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Current status of SSR-directed imaging and therapy in meningioma

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Abstract

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.

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Acknowledgements

We acknowledge Inglewood Biomedical Editing for professional manuscript editing.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    M. Unterrainer, H. Ilhan, P. Bartenstein & N. L. Albert

  2. German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany

    M. Unterrainer, M. Niyazi, J. C. Tonn, P. Bartenstein & N. L. Albert

  3. Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany

    M. Niyazi

  4. Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany

    J. C. Tonn

Authors
  1. M. Unterrainer
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  2. M. Niyazi
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  3. J. C. Tonn
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  4. H. Ilhan
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  5. P. Bartenstein
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  6. N. L. Albert
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Contributions

MU: conception and design of the article, drafting of the article, final approval. MN: conception and design of the article, critical revision for important intellectual content, final approval. JCT: conception and design of the article, critical revision for important intellectual content, final approval. HI: conception and design of the article, critical revision for important intellectual content, final approval. PB: conception and design of the article, critical revision for important intellectual content, final approval. NLA: conception and design of the article, critical revision for important intellectual content, final approval.

Corresponding author

Correspondence to M. Unterrainer.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with animals or human participants performed by any of the authors; therefore, the local ethics committee of the LMU Munich waived the requirement for additional approval.

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Unterrainer, M., Niyazi, M., Tonn, J.C. et al. Current status of SSR-directed imaging and therapy in meningioma. Clin Transl Imaging 7, 171–180 (2019). https://doi.org/10.1007/s40336-019-00331-6

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  • DOI: https://doi.org/10.1007/s40336-019-00331-6

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