¹¹C-Methionine uptake in meningiomas after stereotactic radiotherapy

¹¹C-Methionine positron emission tomography (MET-PET) is used for stereotactic radiotherapy planning in meningioma patients. The role of MET-PET during subsequent follow-up (FU) is unclear. We analyzed the uptake of ¹¹C-Methionine before and after stereotactic radiotherapy (SRT) in patients with a complex meningioma and investigated if there was a difference between patients with progressive disease (PD) and stable disease (SD) during FU.

This retrospective study investigates 62 MET-PETs in 29 complex meningioma patients. Standardized uptake value (SUV)_max and SUV_peak tumor-to-normal ratios (T/N-ratios) were calculated, comparing the tumor region with both the mirroring intracranial area and the right frontal gray matter. The difference in ¹¹C-Methionine uptake pre- and post-SRT was analyzed, as well as the change in uptake between PD or SD.

Median (IQR) FU duration was 67 months (50.5-91.0). The uptake of ¹¹C-Methionine in meningiomas remained increased after SRT. Neither a statistically significant difference between MET-PETs before and after SRT was encountered, nor a significant difference in one of the four T/N-ratios between patients with SD versus PD with median (IQR) SUV_max T/N_{R front} 2.65 (2.13-3.68) vs 2.97 (1.55-3.54) [p = 0.66]; SUV_max T/N_mirror 2.92 (2.19-3.71) vs 2.95 (1.74-3.60) [p = 0.61]; SUV_peak T/N_{R front} 2.35 (1.64-3.40) vs 2.25 (1.44-3.74) [p = 0.80]; SUV_peak T/N_mirror 2.38 (1.91-3.36) vs 2.35 (1.56-3.72) [p = 0.95].

Our data do not support use of MET-PET during FU of complex intracranial meningiomas after SRT. MET-PET could not differentiate between progressive or stable disease.