Synchronous multiple meningiomas and renal cell carcinoma metastasis to the brain in a ₆₈Ga-DOTATATE scan: illustrative case

BACKGROUND In the last few years, there has been an increased use of theragnostics for the detection of intracranial lesions. The use of ₆₈ Ga-DOTATATE has shown beneficial use for meningiomas, but it can pose a challenge when evaluating dura-based metastatic lesions. OBSERVATIONS The authors describe the case of a 60-year-old patient with a confirmed diagnosis of renal cell carcinoma (RCC) that presented on brain MRI with two dura-based lesions and an intra-axial mass. All three lesions presented uptake on ⁶⁸Ga-DOTATATE with different standardized uptake value (SUV) levels. LESSONS ⁶⁸Ga-DOTATATE is highly sensitive for detecting benign and malignant CNS tumors, including small lesions. It aids in planning treatment, defining radiosurgical targets, and monitoring response. In RCC, it yields a higher SUV than ¹⁸F-fluorodeoxyglucose positron emission tomography, making it a more effective diagnostic tool. In meningiomas, the SUV correlates with tumor growth rate. However, specificity is limited, and interpretation requires correlation with MRI, CT, and clinical findings. As its use in CNS tumors grows, understanding its capabilities and limitations is crucial for proper application.