UpToDate: Positron emission tomography for intracranial meningioma

Positron emission tomography for intracranial meningioma

MET PET/CT showed a high sensitivity compared with FDG PET/CT for detection of newly diagnosed WHO grades I and II intracranial meningiomas. Both FDG and MET uptake were found to be useful for evaluating tumor proliferation in meningiomas 1).

Although positron emission tomography has not been routinely used in the diagnostic workup and follow-up of patients with meningiomas, it can be useful in cases of skull base meningiomas that are frequently difficult to visualize by using standard CT and MR imaging techniques 2).

Primary intracranial meningioma is typically reported as having low FDG uptake, because glucose metabolism in meningioma is similar to that of surrounding tissue 3).

There have been a few isolated reports describing the imaging features of metastatic meningioma on FDG-PET imaging. Ghodsian et al., described a moderately hypermetabolic sacral metastatic mass by FDG-PET/CT. This was a Grade III malignant meningioma on histology 4).

Meirelles et al., described a pulmonary meningioma that manifested as a solitary pulmonary nodule and had very high metabolic activity on PET scan. The current case also showed avid uptake of FDG; the SUV was >7 in each pulmonary lesion. The uptake was more avid in the periphery and slightly less in the centre of both lesions, corresponding to the central areas of low density on CT. It was useful to note that there were no other foci of abnormal FDG uptake elsewhere to suggest other metastases. It is reassuring to note that 10 months after the PET/CT with clinical follow-up, the patient remains asymptomatic with no evidence of local or distant spread. The diagnosis of pulmonary metastatic meningioma was confirmed histologically by CT-guided percutaneous biopsy, which has been previously reported 5).


In 2007, Rutten et al., described the combination of CT and MRI as limited in the diagnosis of local skull involvement from adjacent intracranial meningioma. In their study, the authors demonstrated that skull base tumors could be clearly visualised with 18Ftyrosine PET, even after radiation therapy 6) 7).

Meningiomas are also known to have high somatostatin receptor density allowing for the potential use of octreotide brain scintigraphy to help delineate extent of disease. This may be particularly useful in distinguishing residual tumor from postoperative scarring in subtotally resected/recurrent tumors 8).

References

1)

Mitamura K, Yamamoto Y, Norikane T, Hatakeyama T, Okada M, Nishiyama Y. Correlation of (18)F-FDG and (11)C-methionine uptake on PET/CT with Ki-67 immunohistochemistry in newly diagnosed intracranial meningiomas. Ann Nucl Med. 2018 Jul 21. doi: 10.1007/s12149-018-1284-6. [Epub ahead of print] PubMed PMID: 30032455.

2)

Rockhill J, Mrugala M, Chamberlain MC. Intracranial meningiomas: an overview of diagnosis and treatment. Neurosurg Focus. 2007;23(4):E1. Review. PubMed PMID: 17961033.

3)

Kaminski JM, Movsas B, King E, Yang C, Kronz JD, Alli PM, et al. Metastatic meningioma to the lung with multiple pleural metastases. Am J Clin Oncol 2001;24:579–82

4)

Ghodsian M, Obrzut SL, Hyde CC, Watts WJ, Schiepers C. Evaluation of metastatic meningioma with 2-deoxy-2-[18F] fluoro-d-glucose PET/CT. Clin Nucl Med 2005;30:717–20

5)

Brennan C, O’Connor OJ, O’Regan KN, Keohane C, Dineen J, Hinchion J, Sweeney B, Maher MM. Metastatic meningioma: positron emission tomography CT imaging findings. Br J Radiol. 2010 Dec;83(996):e259-62. doi: 10.1259/bjr/11276652. PubMed PMID: 21088084; PubMed Central PMCID: PMC3473618.

6)

Rutten I, Cabay JE, Withofs N, Lemaire C, Aerts J, Baart V, et al.: PET/CT of skull base meningiomas using 2–18F-fluoro-L-tyro-sine: initial report. J Nucl Med 48:720–5, 2007

7)

Conti PS, Cham DK, editors. Singapore: Springer; 2005. PET/CT: a case based approach book.

8)

Klutmann S, Bohuslavizki KH, Brenner W, Behnke A, Tietje N, Kröger S, et al.: Somatostatin receptor scintigraphy in postsurgical follow-up examinations of meningioma. J Nucl Med 39:1913–1917, 1998

Update: Asymptomatic Meningioma

Asymptomatic Meningioma

Asymptomatic intracranial meningioma is a benign disease; however, nearly two-thirds of patients experience tumor growth and one-third of untreated patients eventually require neurosurgical interventions during watchful waiting 1).

In the series of Jadid et al., long-term tumour growth of incidentally detected asymptomatic meningiomas appeared to be much higher than expected. This information needs to be considered when discussing surgery, since the indication for surgery may be stronger than previously stated, especially for younger patients with tumours that can be reached at low risk 2).

Niiro et al., stated that in elderly patients with asymptomatic meningiomas, careful clinical follow up with imaging studies is important. The imaging features mentioned in his article may contribute to prediction of tumour growth 3).

For Yoneoka et al., clinical and radiological observations would be advisable for these patients (especially young patients and patients with a large tumour), in view of the presence of rapidly growing tumours in some of the patients 4).

Hashimoto et al., observed that Skull base incidental meningiomas (IDM) tend not to grow, which is different from non-skull base tumors. Even when IDMs grow, the rate of growth is significantly lower than that of non-skull base tumors. The same conclusion with regard to biological behavior was confirmed in symptomatic cases based on MIB-1 index analyses. This findings may impact the understanding of the incidental intracranial meningioma natural history, as well as strategies for management and treatment of IDMs and symptomatic meningiomas 5).

Asymptomatic meningioma treatment

Asymptomatic meningioma case series

References

1)

Kim KH, Kang SJ, Choi JW, Kong DS, Seol HJ, Nam DH, Lee JI. Clinical and radiological outcomes of proactive Gamma Knife surgery for asymptomatic meningiomas compared with the natural course without intervention. J Neurosurg. 2018 May 18:1-10. doi: 10.3171/2017.12.JNS171943. [Epub ahead of print] PubMed PMID: 29775154.

2)

Jadid KD, Feychting M, Höijer J, Hylin S, Kihlström L, Mathiesen T. Long-term follow-up of incidentally discovered meningiomas. Acta Neurochir (Wien). 2015 Feb;157(2):225-30. doi: 10.1007/s00701-014-2306-3. Epub 2014 Dec 14. PubMed PMID: 25503298.

3)

Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J. Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):25-8. PubMed PMID: 10601396; PubMed Central PMCID: PMC1760589.

4)

Yoneoka Y, Fujii Y, Tanaka R. Growth of incidental meningiomas. Acta Neurochir (Wien). 2000;142(5):507-11. PubMed PMID: 10898357.

5)

Hashimoto N, Rabo CS, Okita Y, Kinoshita M, Kagawa N, Fujimoto Y, Morii E, Kishima H, Maruno M, Kato A, Yoshimine T. Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies. J Neurosurg. 2012 Mar;116(3):574-80. doi: 10.3171/2011.11.JNS11999. Epub 2011 Dec 16. PubMed PMID: 22175721.
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