Abstract Objective Meningiomas are common brain tumors with somatostatin receptors that bind octreotide. We report the use of 111 indium-octreotide brain scintigra- phy (OBS) for the non-invasive differentiation of meningiomas from other cranial dural-based pathol- ogy. Methods A retrospective analysis of our experience with OBS for non-invasive identification of meningio- mas was performed. Two neuroradiologists, blinded to clinical data, utilized a standardized grading scheme to define the uptake of octreotide at 6 and 24 h post- administration. The correlation between (18) F-fluoro- 2-deoxy-d-glucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) scans, and octreotide uptake was assessed. Results The cohort consisted of 50 patients having a mean age of 62.4 years and a median follow-up time of 24 months. Management consisted of biopsy (n = 4); resection (n = 10); observation (n = 16); radiosurgery (n = 21); and external beam radiotherapy (n = 3). OBS was correlated with MRI (n = 50); FDG-PET brain studies (n = 38); histology (n = 14), and angiography (n = 1). In cases where definitive diagnosis could be made, the sensitivity, specificity, positive and negative predictor values for OBS alone were 100; 50; 75; and 100, respectively. OBS provided false positive data in 3 patients (metastasis, chronic inflammation, lym- phoma). Use of OBS with MRI to differentiate men- ingiomas from other lesions was highly significant (P < 0.001). FDG-PET correctly identified malignant pathology with 100% sensitivity and specificity. Conclusion OBS may increase the diagnostic speci- ficity of conventional MRI when differentiating menin- gioma from other dural-based pathologies, while the addition of FDG-PET differentiates benign from malignant lesions. Keywords Brain Æ Dura Æ Meningioma Æ Octreotide Æ Scintigraphy Æ FDG-PET Introduction Radiographic discrimination of meningiomas from other cranial dural-based lesions can be problematic. The widespread use of magnetic resonance imaging (MRI) has resulted in increased detection of patients harboring asymptomatic intracranial lesions. Following N. Nathoo Æ K. Ugokwe Æ M. A. Vogelbaum Æ G. H. Barnett Department of Neurosurgery, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH, USA A. S. Chang Æ J. Ross Department of Neuroradiology, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH, USA L. Li Department of Biostatistics and Epidemiology, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH, USA J. H. Suh Department of Radiation Oncology, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH, USA N. Nathoo Æ K. Ugokwe Æ J. Ross Æ J. H. Suh Æ M. A. Vogelbaum Æ G. H. Barnett (&) Brain Tumor Institute, The Taussig Cancer Center, The Cleveland Clinic Foundation, R20, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail: barnett@neus.ccf.org J Neurooncol (2007) 81:167–174 DOI 10.1007/s11060-006-9210-5 123 CLINICAL-PATIENT STUDIES The role of 111 indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas Narendra Nathoo Æ Kene Ugokwe Æ Albert S. Chang Æ Liang Li Æ Jeffrey Ross Æ John H. Suh Æ Michael A. Vogelbaum Æ Gene H. Barnett Received: 3 November 2005 / Accepted: 8 June 2006 / Published online: 19 July 2006 Ó Springer Science+Business Media B.V. 2006