PET/MR Imaging of Somatostatin Receptor Expression and Tumor Vascularity in Meningioma: Implications for Pathophysiology and Tumor Outcomes

Michelle Roytman; Sean Kim; Shannon Glynn; Charlene Thomas; Eaton Lin; Whitney Feltus; Rajiv S Magge; Benjamin Liechty; Theodore H Schwartz; Rohan Ramakrishna; Nicolas A Karakatsanis; Susan C Pannullo; Joseph R Osborne; Jonathan P S Knisely; Jana Ivanidze

doi:10.3389/fonc.2021.820287

PET/MR Imaging of Somatostatin Receptor Expression and Tumor Vascularity in Meningioma: Implications for Pathophysiology and Tumor Outcomes

Front Oncol. 2022 Jan 28:11:820287. doi: 10.3389/fonc.2021.820287. eCollection 2021.

Authors

Affiliations

¹ Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.
² Weill Cornell Medical College, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.
³ Departments of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States.
⁴ Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.
⁵ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.
⁶ Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.
⁷ Department of Radiation Oncology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States.

Abstract

Background and purpose: Meningiomas, the most common primary intracranial tumor, are vascular neoplasms that express somatostatin receptor-2 (SSTR2). The purpose of this investigation was to evaluate if a relationship exists between tumor vascularity and SSTR2 expression, which may play a role in meningioma prognostication and clinical management.

Materials and methods: Gallium-68-DOTATATE PET/MRI with dynamic contrast-enhanced (DCE) perfusion was prospectively performed. Clinical and demographic patient characteristics were recorded. Tumor volumes were segmented and superimposed onto parametric DCE maps including flux rate constant (Kep), transfer constant (Ktrans), extravascular volume fraction (Ve), and plasma volume fraction (Vp). Meningioma PET standardized uptake value (SUV) and SUV ratio to superior sagittal sinus (SUVR_SSS) were recorded. Pearson correlation analyses were performed. In a random subset, analysis was repeated by a second investigator, and intraclass correlation coefficients (ICCs) were determined.

Results: Thirty-six patients with 60 meningiomas (20 WHO-1, 27 WHO-2, and 13 WHO-3) were included. Mean Kep demonstrated a strong significant positive correlation with SUV (r = 0.84, p < 0.0001) and SUVR_SSS (r = 0.81, p < 0.0001). When stratifying by WHO grade, this correlation persisted in WHO-2 (r = 0.91, p < 0.0001) and WHO-3 (r = 0.92, p = 0.0029) but not WHO-1 (r = 0.26, p = 0.4, SUVR_SSS). ICC was excellent (0.97-0.99).

Conclusion: DOTATATE PET/MRI demonstrated a strong significant correlation between tumor vascularity and SSTR2 expression in WHO-2 and WHO-3, but not WHO-1 meningiomas, suggesting biological differences in the relationship between tumor vascularity and SSTR2 expression in higher-grade meningiomas, the predictive value of which will be tested in future work.

Keywords: DCE = dynamic contrast enhanced; DCE Perfusion MRI; DOTATATE; PET/MRI; meningioma; somatostatin receptor.