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    Nuero Oncology Article

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    Neuro-Oncology ew esoay 172, 312-328, 2018, ‘ced ossineuonemen ‘Advance feces de 8) 2016 Comparison of °°Ga-DOTATOC-PET/CT and PET/MRI hybrid systems in patients with cranial meningioma: Initial results [Al Afshar-Oromieh, Maya 8. Wol, Clemens Kratochwi, Frederik L. Giese, Stephanie E. Combs, ‘Antonia Dimitrokopoulou-Strauss, Regula Gnirs, Matthias C. Roethke, Heinz P. Schlemmer’, and Uwe Haberkornt ‘Deparment of Mucler Match, Unversty Hosp of Hecelbe, Hedaberg, Geman (ABO, CK, FL, UM); Department of odiiogy, German Cancer serch Conte OZ), Helberg Germany (4A-0. MBWY.. MCR. HP); Cincl Coopeaton UN ‘of hace’ Medic, Goan Cancer Resear Certar EXZ Hetobare. Garay (AAO. AD. Si: Depertmert of Padaton ‘Onclogyand Therapy, Unversity hespia of Heidelberg, Hedabers, Germany SEC) “conespending Autor Ahr Conich, vO, samen of Nude Mare, Urey Hosp of Heber. IN 400, <9120 eg, ‘mney ah senoeeedan see.) ‘ceserk outer. ‘Bockround *Go-OTATOC-PEICTs 2 wel-estabishes method fr detecting an targeting the vaume defeition of mening tos po acitherony Hoteuer, hee yidnee the this method sls to detect meninges with igre sensu tan the gldsonsor MR. Shice he hyats PETMRT sconne become ovaicbe nthe pos feu yor, the ext ge of develope ‘could consaquerity erie by evaluating te easily of a hybrid PETIVR! Scarer using "Ga DOTATOC for detecting mening Methods. Fiteen patents received “Ga-DOTATOCPSTICT (5h pst injection [ni flowed by PETAR 2 Hous Both rs ‘igtins were analyzed sepratly nd tren compared with respect o nage quit, cetecton of noone meningomes ond rodotroce uptake values VS). nation, rates between rodotoce upioke n meningiomas ond uta glands wer co pred between bath PETIT ond ETM, Results vero 33 ntocrario meringjomos were detected. Al were sb with high controst in both PETICTard PEUINRL “Go DDOTATOC- PEM proved foulssimage quit whut erelcts Caladated SUV in meningiomas os wel esthetics of RUS Ir meningemasta those of cory lands ware ghar in ETICT Ae a eal meningioma con be tingusned em pLtery ‘lands Detter n eety mages ‘Conclusions. *Go-DOTATOC PET/MR. provided owlessimage qulty and presented an deal combinaon of igh sense ‘Sty PET) end ve bes posable morpreiogea VeuLaaton of mesngemes (In osator,excelet catacson of Mew ‘gamas it abeady posable 2 0. nours pi Liter mages co not inprave the stnction between phatary glans ans oxjocer Ianingmos Hovever, 8s nasa to be coulycoenpored betwaen sth ages modes Keywords: hyo maging. meninglomo, Ms, o-DOTATOC, PETCT, PETIMR, somatostatin rector. en rgoras, he most common ronglsltumassof the bon, ‘fe fomthe membranous ayers srounding tie cenal ner ‘ous ster. Nore than 90% of meningiomas oe berign inns {ne and show lw polfeation index an predomi fernles Many meningiomas ore asyrnatorratic ord require ‘only proce abservaton. Sympromate tumors ously trecced by surgica resection, tesuiong in ong tam conta rates of 3386-60% (bserctions upto 15 yesh“ Rediaten ‘therapy con a0 De used 08 0 pary treatment for tumors tet are surgealy unvesecteble her “ndicalons” for ‘ec 25 ay 206; ccpted 7 re 2016 ‘eclrnetpy oe poles wth tes menngom folowing Sugary o the uo aeinoperbie for otrer real eosons Meningimas bxoted ot the shullbase are portly cult to toot due ta thes lad surged aporeaen ther Doxmiy to vtl sructures such o& Blood vessels, one ewes 0: the brainstorm tn uch cases, o maximum evel of ‘Heaiment cecurecy § mpertve Aecarete cagnostc tools are on important plerequiste for such