PMC9596965_01
T1-contrast-enhanced MRI scan in axial (A) and coronal (B) sections at the initial diagnosis showing a large right frontal (approximately 5.5 cm x 7.0 cm) tumor with dural attachment, suggestive of a meningioma, with midline and brain shift.
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MRI revealed a large (5.5 cm x 7.0 cm) contrast-enhancing lesion in the right frontal lobe with attachment to the dura, suggestive of a meningioma, with a distinctive perifocal edema and midline shift of 11 mm ( Figure 1 ).
T1-contrast-enhanced MRI and 68Ga-DOTATATE-PET/CT showing three PET-positive lesions in different locations (D-F). The contrast- enhanced MRI (A-C) showed no clear correlate for the displayed PET-positive right frontopolar lesion (white arrow). The maximum standardized uptake value (SUVmax) was lower in the previously irradiated lesion (D) compared to those of the untreated lesions (E, F) (SUVmax of 1.9 vs. SUVmax of 9.8 and 3.0).
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In contrast to MRI, 68Ga-DOTATATE PET revealed an additional distant small dural and intraosseous right frontopolar lesion ( Figure 2 ).
Follow-up MRI after 10 weeks (A) showing a progressive lesion (red circle) compared to the baseline MRI (B). At initial evaluation, only a small dural alteration was observed (white arrow). In contrast, PET imaging detected considerably increased somatostatin receptor (SSTR) expression as assessed by 68Ga-DOTATATE uptake.
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Reviewing the baseline MRI, a small dural alteration in this particular region may have been interpreted as abnormal ( Figure 3 ).
Immunohistochemistry did not reveal differences in the expression of somatostatin receptor subtype 2A (SSTR2A) between the right temporopolar (A) and right frontal tumor (B). Immunohistochemistry with polyclonal rabbit anti-SSTR2A, slide counterstain hematoxylin (1:100 dilution; Zytomed-Systems), original magnification x400.
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Immunohistochemistry did not reveal differences in the expression of SSTR2A between the two lesions ( Figure 4 ).