1. Detection of Estrogen Receptors in Meningiomas Using FES PET-CT Scans, a Pilot Study
National Institute of Neurology and Neurosurgery , Mexico  City, Mexico 
National Autonomous University of Mexico 
Norma Elizabeth Vázquez Estrada , MD. Sergio Moreno Jímenez, MD. Laura Hernández Sánchez, MD.

2. INTRODUCTION Tumors derived from meningeal arachnoid cells.
Females, age 50 to 60 years
30% of intracranial tumors in adults.
WHO classification grades I to III; 1% to 3% can be aggressive. 1,2 
Hormonal receptors previously reported.
PR in 70% , ER 40%  (ER –β) 33.3% 3,4

3. Diagnosis
Treatment
Follow up
Diagnosis: CT Scan, MRI, Pathology
Treatment: Active observation, surgical resection, radiation therapy.
Hard to distinguish between scar or recurrence
Tumours close to the bone or in the skull base.

4. [l8F] Fluoro-17beta-estradiol (FES) PET
PET Positron Emission Tomography
Radiotracers FDG, DOTATOC 6
The [l8F] Fluoro-17beta-estradiol ([18F]FES)  
Breast and endometrial cancer
Similar metabolism to estradiol. 7 
Image via Wikimedia Commons

5. RESEARCH QUESTION
Is it possible to Identify the presence of estrogen receptors in human meningiomas using [ [18F] FES PET CT scans?
Is it feasible to conduct further formal studies using [18F] FES PET CT scans in human meningiomas?

6. MATERIALS AND METHODS External pilot study.
Five subjects with previous diagnosis of Meningioma (2 males, 3 females)
Exclusion criteria:
Hormonal therapy,  <18, no previous diagnosis, lactating and pregnant women.

7. Nuclear Medicine interpretation
Informed consent 
Radiotracer synthetized in the National Autonomous University of Mexico.
Nuclear Medicine service at our institution.
Injection of (6.1 mci) FES 
PET/CT Siemens Biograph mCT 64
Recruitment
FES PET 
Nuclear Medicine interpretation

8. Follow Up Surgery Standard Pathology
T/NT (ratio of tumor activity to that of normal tissue)
SUV (standardized uptake value)
30 min after tracer intake.
Six months follow up, new surgical resection. 
Standard Pathology 
Follow Up  
Surgery 
Standard Pathology

9. RESULTS
Positive uptake of [18F]FES tracer by the tumor in the five patients included.
No adverse effects during the scan or  following 6 months.
Pathology reports confirmed a meningioma diagnosis

10. Subject
Age
Localization of regional uptake
maxSUV index
Max
T/NT
Pathology 1 72
Anterior Falx Cerebri
1.76
5.10
Meningioma GI  2 60
Right Temporal
2.4
5.20
Meningioma GI 3 73
Left Greater 
sphenoidal wing
1.85
5.13
Meningioma GII 4 58
Middle Falx Cerebri
2.0
5.17 5 57
Parasagital and right middle fossa
1.8
5.15
Meningioma GIII
3 GI Meningiomas
1 GII Meningioma
 1 GIII Meningioma
Average Age: 64 years
Average maxT/NT: 
5.15
Average maxSUV Index: 1.96

11. Figure 1: 58 years old male.  CT scan (a) [18F]FES PET (b) and fused PET/CT (c) images of a falx meningioma with tracer uptake of the lesion.
Figure 1: A B C

13. CONCLUSION 
A positive tumor uptake was demonstrated in the five patients,
this could mean a correlation between the presence of ER
and our imaging findings, however, further validation
in larger studies is needed.
It is feasible to perform further formal studies using FES PET scans
in Meningiomas. 

14. DISCUSSION Small sample size, poor external validity.
Immunochemistry and control group needed.
Studies are needed to establish the normal biodistribution of the [18F]FES tracer in the human brain. 

15. FUTURE PERSPECTIVE
Opens the gate to the conduction of formal studies using [18F]FES PET CT to detect the presence of estrogen receptors in meningiomas.
Understanding the role of estrogen receptors in meningiomas
would allow to create new therapies and prognosis.

16. REFERENCES
1 Fathi A-R, Roelcke U. Meningioma.Current Neurology and Neuroscience Reports. 2013;13(4). doi: /s Saraf S, Mccarthy BJ, Villano JL. Update on Meningiomas. The Oncologist. 2011;16(11): doi: /theoncologist Wahab M, Al-Azzawi F. Meningioma and hormonal influences. Climacteric. 2003;6(4): doi: / Liu M, Zhang K, Zhao Y, Guo Q, Guo D, Zhang J. Evidence for involvement of steroid receptors and coactivators in neuroepithelial and meningothelial tumors. Tumor Biology. 2014;36(5): doi: /s Valotassiou V, Leondi A, Angelidis G, Psimadas D, Georgoulias P. SPECT and PET Imaging of Meningiomas. The Scientific World Journal. 2012;2012:1-11. doi: /2012/ DOTATOC PET/CT and contrast-enhanced MRI. European Journal of Nuclear Medicine and Molecular Imaging. 2012;39(9): doi: /s Sundararajan L, Linden HM, Link JM, Krohn KA, Mankoff DA. 18F-Fluoroestradiol. Seminars in Nuclear Medicine. 2007;37(6): doi: /j.semnuclmed