ntreate precedes In {hs conte. PET/CT Imoging with the somacostonn receptor nelogue DOTAD. Phat Tyre ocueotide DOTATOO labeled {© the Athol 014 Pbkched by Gferd Unies Pres n behalf of the Scie for Neu Oncsagy Al ight seid Fer permasons please eat oul perisionsB0,R.c0%. a S10 re ao woe a lrmuneacye Aeom ne a oRERAoC [Afshar-Oromich etal: DOTATOC-PETICT vs. PETIMR for imaging meningiomas wth has inerasingly become o method for detection nd large souume ceintion of mering eos prot te raciexhereey ‘aur hose This imoging mocelty sbsed on te fet hak ‘lrest el mevixiomas hiersdly cress the somctostainre {epte subtype 7 (STR 2), touch DOTATDS sce to ind {with ery igh efi.” Th coros tol comersiona ir Ingmageles (nding the gold tera, convastenterced WHR), "Ge-DOTATOC- PET/CT Con clecly dsngish Deane ‘tal meningloma tesueandcther types of tssue such os post- ‘Opeseive scoring, n cation, DOTATOC is cle to dent me ngs with vay high conttost because nal ba sue ds pot express SSTR coz forthe pitty sland. Marco, theres encence thet this mashod = move sensitive detecting meringemes than the eument gold senderd, ‘ontrest enhanced MR Folring mary yeas of complex development hid ET? ya scornats have nly become erica. wo types of ET? THR rach ae onthe mots however One types ole: Emutaneousy acquire eT ane Wt images wien as for faster invezigetions with more aceurte *yage fusion. The ‘lhe ype of PETIMRE veux PT and MRE imoges consecs- tie, 87 using PETIMEL al muesigoners necessary fo plan ringradosheropy con e conducted ina singe seston neh reports of the hybrid FETIMRL system, which uses the mast ‘omnmot odavacer "F706, sfow ia bea pemishg et ‘However, rece studies epat ato estecLmtators wen "Godhead ores ae pies The net sep n ‘elopment ofthe hyora PETINR! waude consequenyevalve from the feosbiy ond image quoly using “Go DOTATOC for the detection of meningiomts Mis new meth’ coud be on Intaga porof the eimcalyutine nthe tur nd pasty em ‘dhe eteclon and therapy of menngiomos wth inprosed sereiy ond accra. Materials and Methods “Tis study wos approve by the eis committe of the Uiver- Sy of Helberg (5485/2012) Ptleres portcpatig in the ble 1. Coren fe 35 potent i iy resent study provided vrten formed consent prot tore {eng PETINR! examinations ond diowig Scere ois of obches cove. otionts Patent horace or sunerraed nT 1. teen con ‘eae menngame Grderwert sate Peer Grainger ord Seok rs (20 = 2659 get econ ipidet Scoebaina DOITOC Serts wna wave unbie tovte informed consent or had metalic Tplnts (nt Sr compat or uneoun) were excuses (om ne sy (n=O, due to peter eggvaton fur symptoms By {he MRL those pasate wo ware nt wing acap he fac woul also Pay been seus om easy =) ‘re cnrage pct age wes ca yor (2139 The cobart {onektedt Smocs ond 0 fences he PEUCr was tated Sy radon onoagt reef dering es turer ie GO Trocer For the PICT, DOTAO.2 they. octreatide wos produced (2s previgsly published. a (le, 68:3) was eluted froma "Ge!"Ga redonucide generator. Boh components sere coupladas eserbed prevausly The te DOTATOC sa tion wos acrinstred to parierts voc troenous bol (reon, 1903 43 Magy range, 100-265 Mac). Vartion fin gels roster ccovty wos cused by be sors ie of ‘Ga and vrs elution efciances obtained dung te i= ‘ime of he “e/a rodonacce genera”. However, Dose (on our previous experiences, ol octties injected wee sf ‘Gort detect meningomes”Tergeted ecivty wos 3 MBa/ ig Because nding of BOIAIOC ives o spec acepter ‘econ thot might be wauthcint bythe amount of pupa, “the qursty ofthe tocerinjectes os chosen ono peptide bos ond all rodiotrocer preporatons