Somatostatin receptor PET in meningioma: diagnosis, therapy, and surveillance

Meningiomas account for 41.7% of primary central nervous system (CNS) tumors and overexpress somatostatin receptor 2 (SSTR2) receptors, enabling superior tumor-to-background contrast compared with MRI and computed tomography imaging, which have limited ability to distinguish neoplastic tissue from normal dural enhancement. This review aimed to evaluate SSTR-targeted PET radiotracers for diagnosis, treatment planning, surveillance, and theranostic applications in meningioma management. Literature review of PubMed, Google Scholar, Embase, and Web of Science databases from inception to November 2025. Studies evaluating [ 68 Ga]Ga-DOTATATE, [ 68 Ga]Ga-DOTATOC, [ 68 Ga]Ga-DOTANOC, and novel fluorine-18 tracers in meningioma patients were analyzed. SSTR-PET demonstrated superior diagnostic sensitivity (95-100%) with 10-fold higher SSTR2-binding affinity than conventional scintigraphy. Osseous involvement detection exceeded MRI (98.5 vs. 53.7%; n  = 82). PET-guided radiation planning reduced target volumes by 84% (71.39 → 11.12 cm 3 ; P  < 0.05) while decreasing critical structure exposure by greater than or equal to 50%. Posttreatment surveillance detected residual tumor in 41-63% of patients deemed completely resected by Simpson grading and MRI ( n  = 37). SSTR-PET altered management in 42% of cases by identifying occult disease. The theranostic paradigm using [ 177 Lu]Lu-DOTATATE achieved 60-80% disease stabilization in recurrent/progressive cases. Next-generation [ 18 F]SiTATE tracers offer improved logistics and cost-effectiveness. Technical heterogeneity in acquisition protocols and lack of standardized uptake value thresholds (range: 2.3->4.0) limit generalizability. SSTR-targeted PET provides superior molecular characterization, enhancing diagnostic accuracy, treatment precision, and surveillance beyond conventional imaging. The theranostic platform enables both precise visualization and targeted radionuclide therapy. Prospective multicenter trials with standardized protocols are essential to establish evidence-based clinical guidelines.