IMG-74. Postoperative MRI changes mimicking early meningioma recurrence: a case series highlighting the role of somatostatin receptor imaging

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Abstract INTRODUCTION Meningiomas are the most common primary intracranial tumors. The majority of symptomatic cases are managed with surgical resection followed by routine surveillance using MRI. However, the interpretation of later-stage postoperative surveillance MRIs can be challenging, as expected postsurgical changes—such as inflammation, gliosis, or dural thickening—can mimic recurrent disease. Somatostatin receptor-based imaging is a modality that is highly sensitive for recurrent tumor due to the consistent overexpression of somatostatin receptor subtype 2 (SSTR2) in meningiomas. This case series illustrates the critical utility of somatostatin receptor-based imaging in distinguishing normal post-operative changes from recurrent meningioma in later-stage post-operative surveillance MRIs. CASES Three patients underwent resection for presumed meningioma, with final pathology confirming one WHO Grade I meningioma and two WHO Grade II meningiomas. Each patient completed an immediate postoperative MRI showing total or near-total resection. Subsequent surveillance MRIs, obtained between 2-8 months post-operatively, revealed new and unexpected enhancement concerning for tumor recurrence. In each case, somatostatin-receptor based imaging was obtained and demonstrated no radiotracer uptake in the areas of enhancement, confirming the absence of viable tumor and thus avoiding unnecessary escalation of care and invasive procedures. DISCUSSION/CONCLUSION This case series underscores the valuable and often underutilized role of somatostatin receptor-based imaging in the interpretation of ambiguous postoperative MRI findings in meningioma patients. As conventional MRI lacks specificity in differentiating tumor recurrence from benign surgical changes, the integration of somatostatin receptor-based imaging into later-stage post-operative surveillance can meaningfully enhance diagnostic accuracy. This approach reduces clinical uncertainty, mitigates patient anxiety, and prevents invasive interventions. Although limited by a small sample size, these findings advocate for a paradigm shift in the postoperative management of meningiomas—positioning somatostatin receptor-based imaging as a vital adjunct in the long-term follow-up of these patients.

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