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Updated: Feb 23, 2026
Hybrid PET/MRI Imaging of Alzheimer's Disease Based on 18F-AV-1451
Published on: April 18, 2025
Uptake of AV-1451 in meningiomas
Tyler J Bruinsma1, Derek R Johnson2,3, Ping Fang2
1Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. bruinsma.tyler@mayo.edu.
Aim:
AV-1451 is an imaging agent labeled with the positron-emitting radiolabel Fluorine-18. 18F-AV-1451 binds paired helical filament tau (PHF-tau), a pathology related to Alzheimer's disease. In our study of AV-1451 uptake in the brains of cognitively normal subjects, we noted a case of a meningioma with visually significant uptake of AV-1451.
Objective:
We initiated the present retrospective study to further examine cases of meningioma that underwent AV-1451 imaging.
Methods:
We searched the patient records of 650 patients who had undergone AV-1451 at our institution for the keyword "meningioma" to identify potential cases. PET/CT and MRI results were visually reviewed and semi-quantitative analysis of PET was performed. A paired student's t test was run between background and tumor standard uptake values. Fisher's exact test was used to examine the association between AV-1451 uptake and presence of calcifications on CT.
Results:
We identified 12 cases of meningioma, 58% (7/12) of which demonstrated uptake greater than background using both visual analysis and tumor-to-normal cortex ratios (T/N + 1.90 ± 0.83). The paired student's t test revealed no statistically significant difference between background and tumor standard uptake values (p = 0.09); however, cases with a T/N ratio greater than one showed statistically higher uptake in tumor tissue (p = 0.01). A significant association was noted between AV-1451 uptake and presence of calcifications (p = 0.01).
Conclusion:
AV-1451 PET imaging should be reviewed concurrently with anatomic imaging to prevent misleading interpretations of PHF-tau distribution due to meningiomas.
Insights
Meningiomas can show significant uptake of the Alzheimer's imaging agent AV-1451, potentially mimicking tau pathology. Concurrent review with anatomic imaging is crucial to avoid misinterpretation of PET scans.
Area of Science:
- Neurology
- Radiology
- Nuclear Medicine
Background:
- AV-1451 (Fluorine-18 labeled) targets paired helical filament tau (PHF-tau), a key marker in Alzheimer's disease.
- An incidental finding of significant AV-1451 uptake in a meningioma prompted this investigation.
Purpose of the Study:
- To investigate the characteristics of AV-1451 uptake in meningiomas.
- To determine the association between AV-1451 uptake and meningioma features.
Main Methods:
- Retrospective review of 650 patients who underwent AV-1451 PET/CT imaging.
- Identification of 12 meningioma cases; visual and semi-quantitative PET analysis.
- Statistical analysis (t-test, Fisher's exact test) of AV-1451 uptake, tumor characteristics, and calcifications.
Main Results:
- 7 out of 12 meningiomas (58%) showed AV-1451 uptake greater than background.
- Significant association found between AV-1451 uptake and the presence of calcifications (p=0.01).
- Tumor-to-normal cortex ratios > 1 indicated statistically higher uptake in tumor tissue (p=0.01).
Conclusions:
- Meningiomas can exhibit AV-1451 uptake, potentially confounding tau PET imaging interpretation.
- Concurrent review of AV-1451 PET with anatomic imaging (CT/MRI) is essential.
- This finding highlights the importance of considering non-tau-related factors in PET imaging.
