Abstract
A 59 year old patient was referred to our department to detect disease activity related to clinical symptoms of tiredness, weight loss and an elevated serum serotonine, suspicious of a neuro-endocrine tumour. A 18F-fluoro-l-dihydroxy-phenylalanine (FDOPA) PET/CT scan was performed, which showed focally increased uptake in the terminal ileum and in a mesenterial lymph node. Additionally, an area of intense uptake was observed intracranially. Histological analysis confirmed the presence of a WHO grade I meningioma. Few cases of FDOPA PET uptake in meningiomas have been published, underlining it is as a rare finding. Awareness of this potential finding is crucial to avoid misinterpretation as intracerebral metastasis.
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A 59 year old patient was referred to our department to detect disease activity related to clinical symptoms of tiredness, weight loss and an elevated serum serotonine, suspicious of a neuro-endocrine tumour. A 18F-fluoro-l-dihydroxy-phenylalanine (FDOPA) PET/CT scan was performed, which showed focally increased uptake in the terminal ileum and in a mesenterial lymph node (Fig. 1). Additionally, an area of intense uptake was observed intracranially (Fig. 2a, left frontal region). The atypical location of the uptake suggested the presence of a mengioma (Fig. 2b). Based on this PET finding, MRI was performed (2C), which showed an extra-axial mass with extensive contrast enhancement on T1 weighted imaging and a ‘dural tail’, typical of meningioma. Additional findings on MRI were midline shift and edema. Histological analysis confirmed the presence of a WHO grade I meningioma.
FDOPA PET has been used in the evaluation of brain tumours, among other PET techniques using amino acid tracers such as 11C-methionine and -(2-[18F]fluoroethyl)-l-tyrosine (FET) (Becherer et al. 2003; Fueger et al. 2010; Schiepers et al. 2007). The increased uptake of FDOPA is related to the L amino acid transporter (LAT). The LAT facilitates amino acid transport in tumour cells, which in turn use it for protein synthesis. In meningiomas, high LAT1 expression has been described (Zitron et al. 2013). Consequently, increased uptake of FDOPA may be observed in these tumours. In addition, increased uptake of other amino acid PET tracers in meningiomas has been described, including a series of 10 meningiomas which showed increased uptake of -[11C]methyl-L-tryptophan (AMT) (Zitron et al. 2013). as well as of somatostatin radiolabelled analogs (Soto-Montenegro et al. 2014).
Conclusions
Few cases of FDOPA PET uptake in meningiomas have been published (Calabria et al. 2016), underlining it is as a rare finding. Awareness of this potential finding is crucial to avoid misinterpretation as intracerebral metastasis.
Abbreviations
- AMT:
-
Methyl-L-tryptophan
- FDOPA:
-
Fluoro-l-dihydroxy-phenylalanine
- FET:
-
Fluoroethyl)-l-tyrosine
- LAT:
-
L amino acid transporter
References
Becherer A, Karanikas G, Szabo M, Zettinig G, Asenbaum S, Marosi C et al (2003) Brain tumour imaging with PET: a comparison between [18F]fluorodopa and [11C]methionine. Eur J Nucl Med Mol Imaging 30(11):1561–1567
Calabria FF, Chiaravalloti A, Calabria EN, Grillea G, Schillaci O (2016) 18F-DOPA PET/CT and MRI findings in a patient with multiple Meningiomas. Clin Nucl Med 41(8):636–637
Fueger BJ, Czernin J, Cloughesy T, Silverman DH, Geist CL, Walter MA et al (2010) Correlation of 6-18F-fluoro-L-dopa PET uptake with proliferation and tumor grade in newly diagnosed and recurrent gliomas. J Nucl Med 51(10):1532–1538
Schiepers C, Chen W, Cloughesy T, Dahlbom M, Huang SC (2007) 18F-FDOPA kinetics in brain tumors. J Nucl Med 48(10):1651–1661
Soto-Montenegro ML, Pena-Zalbidea S, Mateos-Perez JM, Oteo M, Romero E, Morcillo MA et al (2014) Meningiomas: a comparative study of 68Ga-DOTATOC, 68Ga-DOTANOC and 68Ga-DOTATATE for molecular imaging in mice. PLoS One 9(11):e111624
Zitron IM, Kamson DO, Kiousis S, Juhasz C, Mittal S (2013) In vivo metabolism of tryptophan in meningiomas is mediated by indoleamine 2,3-dioxygenase 1. Cancer Biol Ther 14(4):333–339
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The publication of this article was supported by funds of the European Association of Nuclear Medicine (EANM).
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GNS: writing of the manuscript, lay-out, images. AWJMG, RHJAS, RAJOD: review of the article, providing comments. All authors read and approved the final mansucript.
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Stormezand, G.N., Glaudemans, A.W.J.M., Slart, R.H.J.A. et al. Incidental meningioma detected with [18F]-FDOPA PET/CT. European J Hybrid Imaging 2, 23 (2018). https://doi.org/10.1186/s41824-018-0041-3
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DOI: https://doi.org/10.1186/s41824-018-0041-3