Fluciclovine, Anti-1-Amino-3-[18F]-Fluorocyclobutane-1-Carboxylic Acid: A Novel Radiotracer for Meningioma.

BACKGROUND

Meningiomas are the most common primary intracranial tumors. The current diagnosis and treatment of meningioma is dependent on computed tomography and magnetic resonance imaging, with follow-up management relying mainly on magnetic resonance imaging. The limitations of these structural imaging modalities include delineation of the tumor extent, tumor grade, and differentiation from other meningioma mimickers, especially in or around the skull base. Because studies with positron emission tomography (PET) have shown that PET is able to fulfill some of these gaps, the use of PET for meningiomas has been steadily increasing. Fluciclovine, also known as anti-1-amino-3-[18F]-fluorocyclobutane-1-carboxylic acid (Axumin), is a new PET radiotracer approved by the Food and Drug Administration in 2016 for the detection of suspected recurrent prostate cancer with elevated prostate-specific antigen levels. Because the radiotracer is new, very little is known about the utility of this tracer in brain tumors.

CASE DESCRIPTION: We present 3 cases of meningioma with avid uptake of fluciclovine. In each of these cases, the meningioma was incidentally found during surveillance using PET imaging in patients with prostate cancer.

CONCLUSIONS

These cases illustrate that this new radiotracer has the potential to be a complementary tool in the meningioma workup, treatment, and follow-up, especially for skull base lesions.