Nuclear medicine has progressed from an exploratory discipline, historically constrained by limited spatial resolution and qualitative interpretation, into a rigorously quantitative clinical specialty. This evolution represents a systematic conversion of uncertainty into actionable information. Uncertainty that was once implicit and observer-dependent is increasingly measured, modelled, and managed across the full imaging-therapy continuum. Early tracer work established the foundational diagnostic logic of assessing function before structure. Subsequent instrumentation advances, culminating in the contemporary deployment of long axial field-of-view total-body positron emission tomography (PET) and digital cadmium-zinc-telluride detectors, have compressed spatial ambiguity and enabled true dynamic, multi-organ kinetic modelling. Hybrid imaging further reduced uncertainty by coupling functional signals to anatomical context, while artificial intelligence has emerged as a transformative force, enabling synthetic attenuation correction, automated total tumour volume segmentation, and the deployment of 3D vision-language foundation models for multimodal analysis. Parallel progress in radiochemistry and target biology has shifted tracer development toward highly specific receptor and antigen ligands. This momentum catalysed the theranostics revolution, where diagnostic imaging serves as an explicit, quantitative gatekeeper for radiopharmaceutical therapy. As the field transitions into the "Alpha-Era"-characterized by the clinical maturation of targeted alpha therapies-dosimetry and radiobiology have become paramount. To harness this complexity, the discipline is adopting Theranostics Digital Twins, advanced computational frameworks that integrate physiologically-based radiopharmacokinetic models, radiobiological optimizers, and patient-specific multi-omics to predict dose-response and mitigate toxicity. Though modern nuclear medicine has not eliminated biological uncertainty, it has formalized its quantification, establishing a highly personalized and augmented therapeutic paradigm capable of overriding sub-clonal tumour resistance and redefining systemic oncology.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
To analyze the relationship between fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and ultrasound breast imaging reporting and data system (BI-RADS) classification, and to evaluate the diagnostic value of their combined application in breast diseases. A retrospective analysis was conducted on the 18F-FDG PET/CT images and ultrasound BI-RADS classification data of 110 patients with suspected breast cancer treated at our hospital from July 2020 to May 2022. Pearson correlation analysis was used to assess the relationship between the maximum standardized uptake value (SUVmax) and BI-RADS classification. Using pathology or long-term follow-up results as the "gold standard," the diagnostic value of 18F-FDG PET/CT, ultrasound BI-RADS classification, and their combined application in breast diseases was analyzed. Based on the "gold standard" of pathology or long-term follow-up, of the 110 patients with suspected breast cancer, 49 were benign, and 61 were malignant. The SUVmax levels of malignant lesions were significantly higher than those of benign lesions (P<0.05). Pearson correlation analysis indicated a low correlation between SUVmax and ultrasound BI-RADS classification (r=0.458, P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the combined application of SUVmax and ultrasound BI-RADS classification was higher than that of either method alone, both for breast tumors and for patients classified as BI-RADS category 3 to 4. The correlation between SUVmax and ultrasound BI-RADS classification is low (r=0.458), indicating that these two methods assess different biological aspects of breast tumors. However, the combined use of SUVmax and BI-RADS classification significantly enhances diagnostic accuracy, particularly for patients with BI-RADS 3 to 4 lesions. Although this combination improves diagnostic efficacy, 18F-FDG PET/CT should not be used as a primary screening tool but rather as a complementary method in specific clinical scenarios where imaging findings are inconclusive or suspicion of malignancy is high.
