The role of 111indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas
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Meningiomas are common brain tumors with somatostatin receptors that bind octreotide. We report the use of 111indium-octreotide brain scintigraphy (OBS) for the non-invasive differentiation of meningiomas from other cranial dural-based pathology.
A retrospective analysis of our experience with OBS for non-invasive identification of meningiomas was performed. Two neuroradiologists, blinded to clinical data, utilized a standardized grading scheme to define the uptake of octreotide at 6 and 24 h post-administration. The correlation between (18) F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) scans, and octreotide uptake was assessed.
The cohort consisted of 50 patients having a mean age of 62.4 years and a median follow-up time of 24 months. Management consisted of biopsy (n = 4); resection (n = 10); observation (n = 16); radiosurgery (n = 21); and external beam radiotherapy (n = 3). OBS was correlated with MRI (n = 50); FDG-PET brain studies (n = 38); histology (n = 14), and angiography (n = 1). In cases where definitive diagnosis could be made, the sensitivity, specificity, positive and negative predictor values for OBS alone were 100; 50; 75; and 100, respectively. OBS provided false positive data in 3 patients (metastasis, chronic inflammation, lymphoma). Use of OBS with MRI to differentiate meningiomas from other lesions was highly significant (P < 0.001). FDG-PET correctly identified malignant pathology with 100% sensitivity and specificity.
OBS may increase the diagnostic specificity of conventional MRI when differentiating meningioma from other dural-based pathologies, while the addition of FDG-PET differentiates benign from malignant lesions.
KeywordsBrain Dura Meningioma Octreotide Scintigraphy FDG-PET
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We thank Ms. Christine Moore, CME Department of Neurosurgery, Cleveland Clinic Foundation, for her assistance with the preparation of this manuscript.
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