Magnetic resonance imaging, computed tomography, and 68Ga-DOTATOC positron emission tomography for imaging skull base meningiomas with infracranial extension treated with stereotactic radiotherapy - a case series

Head & Face Medicine

Harun Badakhshi²  Volker Budach²  Winfried Brenner³  Peter Wust²  Reinhard Wurm¹  Ingo G Steffen³  Michail Plotkin³  Reinhold Graf² 

[1] Department of Radiation Oncology, Klinikum Frankfurt (Oder), Germany;Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany;Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany

关键词: Stereotactic radiotherapy;    PET;    ⁶⁸Ga-DOTATOC;    Skull Base;    Meningioma;   

Others  :  819420
DOI  :  10.1186/1746-160X-8-1

 received in 2011-10-29, accepted in 2012-01-04,  发布年份 2012

【 摘 要 】

Introduction

Magnetic resonance imaging (MRI) and computed tomography (CT) with ⁶⁸Ga-DOTATOC positron emission tomography (⁶⁸Ga-DOTATOC-PET) were compared retrospectively for their ability to delineate infracranial extension of skull base (SB) meningiomas treated with fractionated stereotactic radiotherapy.

Methods

Fifty patients with 56 meningiomas of the SB underwent MRI, CT, and ⁶⁸Ga-DOTATOC PET/CT prior to fractionated stereotactic radiotherapy. The study group consisted of 16 patients who had infracranial meningioma extension, visible on MRI ± CT (MRI/CT) or PET, and were evaluated further. The respective findings were reviewed independently, analyzed with respect to correlations, and compared with each other.

Results

Within the study group, SB transgression was associated with bony changes visible by CT in 14 patients (81%). Tumorous changes of the foramen ovale and rotundum were evident in 13 and 8 cases, respectively, which were accompanied by skeletal muscular invasion in 8 lesions. We analysed six designated anatomical sites of the SB in each of the 16 patients. Of the 96 sites, 42 had infiltration that was delineable by MRI/CT and PET in 35 cases and by PET only in 7 cases. The mean infracranial volume that was delineable in PET was 10.1 ± 10.6 cm³, which was somewhat larger than the volume detectable in MRI/CT (8.4 ± 7.9 cm³).

Conclusions

⁶⁸Ga-DOTATOC-PET allows detection and assessment of the extent of infracranial meningioma invasion. This method seems to be useful for planning fractionated stereotactic radiation when used in addition to conventional imaging modalities that are often inconclusive in the SB region.

