A 58-year old female, operated for meningioma in 2001. Ga-68 DOTATATE PET MRI was done for suspected recurrence.
Coronal post contrast T1W (left) and PET MR fused coronal image (right ) reveals a DOTATATE positive enhancing dural based lesion at the previously operated site: recurrent meningioma.
In addition, subcentimeter size focal uptake of Ga 68 DOTATATE was seen in the left posterior parietal parasagittal region adjoining the superior sagittal sinus. Coronal post-contrast image (left) reveals a subcentimeter enhancing lesion adjoining the superior sagittal sinus (red arrow). Corresponding PET image (middle) reveals a focal area of increased tracer uptake. PET MR fused image (right) reveals focal tracer uptake corresponds to the enhancing lesion on MR.
Another discrete subcentimeter size focal uptake of Ga 68 DOTATATE was seen in the left suprasellar region. Axial post-contrast image (left) reveals a subcentimeter enhancing lesion along the dura in the left suprasellar region (red arrow). Corresponding PET MR fused image axial (middle) and coronal (right ) reveals focal tracer uptake corresponding to the enhancing lesion on MR.
Meningiomas have a high density of somatostatin tracer receptor expression and hence accumulate DOTATATE. Positron imaging with radiolabelled synthetic somatostatin receptor analogues such as Ga-68 DOTATATE is an established modality for diagnosis and target volume delineation of intracranial meningiomas prior to any surgical intervention or radiotherapy planning. In these cases, additional foci were identified thus having a significant overall impact on treatment planning and further management.
The case studies described above demonstrate the Ga-68 DOTATATE positivity of meningiomas.
In this case study, additional subcentimeter enhancing dural nodular lesions were identified which were otherwise not well discernable on MRI alone and would have been missed. Additional foci identified in critical locations thus had an overall impact on treatment planning and further management. The simultaneous PET MRI brings the potentiality of MR and PET together in a single study and likely to impact management further.
This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).
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