![]() Trial registration: Identifier: NCT04081701. Future studies validating our findings in different patient populations are needed to continue optimizing the diagnostic performance of -DOTATATE PET/MRI in meningioma patients. We found that the SUVRsss method may have the most robust combination of sensitivity and specificity in the diagnosis of meningioma in the post-treatment setting, with the optimal threshold of 3.2. Developing a diagnostic threshold is key to wider clinical translation of -DOTATATE PET/MRI in meningioma evaluation. An ROC analysis of SUV, SUVRsss, SUVRpit, and SUVRnorm revealed AUC of 0.932, 0.910, 0.915, and 0.800, respectively (P < 0.0001). At the optimal thresholds, SUV had the highest specificity (97.6%) and SUVRsss had the highest sensitivity (86.1%). The optimal thresholds for SUV, SUVRsss, SUVRpit, and SUVRnorm were 4.7, 3.2, 0.3, and 62.6, respectively. SUV, SUVRsss, SUVRpit, and SUVRnorm of meningioma were significantly higher than those of PTC (P < 0.0001). 166 meningiomas and 41 PTC lesions were identified across 62 patients. The optimal thresholds for each method were identified using Youden’s J statistics. Previously published pre-determined thresholds were assessed where applicable. Diagnostic performance of the four methods was compared using contingency tables and McNemar’s test. Lesions were reclassified using the following methods: absolute maximum SUV threshold (SUV), SUV ratio (SUVR) to superior sagittal sinus (SSS) (SUVRsss), SUVR to the pituitary gland (SUVRpit), and SUVR to the normal brain parenchyma (SUVRnorm). Lesions were classified as meningiomas and post-treatment change (PTC), using follow-up pathology and MRI as reference standard. Patients with suspected meningioma were imaged prospectively with -DOTATATE brain PET/MRI. Our purpose was to compare diagnostic performance of different approaches to quantitative brain -DOTATATE PET/MRI analysis in patients with suspected meningioma recurrence and to establish the optimal diagnostic threshold for each method. Multiple approaches with -DOTATATE, a somatostatin analog PET radiotracer, have demonstrated clinical utility in evaluation of meningioma but have not been compared directly.
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