DOTATATE PET/MR 成像可区分继发性进展型和新发的世界卫生组织 3 级脑膜瘤。
DOTATATE PET/MR Imaging Differentiates Secondary-Progressive from de Novo World Health Organization Grade 3 Meningiomas.
机构信息
From the Weill Cornell Medical College (J.T.K., S.J.C.C., A.H.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York.
Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York.
出版信息
AJNR Am J Neuroradiol. 2024 Jun 7;45(6):773-780. doi: 10.3174/ajnr.A8219.
BACKGROUND AND PURPOSE
WHO grade 3 meningiomas are rare and poorly understood and have a higher propensity for recurrence, metastasis, and worsened clinical outcomes compared with lower-grade meningiomas. The purpose of our study was to prospectively evaluate the molecular profile, PET characteristics, and outcomes of patients with World Health Organization grade 3 meningiomas who were imaged with gallium 68 (Ga) DOTATATE PET/MR imaging.
MATERIALS AND METHODS
Patients with World Health Organization grade 3 meningiomas enrolled in our prospective observational cohort evaluating the utility of (Ga) DOTATATE PET/MR imaging in somatostatin receptor positive brain tumors were included. We stratified patients by de novo-versus-secondary-progressive status and evaluated the differences in the PET standard uptake value, molecular profiles, and clinical outcomes.
RESULTS
Patients met the inclusion criteria (secondary-progressive: 7/14; de novo: 7/14). The secondary-progressive cohort had a significantly higher per-patient number of surgeries (4.1 versus 1.6; = .011) and trended toward a higher number of radiation therapy courses (2.4 versus 1.6; = .23) and cumulative radiation therapy doses (106Gy versus 68.3Gy; = .31). The secondary-progressive cohort had a significantly lower progression-free survival compared with the de novo cohort (4.8 versus 37.7 months; = .004). Secondary-progressive tumors had distinct molecular pathology profiles with higher numbers of mutations (3.5 versus 1.2; = .024). Secondary-progressive tumors demonstrated higher PET standard uptake values (17.1 versus 12.4; = .0021).
CONCLUSIONS
Our study confirms prior work illustrating distinct clinical outcomes in secondary-progressive and de novo World Health Organization grade 3 meningiomas. Furthermore, our findings support (Ga) DOTATATE PET/MR imaging as a useful management strategy in World Health Organization grade 3 meningiomas and provide insight into meningioma biology, as well as clinical management implications.
背景与目的
世界卫生组织（WHO）分级 3 级脑膜瘤较为罕见，且了解甚少，与低级别脑膜瘤相比，其复发、转移和临床预后恶化的倾向更高。本研究旨在前瞻性评估接受镓 68（Ga）DOTATATE PET/MR 成像检查的 WHO 分级 3 级脑膜瘤患者的分子谱、PET 特征和结局。
材料与方法
本前瞻性观察队列研究纳入了入组评估镓 68（Ga）DOTATATE PET/MR 成像在生长抑素受体阳性脑肿瘤中的应用的患者，这些患者患有 WHO 分级 3 级脑膜瘤。我们对新发-进展性脑膜瘤和继发性进展性脑膜瘤患者进行分层，评估了 PET 标准摄取值、分子谱和临床结局的差异。
结果
患者符合纳入标准（进展性：7/14 例；新发：7/14 例）。进展性脑膜瘤患者每例患者的手术次数明显更高（4.1 次与 1.6 次；=0.011），且倾向于接受更多的放射治疗疗程（2.4 次与 1.6 次；=0.23）和更高的累积放射治疗剂量（106Gy 与 68.3Gy；=0.31）。进展性脑膜瘤患者的无进展生存期明显短于新发脑膜瘤患者（4.8 个月与 37.7 个月；=0.004）。进展性脑膜瘤的分子病理学谱具有明显更高的突变数量（3.5 个与 1.2 个；=0.024）。进展性脑膜瘤的 PET 标准摄取值更高（17.1 与 12.4；=0.0021）。
结论
本研究证实了先前的工作，即继发性进展性和新发的 WHO 分级 3 级脑膜瘤具有明显不同的临床结局。此外，我们的发现支持镓 68（Ga）DOTATATE PET/MR 成像作为 WHO 分级 3 级脑膜瘤的有用管理策略，并为脑膜瘤生物学以及临床管理意义提供了新的认识。
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