Current status of SSR-directed imaging and therapy in meningioma

Background Meningiomas are the most common tumours of the central nervous system in adults. In clinical routine, their diagnostic workup prior to subsequent therapies such as resection and radiotherapy usually consists of contrast-enhanced MRI and CT of the brain. However, there are several diagnost...

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Bibliographic Details
Published in:Clinical and translational imaging : reviews in nuclear medicine and molecular imaging 2019-06, Vol.7 (3), p.171-180
Main Authors: Unterrainer, M., Niyazi, M., Tonn, J. C., Ilhan, H., Bartenstein, P., Albert, N. L.
Format: Article
Language:English
Subjects:
Brain
Central nervous system
Computed tomography
Diagnosis
Diagnostic Radiology
Diagnostic systems
Emitters
Expert Review
Imaging
Interventional Radiology
Magnetic resonance imaging
Medical and Radiation Physics
Medical imaging
Medicine
Medicine & Public Health
Neuroimaging
Nuclear Medicine
Positron emission
Radiation therapy
Radiology
Radiotherapy
Refractory materials
Tomography
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Summary:Background Meningiomas are the most common tumours of the central nervous system in adults. In clinical routine, their diagnostic workup prior to subsequent therapies such as resection and radiotherapy usually consists of contrast-enhanced MRI and CT of the brain. However, there are several diagnostic uncertainties in the clinical workup, which standard morphological imaging fails to resolve. Molecular imaging has an emerging role for the diagnosis of meningiomas, which characteristically show high expression of the somatostatin receptor subtype 2 (SSR). PET imaging with selective ligands can visualize and quantify this expression against low background signal in healthy brain. Moreover, SSR-directed radioligands labeled with beta-emitters can be effective for radiopeptide therapy (RPT) in patients with recurrent or refractory meningioma. Methods A literature search on the PubMed literature database was conducted using the terms “meningioma”, “PET”, “somatostatin receptor”, “SS(T)R”, “DOTATATE”, “DOTATOC”, “Radiopeptide therapy”, “imaging”, “therapy” alone and in combination, extending until February 2019. The search results were augmented by the authors’ own literature files. Results We summarize the current state of SSR-directed imaging in patients with meningioma regarding the distinct clinical applications for initial diagnosis, differential diagnosis, surgery and radiotherapy planning. Our review also summarizes SSR imaging for the differentiation of recurrent meningioma tissue from post-therapeutic changes within the individual follow-up. Moreover, we discuss the clinical value and place of SSR-directed RPT in patients with refractory or recurrent meningioma. Conclusion Molecular imaging with SSR-directed radioligands contributes to the diagnostic work-up of meningioma patients by providing information that is absent from structural MR or CT imaging. Targeted SSR RPT offers well-tolerated treatment options in patients with refractory or recurrent meningioma.
ISSN:2281-5872
2281-7565
DOI:10.1007/s40336-019-00331-6