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Clinical Value of 24-Hour Delayed Imaging in Somatostatin Receptor Scintigraphy for Meningioma

Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg
Clinics of Nuclear Medicine and Neurosurgery, Christian-Albrechts-University, Kiel, Germany

Correspondence: For correspondence or reprints contact: Karl H. Bohuslavizki, MD, PhD, Department of Nuclear Medicine, University Hospital Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.

ABSTRACT

Somatostatin receptor scintigraphy (SRS) using ¹¹¹In-octreotide has proven useful in patients suspected of having meningiomas. Delayed imaging is regularly performed up to 24 h postinjection. However, this procedure is time consuming and expensive. Therefore, we investigated whether 24-h imaging may be omitted in these patients. Methods: After clinical examination and standard MRI, 71 patients were suspected of having 92 meningioma lesions. Before surgery, all patients underwent SRS after intravenous injection of 200 MBq (5.4 mCi) ¹¹¹In-octreotide. Planar whole-body images were obtained at 10 mm and 1, 4 and 24 h, and SPECT was performed at 4 and 24 h. Results of SAS in all lesions were evaluated with respect to histology and time of image acquisition. Results: SRS yielded 58 true-positive, 20 true-negative and 14 false-negative results, with the false negatives all less than 5 mL (2.3 ± 2.1 mL) in volume. In 52 of 58 true-positive lesions (89.7%), diagnosis could be established by 4-h imaging without further information by 24-h imaging. In 10 of the 52 lesions, SPECT was necessary to confirm planar findings. Imaging at 24 h was necessary in only 6 of 58 true-positive lesions (10.3%): 3 patients who had intracranial relapse of meningioma (volume < 5 mL) and 3 who had spinal meningioma. Thus, a diagnosis of intracranial meningioma could be established in 52 of 55 lesions (95%) using a 4-h imaging protocol. Conclusion: With a 4-h acquisition protocol that includes SPECT imaging, SAS yields sufficient information in patients suspected of having intracranial meningiomas. Delayed imaging at 24 h is recommended only for patients who have small meningiomas (volume < 5 mL), spinal localizations or negative SRS at 4 h.

Key Words: somatostatin receptor scintigraphy • ¹¹¹In-octreotide • meningioma • delayed imaging