Meningioma Diagnostic and Treatment Guidelines

Diagnostic Imaging

The European Association of Nuclear Medicine (EANM), European Association of Neuro-Oncology (EANO), Response Assessment in Neuro-Oncology (RANO), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) recommend SSTR PET imaging in the diagnostic workup for meningiomas when tumor extension is unclear or for differentiating recurrence from post-treatment changes, with evidence class 3 and recommendation level C 1, 2
SSTR PET imaging offers superior detection sensitivity compared to contrast-enhanced MRI alone and should be obtained if tumor extension or diagnosis of recurrence is unclear, particularly for differential diagnosis between meningioma and non-meningioma tissue, assessment of tumoral extent, detection of multifocal disease or extracranial metastases, and differentiation between tumor recurrence and treatment-induced changes 1, 2, 4

The European Journal of Nuclear Medicine and Molecular Imaging suggests Peptide Receptor Radionuclide Therapy (PRRT) using radiolabeled somatostatin receptor ligands shows promising results for treatment-refractory meningiomas 1, 5
Patient eligibility criteria for PRRT include positive somatostatin receptor expression on SSTR PET imaging within the last 2 months, Karnofsky performance status above 60% or ECOG 0-2, and no contraindications to PRRT 6

SSTR PET is useful in distinguishing tumor recurrence from post-treatment changes, according to the European Journal of Nuclear Medicine and Molecular Imaging 1, 6
Response assessment to therapeutic interventions is currently performed using MRI-based criteria such as modified Macdonald criteria or RANO criteria, as stated by the European Journal of Nuclear Medicine and Molecular Imaging 6

Active inflammatory lesions may present increased uptake on SSTR PET, and uptake on SSTR PET may be decreased or absent in rare cases of meningioma, as noted by the European Journal of Nuclear Medicine and Molecular Imaging 6