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Background  High-grade gliomas (HGGs) express somatostatin receptors (SSTR), rendering them candidates for peptide receptor radionuclide therapy (PRRT). Our purpose was to evaluate the potential of  68 Ga-DOTA-1-Nal 3 -octreotide ( 68 Ga-DOTANOC) or  68 Ga-DOTA-Tyr 3 -octreotide ( 68 Ga-DOTATOC) to target SSTR subtype 2 (SSTR 2 ) in HGGs, and to study the association between SSTR 2  expression and established biomarkers.    Methods  Twenty-seven patients (mean age 52 years) with primary or recurrent HGG prospectively underwent  68 Ga-DOTA-peptide positron emission tomography/computed tomography (PET/CT) before resection. Maximum standardized uptake values (SUVmax) and receptor binding potential (BP) were calculated on PET/CT and disruption of blood–brain barrier (BBB) from contrast-enhanced T1-weighted magnetic resonance imaging (MRI-T1-Gad). Tumor volume concordance between PET and MRI-T1-Gad was assessed by Dice similarity coefficient (DC) and correlation by Spearman’s rank. Immunohistochemically determined SSTR 2  status was compared to receptor imaging findings, prognostic biomarkers, and survival with Kruskal-Wallis, Pearson chi-square, and multivariate Cox regression, respectively.    Results  All 19 HGGs with disrupted BBB demonstrated tracer uptake. Tumor SUVmax (2.25 ± 1.33) correlated with MRI-T1-Gad ( r  = 0.713,  P  = 0.001) although DC 0.41 ± 0.19 suggested limited concordance. SSTR 2  immunohistochemistry was regarded as positive in nine HGGs (32%) but no correlation with SUVmax or BP was found. By contrast, SSTR 2  expression was associated with  IDH1  mutation ( P  = 0.007), oligodendroglioma component ( P  = 0.010), lower grade ( P  = 0.005), absence of  EGFR  amplification ( P  = 0.021), and longer progression-free survival (HR 0.161, CI 0.037 to 0.704,  P  = 0.015).    Conclusions  In HGGs, uptake of  68 Ga-DOTA-peptides is associated with disrupted BBB and cannot be predicted by SSTR 2  immunohistochemistry. Thus, PET/CT shows limited value to detect HGGs suitable for PRRT. However, high SSTR 2  expression portends favorable outcome along with established biomarkers such as  IDH1  mutation.    Trial registration  ClinicalTrials.gov  NCT01460706

ejnmmi research

Somatostatin receptor subtype 2 in high-grade gliomas: PET/CT with 68Ga-DOTA-peptides, correlation to prognostic markers, and implications for targeted radiotherapy