CLINICAL HISTORY
A 47-year-old female is a known case locally advanced breast cancer. Invasive ductal carcinoma, grade 2- ER: Positive, Allred score 5+3=8 PR: Positive. FDG PET/CT and CT head are performed for staging.
IMAGING:
FDG PET CT scan shows hypermetabolic lesions in right breast (multicentric, multifocal) involving the overlying skin with multiple FDG avid right level I and II axillary and right internal mammary lymph nodes, likely metastatic.
CT head: show large extra-axial dural based avidly enhancing solid mass lesion along the greater wing of sphenoid on left side, keeping in view patient's known history of cancer breast likely metastatic rather than atypical meningioma.
MRI brain: MRI features favor atypical meningioma along left sphenoid ridge, dural metastasis is less likely possibility.
68Ga-DOTATOC PET/CT showlarge somatostatin avid extra-axial dural based lesion along left sphenoid ridge; likely related to meningioma.
LEARNING POINTS:
1. 68Ga-DOTA TOC PET/CT is a valuable tool in the detection and localization of meningioma as it is known to highly express somatostatin receptors (SSTR).
2. Preoperative planning: 68Ga-DOTA PET provides precise tumor localization and information about the tumor's extent and proximity to critical structures, aiding surgeons in planning their approach and anticipating potential complications.
3. Tumor grade: 68Ga-DOTA PET can assist in predicting the tumor grade of meningiomas, as higher-grade tumors typically exhibit lower somatostatin receptor expression. Grading is crucial for determining the tumor's aggressiveness and guiding treatment decisions.
4. Tumor recurrence and follow-up: 68Ga-DOTA PET are important for monitoring tumor recurrence or residual tumor after treatment, enabling early detection and guiding further management decisions.
5. Radiotherapy Planning: 68Ga-DOTA peptide PET shows promising complementary role in detection and treatment planning of meningiomas. The potential benefits include improved diagnostic sensitivity, surgical planning, determination of the extent of resection, selection of RT target volumes (especially GTV), and differentiation between true and pseudo progression. Furthermore, in evaluation of treatment response.
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