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Background and Purpose  Meningiomas, the most common primary intracranial tumor, are vascular neoplasms that express somatostatin receptor-2 (SSTR2). The purpose of this investigation was to evaluate if a relationship exists between tumor vascularity and SSTR2 expression, which may play a role in meningioma prognostication and clinical management.    Materials and Methods  Gallium-68-DOTATATE PET/MRI with dynamic contrast-enhanced (DCE) perfusion was prospectively performed. Clinical and demographic patient characteristics were recorded. Tumor volumes were segmented and superimposed onto parametric DCE maps including flux rate constant ( Kep ), transfer constant ( Ktrans ), extravascular volume fraction ( Ve ), and plasma volume fraction ( Vp ). Meningioma PET standardized uptake value (SUV) and SUV ratio to superior sagittal sinus (SUVR SSS ) were recorded. Pearson correlation analyses were performed. In a random subset, analysis was repeated by a second investigator, and intraclass correlation coefficients (ICCs) were determined.    Results  Thirty-six patients with 60 meningiomas (20 WHO-1, 27 WHO-2, and 13 WHO-3) were included. Mean  Kep  demonstrated a strong significant positive correlation with SUV (r = 0.84, p &amp;lt; 0.0001) and SUVR SSS  (r = 0.81, p &amp;lt; 0.0001). When stratifying by WHO grade, this correlation persisted in WHO-2 (r = 0.91, p &amp;lt; 0.0001) and WHO-3 (r = 0.92, p = 0.0029) but not WHO-1 (r = 0.26, p = 0.4, SUVR SSS ). ICC was excellent (0.97–0.99).    Conclusion  DOTATATE PET/MRI demonstrated a strong significant correlation between tumor vascularity and SSTR2 expression in WHO-2 and WHO-3, but not WHO-1 meningiomas, suggesting biological differences in the relationship between tumor vascularity and SSTR2 expression in higher-grade meningiomas, the predictive value of which will be tested in future work.

PET/MR Imaging of Somatostatin Receptor Expression and Tumor Vascularity in Meningioma: Implications for Pathophysiology and Tumor Outcomes