Summary
We have studied prospectively 47 patients with CNS tumours including 16 meningiomas and 33 other tumours using combined111In-octreotide and99mTc-DTPA brain scintigraphy.111In-octreotide scintigraphy was used to image somatostatin receptors (SSR) and99mTc-DTPA scintigraphy was used to assess the integrity of the blood-brain barrier (BBB). A total of 32 tumours (65%) were detected. All SSR positive tumours also had positive99mTc-DTPA scans and all SSR negative tumours were negative on99mTc-DTPA scans. Among the tumours located outside the BBB, all meningiomas and two out of six schwannomas were positive on combined SSR/99mTc-DTPA scintigraphy. Among the tumours located inside the BBB, seven out of nine gliomas grade I–III were negatitve, whereas all glioblastomas were positive. Other positive tumours included one malignant non-Hodgkin lymphoma and two cerebral metastases. SSR scintigraphy alone was non-specific in the diagnosis of meningiomas, as 16 non-meningiomatous tumours also had positive SSR scans probably due to a breakdown of the BBB (excluding the malignant lymphoma). Measuring the tumour-to-background ratio on SSR scans improved specificity, but sensitivity was decreased below 70% because some meningiomas were only slightly positive. Only the ratio of SSR scintigraphy to conventional99mTc-DTPA brain scintigraphy (SSR-to-BS index) allowed a reliable differentiation of meningiomas from other CNS tumours, most notably from schwannomas (sensitivity: 94%; specificity: 100%). Our results support the usefulness of combined SSR and conventional brain scintigraphy in the noninvasive pre-operative diagnosis of meningiomas.
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References
Bihl H, Dörr U (1993) Somatostatin receptor imaging. Hor Met Res [Suppl] 27: 1–62
Ell PJ, Britton KE (1991) The brain. In: Maisey MN, Britton KE, Gilday DL (eds) Clinical nuclear medicine. Chapman & Hall, London, pp 158–197
Haldemann AR, Rösier H, Barth A, Waser B, Geiger L, Godoy N, Markwalder RV, Sciler RW, Sulzer M, Reubi JC (1995) Somatostatin receptor scintigraphy in central nervous system tumours: role of blood-brain barrier permeability. J Nucl Med 36: 403–410
Hermanz-Schulman M, Welch K, Strand R, Ordia JI (1986) Acoustic neuromas in children. AJNR 7: 519–521
Hildebrandt G, Scheidhauer K, Luyken C, Schicha H, Klug N, Dahms P, Krisch B (1994) High sensitivity of the in vivo detection of somatostatin receptors by111indium (DTPA-Octreotide)-scintigraphy in meningioma patients. Acta Neurochir(Wien) 126: 63–71
Horie Y, Akagi S, Taguchi K, Yoshino T, Hayashi K, Takahashi K, Akagi T (1990) Malignant schwannoma arising in the intracranial trigeminal nerve. Acta Pathol Jpn 40: 219–225
Koper JW, Markstein R, Kohler C, Kwekkeboom DI, Avezaat CJJ, Lamberts SWJ, Reubi JC (1992) Somatostatin inhibits the activity of adenylate cyclase in cultured human meningioma cells and stimulates their growth. I Clin Endocrinol Metab 74: 543–547
Krenning EP, Bakker WH, Breeman WAP, Koper JW, Kooij PP, Ausema L, Lameris JS, Reubi JC, Lamberts SWJ (1989) Localisation of endocrine-related tumours with radioiodinated analogue of somatostatin. Lancet i: 242–244
Krenning EP, Bakker WH, Kooij PPM,et al (1992) Somatostatin receptor scintigraphy with Indium-111-DTPA-Phe-1-octreotide in man: metabolism, dosimetry and comparison with Iodine-123-Tyr-3-octreotide. J Nucl Med 33: 652–658
Krenning EP, Kwekkeboom DJ, Bakker WH,et al (1993) Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 20: 716–731
