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Somatostatin Receptor Scintigraphy in Central Nervous System Tumors: Role of Blood-Brain Barrier Permeability

Departments of Nuclear Medicine and Neurosurgery, Institute of Pathology, Inselspital and University of Berne, Berne, Switzerland

Correspondence: For correspondence or reprints contact: Prof. Dr. Jean-Claude Reubi, Institute of Pathology, University of Berne, CH-3010 Berne, Switzerland.

ABSTRACT

Somatostatin receptors are expressed in meningiomas and low-grade gliomas, raising the hope that scintigraphy with ¹¹¹In-DTPA-D-Phe1-octreotide might be helpful in the in vivo localization, differential diagnosis and postoperative/postradiotherapy brain tumor follow-up. Methods: Indium-111-DTPA-D-Phe1-octreotide scintigraphy and brain scintigraphy using ^99mTc-DTPA as a nonspecific tracer for blood-brain barrier integrity were simultaneously performed in 60 patients with CNS tumors using dual-isotope acquisition mode SPECT. For 23 patients, the scintigraphic findings were also compared with in vitro somatostatin receptor autoradiography of surgical biopsy specimens. Results: In meningiomas (located outside the blood-brain barrier), the somatostatin receptor scan showed all tumors and scintigraphic signal intensity correlating with in vitro SSR density positive in all meningiomas. Less contrast was seen on ^99mTc-DTPA scans. In all tumors inside the blood-brain barrier, the ¹¹¹In-DTPA-D-Phe1-octreotide scan visualized the tumors with a disrupted blood-brain barrier, as seen by ^99mTc-DTPA scintigraphy. Discrepancies, however, were observed between somatostatin receptor scintigraphy and in vitro receptor autoradiography. Conclusion: Combined somatostatin receptor and ^99mTc-DTPA scintigraphy may be helpful for noninvasive differentiation between meningiomas and other CNS tumors. False-negative scans were observed as a result of shielding by the intact blood-brain barrier. Interpretation of negative and positive somatostatin receptor scans in CNS tumors must therefore be done with caution.

Key Words: indium-111-DTPA-D-Phe1-octreotide • somatostatin receptors • blood-brain barrier

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