Uptake and tracer kinetics of O-(2-¹⁸F-fluoroethyl)-L-tyrosine in meningiomas: preliminary results

Purpose: O-(2-[¹⁸F]Fluoroethyl)-l-tyrosine (¹⁸F-FET) is a well-established PET tracer for the imaging of cerebral gliomas, but little is known about ¹⁸F-FET uptake in meningiomas. The aim of this study was to explore ¹⁸F-FET kinetics and tumour-to-background contrast in meningiomas of various histologies.

Methods: A group of 24 patients with suspected cerebral meningioma on MRI/CT had an additional dynamic ¹⁸F-FET PET scan prior to surgery. Time–activity curves (TAC) of ¹⁸F-FET uptake in the tumours and tumour-to-brain ratios (TBR) for early (3 – 14 min after injection) and late ¹⁸F-FET uptake (20 – 40 min after injection) were analysed and compared with histological subtypes and WHO grade. ¹⁸F-FET uptake in critical structures in the skull base was also evaluated in terms of tumour-to-tissue (T/Tis) ratio.

Results: TBR of ¹⁸F-FET uptake in meningiomas was significantly higher in the early phase than in the late phase (3.5 ± 0.8 vs. 2.2 ± 0.3; P < 0.001). The difference in TBR between low-grade meningiomas (WHO grade I, 18 patients) and high-grade meningiomas (WHO grade II or III, 6 patients) was significant in the late phase of ¹⁸F-FET uptake (2.1 ± 0.2 vs. 2.5 ± 0.2, P = 0.003) while there was no significant difference in the early phase. ROC analysis showed that TBR of ¹⁸F-FET uptake in the late phase had significant power to differentiate low-grade from high-grade meningiomas (AUC 0.87 ± 0.18, sensitivity 83 %, specificity 83 %, optimal cut-off 2.3; P < 0.01). Evaluation of TAC yielded three different curve patterns of ¹⁸F-FET PET uptake. Combination of TBR (cut-off value 2.3) and TAC pattern slightly improved the differentiation of high-grade from low-grade meningiomas (accuracy 92 %; P = 0.001). Analysis of background radioactivity in the skull base indicated that ¹⁸F-FET uptake may be helpful in distinguishing meningioma tissue in the late phase. T/Tis ratios were >1.2 in all patients for the periorbita, sphenoidal sinus, pituitary gland, tentorium, bone and brain, in more than 90 % of patients for the mucosa and dura, but in only 63 % of patients for the cavernous sinus.

Conclusion: ¹⁸F-FET PET may provide additional information for noninvasive grading of meningiomas and possibly for the discrimination of tumour in critical areas of the skull base. A further evaluation of ¹⁸F-FET PET in meningiomas appears to be justified.