contained 125 ng pomwtoc. Faiethe Ae Geos) Sent) GSJOMUC (Meg) ntacenelNewrgome:f) Paves TREEEY 3 a ' ne 1 Sosey ‘ a t 2 1 suey 5 ra ” 0 2 suey ® 4 > ne & Sugey adorn 3 a : 1 i suey ° a t 23 1 ate) a 2 t BL 1 Seay ron 2 a t a 1 one 2 % ' am i gay +rtoton x % + 86 i rere s o ‘ Be 2 tone Nevo oreoeay 33 i i i p i 5 5 [Afthor-Ororich et ol: DOTATOC-PETICT ws. PETIMRI for imaging meningiomas Positron Emission Temography/Computed Tomography ‘Anoneantrast enhanced CT scan ofthe heod wos performed 30 mutes after acer nection using the faloving axerne- tes: sce hciness oF 5mm, Peter of 0.8 mm soft tssue reconstruction kere 130 eo BO mAs, mre aer (Crscanring. PET scr ofthe Head (one bed poston wes Oc (quted 93D fray, 16h 164) For one bec postion (162 oy ueronping sale .2em), we usae © 10 moze ecqustion time. Pet and CT wore performed using the some protce for ‘every porccpont on a EIOGRAP 6 PETICT scones (Semen “feng with senorma:DOTATOC-ustoe tht vu rmotched croracerste appearances of reringioras were ‘courted. addon, the ocleation ore the stondora uptoke {elde (Uannod of meningames andthe piuary gland ‘were deterred. Positron Emission Tomography/Magnetic Resonance Imaging [AL FETINREexrrinations were performed sho hybrid PET at sim (Bogroph mi Smee Nec Sluis) cape Def smultneaus Per ara Mt mogng cing one xa tion oftware, sypgo HB 18, As cescbes previously, the PETIVR-sstem consis of 9 30-Tese whel-Sody stem Ibased on e Sarars Nogretom ero) with a magne length of 163 cm ond a bore se af Soon" The Mt scones cperses weh a maximum gradient stvenghof 45 ritfm anda sew rateof 200 Use nas de tons Tae eod col was used for homogeneous edrequncy lwansmasn the sere eal, when optimzed fara mantel Silke phere atecation was used ‘er Sel detection “The PET doctor techelogy of white Body yb PET imaging bes on tetium onyrthosticce scien crystals in comanaten wii Mi-competble vaarehe photodiodes m= Sco of potorutle’ tubes. een block tector consis of 6 yet elements with c cys se of xtcz0 en. iy ‘elutetim owrthos Sete ovdonche photodiode ack d= {ctor forma datector ng, nt dotcter semen rns fre enenged en tne 2 ani The nie PET scanner has a ald ‘of view (FOV of about 25.8cm n re zdection on ax FOV ‘1 $54 mond an delator ng corate of 65.8 cm. ‘Smzoveou PeTand Mrnaging cota oeauistion ET and tug leaging wee strted ~2hous afer administration ef the tvocer wth 10 nutes of ecqiston me forthe be poston. ‘Aciived PET dato were fecensvuried with gn tetatve 3D ‘xcevedsubset expectation maximization algarthn by ose iterations 21 subsers Gouson Ate of 4mm, kage metric ‘1172, extended ma ap FON. During each PT data acquston sees of MR sequences wos perormed as falows: after grocient cena lecsize 9 ‘er value nterpelte exertion (VBE seauence (7 fop- posed phase ccnique fo eteruaton corecion wes conduct (b repeten ame fective [T=] 671.23 and 246, langle 10% matin sae 256 192-.120, *OV S00 328 mmm brand 965 Hope ord pol imogin GRAPPA foci 2 Protocol Head Te-weightec anil T= (TE 4000/109 ms turofoctr 17:-OV 220; plone vesclion O6x05% 40 rm gral cequsiton ae ‘cchniues PAT] groppa factor 2; overoges 2). Th-welghtes 3D owol FLASH CHUTE 1604.32 ms; ip onge 20" FOV 230; inpane esolstion 0 «0.83.0 rem pore cation te gues [PAT] non, averages 1). al ep (UTE SOOO rs FOV 22m, nplane relation 1S 1 Sx 39mm; PAT CAPR foctor 3; ovroges ). 