Lamberts SWJ, Krenning EP, Reubi JC (1991) The role of somatostatin and its analogs in the diagnosis and treatment of tumors. Endocr Rev 12: 450–482
Maini CL, Tofani R, Sciuto R, Carapella C, Cioffi R, Crecco M (1993) Somatostatin receptors in meningiomas: a scintigraphic study using111In-DTPA-D-Phe-1-octreotide. Nucl Med Comm 14: 550–558
Maini CL, Sciuto R, Tofani A, Ferraironi A, Carapella CM, Occhipinti E, Mottolese M, Crecco M (1995) Somatostatin receptors imaging in CNS tumours using111In-octrotide. Nucl Med Comm 16: 756–766
Moertel CL, Reubi JC, Scheithauer BS, Scahid DJ, Kvols LK (1994) Expression of somatostatin receptors in childhood neuroblastoma. Am J Clin Pathol 102: 752–756
Moyse E, Le Dafniet M, Epelbaum J, Pagesy P, Peillon F, Kordion C, Enjalbert A (1985) Somatostatin receptors in human growth hormone and prolactin-secreting pituitary adenomas. J Clin Endocrinol Metab 61: 98–103
Müller HL, Frühwald M, Rendt J, Warmuth-Mertz M, Reubi JC, Kühl J (1995) Somatostatin receptor scintigraphy (SSRS) and somatostatin receptor autoradiography (SSRA) on tumor tissues from children with malignant brain tumors [Abstract]. Eur Soc Pediatr Endocr, Edinburgh (in press)
Reubi JC, Horisberger U, Lang W, Koper JW, Braakman R, Lamberts SWJ (1989) Coincidence of EDF receptors and somatostatin receptors in meningiomas but inverse, differentiation-dependent relationship in glial tumors. Am J Pathol 134: 337–344
Reubi JC, Landolt AM (1984) High density of somatostatin receptors in pituitary tumors from acromegalic patients. J Clin Endocrinol Metab 59: 1148–1151
Reubi JC, Lang W, Maurer R, Koper JW, Lamberts SWJ (1987) Distribution and biochemical characterization of somatostatin receptors in tumors of the human central nervous system. Cancer Res 47: 5758–5764
Reubi JC, Maurer R, Klijn JGM, Stefanko SZ, Foekens JA, Blaauw G, Blankenstein MA, Lamberts SWJ (1986) High incidence of somatostatin receptors in human meningiomas: biochemical characterization. J Clin Endocrinol Metab 63: 433–438
Rubi JC, Maurer R, von Werder K, Torhorst J, Klijn JGM, Lamberts SWJ (1987) Somatostatin receptors in human endocrine tumors. Cancer Res 47: 551–558
Reubi JC, Schaer JC, Waser B, Mengod G (1994) Expression and localization of somatostatin receptor SSTR1, SSTR2, and SSTR3 messenger RNAs in primary human tumours using in situ hybridization. Cancer Res 54: 3455–3459
Reubi JC, Waser B, Vanhagen M, Lamberts SWJ, Krenning EP, Gebbers JO, Laissue JA (1992) In vitro and in vivo detection of somatostatin receptors in human malignant lymphomas. Int J Cancer 50: 895–900
Riccabona G (1994) Brain tumor scanning revisited in 1994. Nucl Med Comm 15: 125–127
Schober R, Vogeley KT, Urich H, Hölzle E, Wechsler W (1992) Vascular permeability changes in tumours of the peripheral nervous system. Virchows Archiv A Pathol Anat 420: 59–64
van Hagen PM, Krenning EP, Reubi JC, Mulder AH, Bakker WH, Oei HY, Löwenberg B, Lamberts SWJ (1993) Somatostatin analogue scintigraphy of malignant lymphomas. Br J Haematol 83: 75–79
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Barth, A., Haldemann, A.R., Reubi, J.C. et al. Noninvasive differentiation of meningiomas from other brain tumours using combined111indium-octreotide/99mtechnetium-DTPA brain scintigraphy. Acta neurochir 138, 1179–1185 (1996). https://doi.org/10.1007/BF01809748
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DOI: https://doi.org/10.1007/BF01809748