This study investigated the diagnostic test accuracy of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) based radiomics features for prediction of programmed cell death protein 1 and its ligand (PD-L1) expression in non-small cell lung cancer (NSCLC). A systematic search was performed in PubMed and EMBASE (last updated in 31 August 2024). Studies evaluating diagnostic performance of 18F-FDG PET/CT based radiomics features for prediction of PD-L1 expression in NSCLC. The sensitivities, specificities, positive and negative likelihood ratios (LR+ and LR-), and pooled area under curve (AUC) were estimated. The pooled sensitivity of 18F-FDG PET/CT was 0.75 (95% CI; 0.64-0.83) and a pooled specificity of 0.66 (95% CI; 0.52-0.78) for prediction of >1% expression of PD-L1. For prediction of >50% expression of PD-L1, the pooled sensitivity of 18F-FDG PET/CT was 0.77 (95% CI; 0.67-0.85) and a pooled specificity of 0.61 (95% CI; 0.55-0.66). For >1% expression of PD-L1, the pooled AUC of fixed effects was 0.791 (95% CI; 0.771-0.811) and of random effects was 0.783 (95% CI; 0.722-0.845). For >50% expression of PD-L1, the pooled AUC of fixed effects was 0.735 (95% CI; 0.718-0.751) and of random effects was 0.766 (95% CI; 0.706-0.825). Analysis of the available studies indicated that 18F-FDG PET/CT based radiomics features showed a moderate diagnostic performance for prediction of PD-L1 expression in NSCLC. However, future studies would be necessary for standardization of the method for prediction of PD-L1 expression in NSCLC using 18F-FDG PET/CT based radiomics features.
The aim of this retrospective study was to evaluate the clinical characteristics, treatment response and toxicity profile of patients treated withpeptide receptor radionuclidetherapy (PRRT) using 177Lu-DOTATATE at the Department of Nuclear Medicine at Theageneio Cancer Hospital. Forty-nine patients with advanced somatostatin receptor-positive neuroendocrine tumors (NETs) and related neoplasms underwent treatment with 177Lu-DOTATATE between January 2022 and January 2026. Demographic, clinical, imaging and therapeutic data were retrospectively analyzed. Response assessment was performed according to RECIST 1.1 criteria. Toxicity evaluation included hematologic, renal and hepatic adverse effects. Pancreatic and small intestine NETs represented the most common primarytumors. Liver, lymph node and bone metastases were the predominant metastaticsites. Disease control was achieved in 81.3% of patients, with partial response observed in 27.1% and stable disease in 54.2% of patients, and most individuals completed the planned four treatment cycles. Hematologic toxicity was recorded in a minority of eight cases, while severe renal or hepatic toxicity remained uncommon. PRRT with 177Lu-DOTATATE appears to be an effective and generally well-tolerated therapeutic option in patients with advanced NETs, providing high disease control rates with acceptable toxicity.
Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.
The aim of the presented study was to evaluate the efficacy and safety of 177Lu-PSMA radioligand therapy in patients with metastatic castration-resistant prostate cancer (mCRPC) in a hospital clinical setting.
Malignant melanoma is one of the most aggressive skin neoplasms and a major example of progress in modern oncology. The objective of this article is to review the most recent therapeutic data and the transition from diagnosis to modern immunotherapy based on a comprehensive review of the current literature and pivotal clinical trials. The results demonstrate that the profound understanding of the relationship between cancer and the immune system, along with the development of immunotherapies (CTLA-4 and PD-1 inhibitors) and targeted therapies (BRAF/MEK inhibitors), have radically changed the therapeutic approach and patient prognosis. Today, a significant number of patients can achieve long-term disease remission, even in advanced stages. Furthermore, modern molecular medicine has highlighted the importance of biomarkers, while neoadjuvant and adjuvant treatments significantly reduce the risk of relapse. In conclusion, the transition from chemotherapy to targeted and immunological therapies marks a new era in oncology, where treatment personalization and the utilization of the immune system itself constitute the core of the modern oncological strategy.
For scientists, Nuclear Medicine is a dynamic and evolving branch of medical science, with high-tech tools, highly precise imaging methods, and therapeutic applications that open up new doors and opportunities. As for the patient, Nuclear Medicine is much more. It is the moment when science meets anxiety, uncertainty, but nonetheless hope.
