–weighted MRI was evaluated by mean standardized uptake value (SUV) and mean tumor-to-brain ratio (TBR). The progression-free survival (PFS) of photopenic gliomas was compared with that of gliomas with indifferent FET uptake. Results Of 100 FET-negative gliomas, 40 cases with photopenic defects were identified. Fifteen of these 40 cases (38%) had World Health Organization (WHO) grades III and IV gliomas. FET uptake in photopenic gliomas was significantly decreased compared with both the healthy-appearing brain tissue (SUV, 0.89 ± 0.26 vs 1.08 ± 0.23; P < 0.001) and gliomas with indifferent FET uptake (TBR, 0.82 ± 0.09 vs 0.96 ± 0.13; P < 0.001). Irrespective of the applied treatment, isocitrate dehydrogenase (IDH)–mutated WHO grade II diffuse astrocytoma patients with indifferent FET uptake (n = 25) had a significantly longer PFS than patients with IDH-mutated diffuse astrocytomas (WHO grade II) with photopenic defects (n = 11) (51 vs 24 mo; P = 0.027). The multivariate survival analysis indicated that photopenic defects predict an unfavorable PFS (P = 0.009). Conclusion Photopenic gliomas in negative FET PET scans should be managed more actively, as they seem to have a higher risk of harboring a higher-grade glioma and an unfavorable outcome.

Download Full-text

The Dependence of Renal 68Ga[Ga]-DOTATOC Uptake on Kidney Function and Its Relevance for Peptide Receptor Radionuclide Therapy with 177Lu[Lu]-DOTATOC

Diagnostics ◽

10.3390/diagnostics11071216 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1216

Author(s):

Falk Gühne ◽

Alexander Heinzig ◽

Philipp Seifert ◽

Robert Drescher ◽

Martin Freesmeyer

Keyword(s):

Kidney Function ◽

Specific Binding ◽

Correlation Coefficients ◽

Inverse Correlation ◽

Peptide Receptor Radionuclide Therapy ◽

Tracer Uptake ◽

Significant Inverse Correlation ◽

Peptide Receptor ◽

Pet Ct ◽

Induced Changes

Background: In addition to its SSTR-specific binding in tumors and healthy tissues, DOTATOC analogues accumulate in kidney parenchyma. Renal tracer uptake might be a surrogate of kidney function or dysfunction. This study aimed to evaluate if kidney function can be estimated from 68Ga[Ga]-DOTATOC uptake in PET/CT and its impact on the nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT. Methods: Two cohorts of patients (A: 128 diagnostic patients; B: 32 PRRT patients) were evaluated retrospectively. SUV values of the kidneys, physiologically SSTR-expressing organs and in background compartments were assessed. Kidney function was calculated as eGFR by CKD-EPI creatinine equation. Pearson’s correlation coefficients and treatment-induced changes of uptake and kidney function were assessed and compared. Results: Kidney function and renal DOTATOC uptake showed a significant inverse correlation (R2 = 0.037; p = 0.029). Evaluated models of PET/CT measurements were not able to predict kidney function sufficiently. The uptake of other organs did not depend on eGFR. While the renal uptake increased after PRRT (p < 0.001), the kidney function did not change significantly (p = 0.382). Neither low pre-therapeutic eGFR nor high pre-therapeutic kidney uptake were risk factors of PRRT-induced deterioration in kidney function. Conclusion: The relevance of kidney function for renal 68Ga[Ga]-DOTATOC uptake is limited. The nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT might be low and cannot be reliably predicted by pre-therapeutic measurements.

Download Full-text

Predicting meningioma recurrence using spectrochemical analysis of tissues and subsequent predictive computational algorithms

Neuro-Oncology ◽

10.1093/neuonc/noz167.020 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv5-iv5

Author(s):

Taha Lilo ◽

Camilo Morais ◽

Kate Ashton ◽

Ana Pardilho ◽

Timothy Dawson ◽

...

Keyword(s):

Feature Extraction ◽

Tissue Bank ◽

Spectrochemical Analysis ◽

Classification Algorithms ◽

Computational Algorithms ◽

Who Grade ◽

Grade Ii ◽

Meningioma Recurrence ◽

Who Grade Ii Meningioma

Abstract Introduction Meningioma recurrence remains a clinical dilemma. This has a significant clinical and huge financial implication. Hence, the search for predictors for meningioma recurrence has become an increasingly urgent research topic in recent years. Objective Using spectrochemical analytical methods such as attenuated total reflection Fourier-transform infrared (ATR-FTIR) and Raman spectroscopy, our primary objective is to compare the spectral fingerprint signature of WHO grade I meningioma vs. WHO grade I meningioma that recurred. Secondary objectives compare WHO grade I meningioma vs. WHO grade II meningioma and WHO grade II meningioma vs. WHO grade I meningioma recurrence. Materials and Methods Our selection criteria included convexity meningioma only restricted to Simpson grade I & II only and WHO grade I & grade II only with a minimum 5 years follow up. We obtained tissue from tumour blocks retrieved from the tissue bank. These were sectioned onto slides and de-waxed prior to ATR-FTIR or Raman spectrochemical analysis. Derived spectral datasets were then explored for discriminating features using computational algorithms in the IRootLab toolbox within MATLAB; this allowed for classification and feature extraction. Results After analysing the data using various classification algorithms with cross-validation to avoid over-fitting of the spectral data, we can readily and blindly segregate those meningioma samples that recurred from those that did not recur in the follow-up timeframe. The forward feature extraction classification algorithms generated results that exhibited excellent sensitivity and specificity, especially with spectra obtained following ATR-FTIR spectroscopy. Our secondary objectives remain to be fully developed.