12 weighted ova ot suppressed CTE {4900/91 ms; Turbofctor 17; FOV 22; nplane resoluton 0.7 (0.7.30 AT none overages 2. FLAIR xa at spores (IRIE 8000189 ms, Turotactar 12, FOV220;mplane soutien 411409330 ne; Pat rene). Th weighted MPR 3D lash oer ‘minsvaion of weight-ochsted gavin cartast red {um OUT 3200/1,66 ms tip engie FOV 300; rele eso tion 09x05%09mm PAT ‘GRAPPA factor 2). onzost enhanced exon anc xi T weights TSE sip Dressed (TE 70081 ms Tubotctor 3 FOV 20, plone re ‘Suion 0910.7 30 emmy AT ane Image Analysis. “woboard cet specistsinnacler mesg andradleay read al datasets independent. The only wes performed {ge wotstason ore Sngosoftware Teed Gere Madea ‘jst Lesions tht were vsuly conser a meingora ‘here counted ona anu wt spect to thar Sandor pte ues (Uvacemn)- Te sore ory os performed th eg te the ssi gland. Al caured MR inoges were ‘sec frther terpetation fr ETM mage TE MRD ‘sn wth contrast aur was ied for mage fusion. ‘Simkor to ur previous reports, SUvs in lee imoges (PET! aD were ceed a inreasng, decreasing, rsa wth in enaly changes of 10%, «10%, or eiwees 10% ond “1% respectively Fer cicdaton of the SU cule egions of erst (01) were rown around ots wih aly nreased upcke vars ‘ewe sles and eutoratcely ocoped oa 3-imersoral 0: Ur of remrest ote 70% socotour Te delermine vinetver dstncion besween meringomas ‘nd puter glans is Bettr in ery or ote images, the SUV cf meninges wes che by the SUV ofthe pitary lands ‘ne testing Sw roti ware tren compared The aeenction besicen he? cbowe mentioned sues por relevant for exter bear radiation tery when meningiomas 2 eject the pista god. Statistical Analysis For statsical onal, Sgmopot version 11 softwore Systat ‘Sotwarel wes usea Sonicare of derences was evlucted by 2-sdes Wicoron signed rand ests for tumor uptake ond anos both PETICT methods A Pvaive <5 was cons ered statistically sinieont Results mage Quelty PETCTond PETIMRL were eos nol cones. oth PET nd MAL bf the TIM sytem proved dagreste mage quolty Wt ‘ut parent image refots Mest lesions crorocersti for meningioma derenststed higher upie end contest in ue peo yp 0 a ROR [Afcnor Oromish et al: DOTATOC-PETICT vs. PEM for imaging meningiomas ety eragesPEVICT 30 min_p). Tiss sessed inmove de {ed Inthe section “Lesions Choracterstie for Wenngerna = oreover,houng sever eiferent MRI sequences ovoobe ‘wih igh esluton fot tated evluction othe moges prov (sd by te PETAL ster (Figs ane 2) puta Gland “bie? presents the ean uptke value ofthe 25 pitoy (Gents in PETC ond DEL ncn andar cevion Eimamum, rox ord medion ‘ie cerarstady Fe Seulement 8 SW onn incase cary (20%) 2 atutaren cecreases Cocry (at nbptutares ondremned san (st0%)m Pp (10%) in2 pituitaries, decreased clearly (>10%) in outa Ses crd remained sce (205) 3 pstaten bee PT ‘Crancoeinie IRmary coses, UN ofthe ptultoy gonds wee ier the cary mogis FECT tan the ate rages Tne), a trough te wos rot stately sgifcase = Sal far Simson Pos ra Lesions Characteristic for Meningioma ‘Aevong the 15 peri pnt investigated by both maging tech gues, 33 lesions choracteriti or inforon ek meningioma ‘here detected. lesions were cleory etectobe in Bay ‘early PETE and lace images PETC) ‘Suerozeustake values ong ie 33 represetaivemerin= sjomos ot oso presented n Tole © As demonstrated by Fig. 2, SWcun increas clearly (101 in iestns, decrease eet (10%) in 20 lesions, Sl emcined tobe (10%) in 9 elon betwen PETICT on FETIMGG SUV increased clerly (>108) in 5 lesions, de ‘reased clearly (10%) n 23 less, and remained stole (Tin iesons bemeen PET/CT ond PETA ‘Sus cf the meningiomas were sigficanty nigher in PEICT (vpn P= 1 and UVens P= 007) Maan rie ofthe uptake n meningiomas to those tu sory sands ee presented Tose 7 andi. ing SUvonr ros betucen meringiomes ond ptutory gland inreosed daar (=10%) in 4 costs, decreased cory eto) 17 