Dynamic ⁶⁸ Ga-DOTATATE PET/MRI in the Diagnosis and Management of Intracranial Meningiomas

Abstract

Purpose To evaluate dynamic gallium 68 (⁶⁸Ga) tetraazacyclododecane tetraacetic acid octreotate (DOTATATE) brain PET/MRI as an adjunct modality in meningioma, enabling multiparametric standardized uptake value (SUV) and Patlak net binding rate constant (<i>K</i>_i) imaging, and to optimize static acquisition period. Materials and Methods In this prospective study (ClinicalTrials.gov no. NCT04081701, DOMINO-START), ⁶⁸Ga-DOTATATE PET/MRI-derived time-activity curves (TACs) were measured in 84 volumes of interest in 19 participants (mean age, 63 years; range, 36-89 years; 13 women; 2019-2021) with meningiomas. Region- and voxel-specific <i>K</i>_i were determined using Patlak analysis with a validated population-based reference tissue TAC model built from an independent data set of nine participants. Mean and maximum absolute and relative-to-superior-sagittal-sinus SUVs were extracted from the entire 50 minutes (SUV₅₀) and last 10 minutes (SUV₁₀) of acquisition. SUV versus <i>K</i>_i Spearman correlation, SUV and <i>K</i>_i meningioma versus posttreatment-change Mann-Whitney <i>U</i> tests, and SUV₅₀ versus SUV₁₀ Wilcoxon matched-pairs signed rank tests were performed. Results Absolute and relative maximum SUV₅₀ demonstrated a strong positive correlation with Patlak <i>K</i>_i in meningioma (<i>r</i> = 0.82, <i>P</i> < .001 and <i>r</i> = 0.85, <i>P</i> < .001, respectively) and posttreatment-change lesions (<i>r</i> = 0.88, <i>P</i> = .007 and <i>r</i> = 0.83, <i>P</i> = .02, respectively). Patlak <i>K</i>_i images yielded higher lesion contrast by mitigating nonspecific background signal. All SUV₅₀ and SUV₁₀ metrics differed between meningioma and posttreatment-change regions (<i>P</i> < .001). Within the meningioma group, SUV₁₀ attained higher mean scores than SUV₅₀ (<i>P</i> < .001). Conclusion Combined SUV and Patlak <i>K</i>_i⁶⁸Ga-DOTATATE PET/MRI enabled multiparametric evaluation of meningioma, offering the potential to enhance lesion contrast with <i>K</i>_i imaging and optimize the SUV measurement postinjection window. <b>Keywords:</b> Molecular Imaging-Clinical Translation, Neuro-Oncology, PET/MRI, Dynamic, Patlak ClinicalTrials.gov registration no. NCT04081701 © RSNA, 2022.