The integration of artificial intelligence (AI), particularly large language models (LLM), into medical research writing is reshaping the landscape of academic authorship, productivity, and scholarly merit. It has been demonstrated that LLM are capable of greatly expediting the process of researching, drafting, and publishing manuscripts, despite current limitations currently necessitating intensive human oversight to ensure veracity and mitigate the phenomenon of "hallucination". With these limitations being addressed by AI developers and perhaps on their way to irrelevance, a different question emerges as the most, and perhaps only, important one. This paper adopts a first-principles ethical approach to examine the core moral question: independent of technological feasibility, to what extent is it ethically permissible to use AI in the drafting of medical research? We argue that the ethical imperative to accelerate scientific discovery, especially in Medicine, outweighs traditional concerns about the mechanics of authorship and merit attribution. Drawing on Aristotelian teleological reasoning, we contend that the primary value of research lies not in the process of its composition but in its capacity to alleviate suffering and advance human knowledge. Further, we understand authorship as inherently human, as only humans possess the moral agency required to accept responsibility for their work, which is something AI, by its nature, lacks. The paper concludes with a set of normative recommendations to guide the responsible and transparent integration of LLM in research.
To analyze and compare the diagnostic value of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging and integrated PET/magnetic resonance imaging (MR) in pediatric tumors. A retrospective analysis was conducted on the clinical data of 61 pediatric patients with malignant tumors admitted to our hospital from September 2022 to December 2023. All patients underwent pathological examinations as well as 18F-FDG PET/CT and integrated PET/MR imaging. The pathological diagnosis results were used as the gold standard. Pearson correlation analysis, Bland-Altman analysis, and t-tests were used to compare the maximum standardized uptake value (SUVmax), signal-to-noise ratio (SNR), and target-to-background ratio (T/B) between the two methods. Chi-square tests were employed to compare the diagnostic efficacy differences of each index. Among the 61 pediatric malignant tumor patients, a total of 417 lesions were detected, of which 363 lesions showed high uptake on both PET/MR and PET/CT. Among the remaining 54 PET-negative lesions, 9 were CT-positive but MR-negative, including 6 in the lungs and 3 in the vertebrae, while 12 lesions were MR-positive but CT-negative, including 5 in the liver, 4 in the brain, and 3 in the breasts. No statistically significant difference was found in the PET positivity rate or diagnostic results between the two devices (P<0.05). Bland-Altman analysis showed that the background uptake of PET/MR images was lower than that of PET/CT, and the SNR was higher (P<0.05); the SUVmax of the lesions on PET/MR was higher than that on PET/CT (P<0.05); the T/B value of PET/MR images was higher than that of PET/CT (P<0.05). In terms of correlation, the SUVmax, SNR, and T/B values between PET/MR and PET/CT were positively correlated (r=0.919, 0.507, 0.698, P<0.05). In the diagnosis of pediatric malignant tumors, PET/MR and PET/CT have relatively consistent lesion detection rates. PET/MR images have a higher SNR and better resolution, making them more advantageous than PET/CT for evaluating lesions in the liver, brain, and other soft tissue organs, thus warranting clinical application.
Clinical practice guidelines are indispensable tools for evidence-based decision-making, yet they are not inherently free of subjectivity and cannot replace clinical expertise or critical judgment. This is particularly relevant in differentiated thyroid cancer, where disease heterogeneity, overdiagnosis of low-risk tumors, and variability among available recommendations often complicate management, especially in relation to postoperative radioiodine administration. This review critically appraises contemporary guideline documents relevant to differentiated thyroid cancer, with emphasis on their evidence base, practical applicability, and implications for nuclear medicine practice. Major European recommendations from ESMO, ETA, and SNMMI/EANM were compared with the 2025 American Thyroid Association guidelines, focusing on risk stratification, radioiodine use, molecular testing, surveillance, and multidisciplinary implementation. Real-world applicability was also considered in light of published comparative analyses. Across the reviewed documents, a clear trend toward individualized, risk-adapted management was observed. Routine radioiodine ablation is increasingly discouraged in low-risk disease, while selective use is recommended in intermediate-risk patients and retained in high-risk settings. Dynamic reassessment, structured follow-up with ultrasound and thyroglobulin monitoring, and incorporation of molecular markers are now integral components of modern management frameworks. However, differences in terminology, structure, and implementation persist between European and American guidance. