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Simpson grading revisited – surgeon’s estimation of meningioma removal vs. postoperative 68GA-DOTATATE PET/CT
Simpson grading revisited – chirurgische Einschätzung des Resektionsausmaßes von Meningeomen vs. postoperatives 68GA-DOTATATE PET/CT
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Veröffentlicht: | 8. Mai 2019 |
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Objective: The surgeon’s intraoperative estimation of meningioma extent of resection (Simpson-Grade, SG) is widely used as a prognostic factor for tumour recurrence. However, the validity of SG is still a matter of debate. In pre-operative imaging, 68Ga-DOTATATE PET/CT has been shown to detect meningioma tissue even more sensitively and specifically than MRI. Our study evaluates the Simpson grading within the framework of modern imaging techniques (MRI/PET-CT) in a prospective data set.
Methods: 53 adult patients with primary or recurrent WHO°I meningioma and surgical resection between 06/2016 and 09/2017 were prospectively investigated. Inclusion criteria were documented SG, postoperative MRI and 68Ga-DOTATATE PET/CT scan within 4 months after surgery. The PET parameters SUVmax, SUVmean and threshold-based biological tumor volume (BTV; SUV>2.3) were assessed by two independent experienced raters. MRI was performed according to the recommendations of the society for neurooncology and interpreted by experienced raters.
Results: There were 37/53 resections classified as SG I and II, 5/53 SG III and 11/53 as SG IV. PET displayed tracer uptake in 13/39 SG I or II resections, indicating tumour remnants (35% false negative). MRI was false negative in 10 of these 13 cases, indicating underestimated SG in 14% of SG I and II resections. All SG IV resections showed tumor remnants in PET-CT while MRI was false negative in 2 of these cases. Discordant results were more often in convexity (40%) and falcine (43%) meningiomas than skull base meningiomas (16%).
Conclusion: We here show that postoperative meningioma remnants can be assessed more precisely by 68Ga-DOTATATE-PET/CT than by the surgeon’s estimated SG or postoperative MRI. This should be considered for follow-up management, subsequent therapies as well as in planning clinical studies.