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. 2025 Jul 23.
doi: 10.1007/s00259-025-07476-9. Online ahead of print.

Validation of SUV thresholds in [¹⁸F]SiTATE PET/CT for accurate meningioma segmentation

Nabeel Mansour  1 , Julian Joram  2 , Freba Grawe  3   4 , Anna Hinterberger  3   4 , Johannes Rübenthaler  2 , Konstantin Klambauer  2 , Wolfgang G Kunz  2 , Michael Winkelmann  2 , Clemens C Cyran  2 , Jens Ricke  2 , Osman Öcal  2   5 , Marcus Unterrainer  6   7 , Klaus Jurkschat  8 , Carmen Wängler  9 , Björn Wängler  10 , Ralf Schirrmacher  11 , Alexander Nitschmann  12 , Tobias Greve  13 , Gabriel Sheikh  6 , Adrien Holzgreve  6 , Nathalie L Albert  6 , Matthias P Fabritius  2
Affiliations
Free article

Validation of SUV thresholds in [¹⁸F]SiTATE PET/CT for accurate meningioma segmentation

Nabeel Mansour et al. Eur J Nucl Med Mol Imaging. .
Free article

Abstract

Purpose: Somatostatin receptor (SSTR)-targeted PET/CT provides valuable clinical insights beyond standard imaging in meningioma patients. Due to its excellent diagnostic capabilities and favorable logistics, the 18F-labeled SSTR-targeting peptide SiTATE is increasingly in demand. We aimed to validate a recently proposed standard uptake value (SUV) threshold for accurate meningioma delineation in a clinically diverse patient cohort, including complex anatomical locations and lesions with prior surgical intervention.

Methods: Consecutive patients with known or suspected meningioma who underwent [18F]SiTATE PET/CT and contrast enhanced cerebral MRI were included. Lesions were semi-automatically segmented on PET images using an individualized minimal SUV (SUVmin) within a manually defined volume of interest. Correlative CT and MRI images were used to refine segmentations for each lesion, identifying the optimal lesion-specific SUVmin to accurately capture the true volume of the meningioma. All lesions were additionally segmented using the recently proposed threshold of 4.0, and resulting volumes were compared.

Results: 61 patients with 109 lesions were analyzed: 40 (37%) extraosseous, 32 (29%) partial trans-osseous, and 37 (34%) predominantly intraosseous. The median optimal SUVmin for lesion delineation was 4.2. Osseous involvement did not significantly affect the median SUVmin (p = 0.1). Individualized SUV volumes showed excellent absolute agreement with those obtained using the fixed threshold of 4.0 (ICC[A,1] = 0.967; 95% CI: 0.952-0.977; p < 0.0001). However, 17 lesions (SUVmax < 4.2) were not captured by the fixed threshold.

Conclusion: The proposed SUV threshold of 4.0 showed promising results, supporting its suitability for clinical practice. Although limitations were evident, with 16% of lesions - primarily very small - showing reduced uptake and therefore not captured by this threshold, the study underscores its applicability in clinical practice.

Keywords: Meningioma; PET/CT; Segmentation; SiTATE; Threshold.

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Conflict of interest statement

Declarations. Ethics approval: This study complied with the Declaration of Helsinki and its amendments and was approved by the institutional ethics board of Ludwig Maximilians University (LMU) Munich (IRB 22–0353). Competing interests: Author AH reports compensation for scientific consulting by advanced biochemical compounds (ABX).

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