coses, and remained stable (= 10%) in 12 Eases between PETICT and DE/MRL. With regard to SUN thesome eos nceosed leary (>10%) nS cose decensed Peary (2108) in 16 coses, ard rereined sible (2105) 012 tases between PETIC ond PETAL Th cancioson, ros between Meningamas and stutary glands were sgnicony grein PIPE P= 003 SW SrdP=035 for Noel. Discussion ‘G0 DOTATOC PETICTis a highly effective method fr dete. ‘ion of manngiomes anc ta Geneon om oer types ‘ssues Sich os postopeeive searing In aston to the cu tert dogrosie god stordor, convst-enhonced MT, thos become ¢ useful Cognos oo or accurately defining GTV prot ip redetheropy et ou hosatel "Theres aso evaaroe ‘hot Ge DOTATOC PETIT isabe to ceteermeningomes wih Figs. co co1aloc ink. c)ane FECT. atpanertS demanstntng 2 meng ith slr ana adca tothe lu cd witsanous ate naoes PTR do reteset dcr beeen 2 pest ses A canberra ‘etn MRL) OOHTOC HET Omar ps ated Fam hw SCID) nan a (Gated Moth FETNR an oT Dard (Oj ecte CE OOTAIOE AT 2 hop Nevo oreoeay 35 mepejw yom ‘a Aang wo pon _Afsror Oromih et al: DOTATOC-PETICT vs. FETIVR! for imaging meningiomas Fig. 2, “coOOTAIOCPETNR AC ord ATT Olof pcre 1. tense and rromogeneo.s renigore ote sil sting the al oy, DTATOC FE can ast oetucn val ennala ca er Sais Su as pasapere argo are Lue {court sthonces Iv wegrtee hf) OU AGCAT Tommie cers tom neil neon staones Di nae BSotetoc be Prous pr aed om be PTD (Yon of Dane ‘io ofthe SLV inthe menigaras to thet pty dares ort merges ord thay glans beth “Ge DOATOC FETT Go min pi enc PTI Bhp Ae ease summesnsso Range vege means forge cer erngonas =35) eaa89 2-me se sonss sista Fitay donde = 15) Sere Doe at ssite 0 aoca so Fata, mney aa aa_ee 2 33507 an ae a somos Renge visser SNS Range Neon erngomas 9 ~35) is.me ao-76 as mis ise 8 Prutay ands »=15) so-21 Seon a fosts = aa-laa 88 Fain, rier, jets aoe uf fest En higher sensty then tht of coneost enone In pot Uc, sal lore odjocant one fa cree of octet the sul bose are dieu for MAU to detect. Adcvoral DDatStoc oe enayes can engrave detection af ‘ond thereby influence eetment planning ad Yolow-ap, all ‘of wbich ae of potential crcl benef 1 poets” ‘Shes hyora MR! sconners hove become aval, the pet toge af development depends onthe easily of sg Sco OOHATOC to deicet menfornas No systamatc evalua tion of "Ge DOTATOC PETAR exits, ed oy one eos ep: has een puisnad to doe ‘Some cxpars org thatthe development of tyr PETINAE scanners ns full becouse ceran software aveody exists 6 ‘thot cn fuse Separately ocqules FET one st ages Simlor btquments were voiced tthe ume of hyd PETIT scanner development However, the ensuing yeas Pov cleat shown ‘ute aavantages of PTET hyo scanners The rhage fo ‘Bon os foun tobe more cccurte comaored with images thot were recorstucted based on revoocive fusion of so ‘eelyabtcnad Pel an CI/i mages Ine cewscpment of yor PET/CT res emotes mere ocurce traps expec ‘ternal rodation Moreover, mage fusion canbe easly ox fanmpished eenadealy fe te sears, ng the same cn fro. unt of the seonnerGacouse ft date net requre ‘aniplion by ether ysiios or tectni personel ore ‘ents humon erorin the cont of image futon. Ae result, Sam wo oe Aarau [Afshar-Oromich et al: DOTATOC-PETICT vs. PETIMR for imosing meningiomas $V ane 3 ferent Meninglomas srever ssrcrnans Fig. eon en estrus lies UVa) ft 33 nines no DOTIOC FECT 0 win pi and ETA (2 pf Emory of te case asevece upatewes ie hay frogs image fusion soves time and resources, Ts important ‘carateroton fora modern Peat cre system, wh eotiu= ‘ousy pushes ne bourdaves fe

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