【 授权许可】

   
2012 Graf et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Preston-Martin S: Descriptive epidemiology of primary tumors of the brain, cranial nerves and cranial meninges in Los Angeles County. Neuroepidemiology 1989, 8:283-295.
• [2]Leonetti JP, Reichman H, Smith PG, Grubb RL, Kaiser P: Meningiomas of the lateral skull base: Neurotologic manifestations and patterns of recurrence. Otolaryngol Head Neck Surg 1990, 103:972-980.
• [3]Jääskeläinen J: Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 1986, 26:461-469.
• [4]Bonnal JP, Thibaut A, Brotchi J, Born J: Invading meningiomas of the sphenoid ridge. J Neurosurg 1980, 53:587-599.
• [5]Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL: Meningioma: Analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985, 62:18-24.
• [6]Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957, 20:22-39.
• [7]Khoo VS, Adams EJ, Saran F, Bedford JL, Perks JR, Warrington AP, Brada M: A comparison of clinical target volumes determined by CT and MRI for the radiotherapy planning of base of skull meningiomas. Int J Radiat Oncol Biol Phys 2000, 46:1309-1317.
• [8]Tomura N, Hirano H, Sashi R, Hashimoto M, Kato K, Takahashi S, Watanabe O, Watarai J: Comparison of MR imaging and CT in discriminating tumor infiltration of bone and bone marrow in the skull base. Comput Med Imaging Graph 1998, 22:41-51.
• [9]Paling MR, Black WC, Levine PA, Cantrell RW: Tumor invasion of the anterior skull base: a comparison of MR and CT studies. J Comput Assist Tomogr 1987, 11:824-830.
• [10]Durden DD, Williams DW: Radiology of skull base neoplasms. Otolaryngol Clin North Am 2001, 34:1043-1064.
• [11]Dutour A, Kumar U, Panetta R, Ouafik L, Fina F, Sasi R, Patel YC: Expression of somatostatin receptor subtypes in human brain tumors. Int J Cancer 1998, 76:620-627.
• [12]Schulz S, Pauli SU, Schulz S, Händel M, Dietzmann K, Firsching R, Höllt V: Immunohistochemical determination of five somatostatin receptors in meningioma reveals frequent overexpression of somatostatin receptor subtype sst2A. Clin Cancer Res 2000, 6:1865-1874.
• [13]Bohuslavizki KH, Brenner W, Braunsdorf WE, Behnke A, Tinnemeyer S, Hugo HH, Jahn N, Wolf H, Sippel C, Clausen M, Mehdorn HM, Henze E: Affinity profiles for human somatostatin receptor subtypes SST1-SST5 of somatostatin radiotracers selected for scintigraphic and radiotherapeutic use. Eur J Nucl Med 2000, 27:273-282.
• [14]Henze M, Schuhmacher J, Hipp P, Kowalski J, Becker DW, Doll J, Mäcke HR, Hofmann M, Debus J, Haberkorn U: PET imaging of somatostatin receptors using [68GA]DOTA-D-Phe1-Tyr3-octreotide: first results in patients with meningiomas. J Nucl Med 2001, 42:1053-1056.
• [15]Henze M, Dimitrakopoulou-Strauss A, Milker-Zabel S, Schuhmacher J, Strauss LG, Doll J, Mäcke HR, Eisenhut M, Debus J, Haberkorn U: Characterization of 68Ga-DOTA-D-Phe1-Tyr3-octreotide kinetics in patients with meningiomas. J Nucl Med 2005, 46:763-769.
• [16]Milker-Zabel S, Zabel-du Bois A, Henze M, Huber P, Schulz-Ertner D, Hoess A, Haberkorn U, Debus J: Improved target volume definition for fractionated stereotactic radiotherapy in patients with intracranial meningiomas by correlation of CT, MRI, and [68Ga]-DOTATOC-PET. Int J Radiat Oncol Biol Phys 2006, 65:222-227.
• [17]Nyuyki F, Plotkin M, Graf R, Michel M, Denecke T, Geworski L, Fahdt D, Brenner W, Wurm R: Potential impact of 68Ga-DOTATOC PET/CT on planning the stereotactic radiotherapy in meningiomas. Eur J Nucl Med Mol Imag 2010, 37:310-318.
• [18]Grosu AL, Lachner R, Wiedenmann N, Stärk S, Thamm R, Kneschaurek P, Schwaiger M, Molls M, Weber WA: Validation of a method for automatic image fusion (BrainLAB System) of CT data and 11C-methionine-PET data for stereotactic radiotherapy using a LINAC: first clinical experience. Int J Radiat Oncol Biol Phys 2003, 56:1450-1463.
• [19]Astner ST, Dobrei-Ciuchendea M, Essler M, Bundschuh RA, Sai H, Schwaiger M, Molls M, Weber WA, Grosu AL: Effect of 11C-Methionine-Positron Emission Tomography on Gross Tumor Volume Delineation in Stereotactic Radiotherapy of Skull Base Meningiomas. Int J Radiat Oncol Biol Phys 2008, 72:1161-1167.
• [20]Nyberg G, Bergström M, Enblad P, Lilja A, Muhr C, Långström B: PET-methionine of skull base neuromas and meningiomas. Acta Otolaryngol 1997, 117:482-489.
• [21]Pieper DR, Al-Mefty O, Hanada Y, Buechner D: Hyperostosis associated with meningioma of the cranial base: Secondary changes or tumour invasion. Neurosurg 1999, 44:742-746.
• [22]Schmalfuss IM, Camp M: Skull base: pseudolesion or true lesion? Eur Radiol 2008, 18:1232-1243.
• [23]Farr HW, Gray GF, Vrana M, Panio M: Extracranial meningioma. J Surg Oncol 1973, 5:411-420.
• [24]Curtin HD, Williams R: Computed tomographic anatomy of the pterygopalatine fossa. Radiographics 1985, 5:429-440.
• [25]Adegbite AB, Khan MI, Paine DW, Tan LK: The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 1983, 58:51-56.
• [26]Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL: Meningioma: Analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985, 62:18-24.
• [27]Shin M, Kurita H, Sasaki T, Kawamoto S, Tago M, Kawahara N, Morita A, Ueki K, Kirino T: Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg 2001, 95:435-439.
• [28]Pieper DR, Al-Mefty O: Management of intracranial meningiomas secondarily involving the infratemporal fossa: radiographic characteristics, pattern of tumor invasion, and surgical Implications. Neurosurgery 1999, 45:231-237.
• [29]Desai R, Bruce J: Meningiomas of the cranial base. J Neurooncol 1994, 20:255-279.
• [30]Abrahams JJ, Eklund JA: Diagnostic radiology of the cranial base. Clin Plast Surg 1995, 22:373-405.
• [31]Dammers R, Hsu SP, Krisht AF: Radioguided improved resection of a cranial base meningioma. Neurosurgery 2009, 64:(3 Suppl):84-85.
• [32]Gehler B, Paulsen F, Öksüz MÖ, Hauser TK, Eschmann SM, Bares R, Pfannenberg C, Bamberg M, Bartenstein P, Belka C, Ganswindt U: [68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol 2009, 4:56. BioMed Central Full Text
• [33]Thorwarth D, Henke G, Müller AC, Reimold M, Beyer T, Boss A, Kolb A, Pichler B, Pfannenberg C: Simultaneous (68)Ga-DOTATOC-PET/MRI for IMRT Treatment Planning for Meningioma: First Experience. Int J Radiat Oncol Biol Phys 2011, in press.
• [34]Boss A, Bisdas S, Kolb A, Hofmann M, Ernemann U, Claussen CD, Pfannenberg C, Pichler BJ, Reimold M, Stegger L: Hybrid PET/MRI of Intracranial Masses: Initial Experiences and Comparison to PET/CT. J Nucl Med 2010, 51:1198-1205.
• [35]Rutten I, Cabay JE, Withofs N, Lemaire C, Aerts J, Baart V, Hustinx R: PET/CT of skull base meningiomas using 2-18F-fluoro-L-tyrosine: initial report. J Nucl Med 2007, 48:720-725.
• [36]Grosu AL, Weber WA, Astner ST, Adam M, Krause BJ, Schwaiger M, Molls M, Nieder C: 11C-methionine PET improves the target volume delineation of meningiomas treated with stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 2006, 66:339-344.