Download Full-text

Prognostic Value of Ki-67 Labeling Index and Postoperative Radiotherapy in WHO Grade II Meningioma

American Journal of Clinical Oncology ◽

10.1097/coc.0000000000000224 ◽

2015 ◽

pp. 1

Author(s):

Yunseon Choi ◽

Do Hoon Lim ◽

Jeong Il Yu ◽

Kyungil Jo ◽

Do-Hyun Nam ◽

...

Keyword(s):

Prognostic Value ◽

Postoperative Radiotherapy ◽

Labeling Index ◽

Ki 67 ◽

Who Grade ◽

Grade Ii ◽

Who Grade Ii Meningioma

Download Full-text

Preferential Tumor Localization in Relation to 18F-FDOPA Uptake for Lower-Grade Gliomas

10.21203/rs.3.rs-186583/v1 ◽

2021 ◽

Author(s):

Hiroyuki Tatekawa ◽

Hiroyuki Uetani ◽

Akifumi Hagiwara ◽

Jingwen Yao ◽

Talia C. Oughourlian ◽

...

Keyword(s):

Frontal Lobe ◽

Standardized Uptake Value ◽

Tumor Segmentation ◽

Tumor Localization ◽

Lower Grade ◽

Wild Type ◽

Who Grade ◽

Positron Emission ◽

Grade Ii ◽

Differential Involvement

Abstract PurposeAlthough tumor localization and 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (FDOPA) uptake may have an association, preferential tumor localization in relation to FDOPA uptake is yet to be investigated in lower-grade gliomas (LGGs). This study aimed to identify differences in the frequency of tumor localization between FDOPA hypometabolic and hypermetabolic LGGs using a probabilistic radiographic atlas.MethodsFifty-one patients with newly diagnosed LGG (WHO grade II, 29; III, 22; isocitrate dehydrogenase wild-type, 21; mutant 1p19q non-codeleted ,16; mutant codeleted, 14) who underwent FDOPA positron emission tomography (PET) were retrospectively selected. Semiautomated tumor segmentation on FLAIR was performed. Patients with LGGs were separated into two groups (FDOPA hypometabolic and hypermetabolic LGGs) according to the normalized maximum standardized uptake value of FDOPA PET (a threshold of the uptake in the striatum) within the segmented regions. Spatial normalization procedures to build a 3D MRI-based atlas using each segmented region were validated by an analysis of differential involvement statistical mapping.ResultsSuperimposition of regions of interest showed a high number of hypometabolic LGGs localized in the frontal lobe, while a high number of hypermetabolic LGGs was localized in the insula, putamen, and temporal lobe. The statistical mapping revealed that hypometabolic LGGs occurred more frequently in the superior frontal gyrus (close to the supplementary motor area), while hypermetabolic LGGs occurred more frequently in the insula. ConclusionRadiographic atlases revealed preferential frontal lobe localization for FDOPA hypometabolic LGGs, which may be associated with relatively early detection.

Download Full-text

Overall Survival Benefit Associated with Adjuvant Radiotherapy in Who Grade II Meningioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1600557 ◽

2017 ◽

Vol 78 (S 01) ◽

pp. S1-S156

Author(s):

Chenyang Wang ◽

Tania Kaprealian ◽

John Suh ◽

Charlotte Kubicky ◽

Jeremy Ciporen ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Radiotherapy ◽

Survival Benefit ◽

Who Grade ◽

Grade Ii ◽

Overall Survival Benefit ◽

Who Grade Ii Meningioma

Download Full-text

Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report

Neurosurgical FOCUS ◽

10.3171/2019.3.focus1948 ◽

2019 ◽

Vol 46 (6) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Jason J. Labuschagne ◽

Dinoshan Chetty

Keyword(s):

Glioblastoma Multiforme ◽

Stereotactic Radiosurgery ◽

Single Case ◽

Case Reports ◽

Rare Complication ◽

Secondary Malignancy ◽

Surgical Removal ◽

Who Grade ◽

Grade Ii ◽

Who Grade Ii Meningioma

The documentation and exact incidence of stereotactic radiosurgery (SRS)–induced neoplasia is not well understood, with most literature restricted to single case reports and single-center retrospective reviews. The authors present a rare case of radiosurgery-induced glioblastoma multiforme (GBM) following radiosurgical treatment of a meningioma. A 74-year-old patient with a sporadic meningioma underwent radiosurgery following surgical removal of a WHO grade II meningioma. Eighteen months later she presented with seizures, and MRI revealed an intraaxial tumor, which was resected and proven to be a glioblastoma. As far as the authors are aware, this case represents the third case of GBM following SRS for a meningioma. This report serves to increase the awareness of this possible complication following SRS. The possibility of this rare complication should be explained to patients when obtaining their consent for radiosurgery.

Download Full-text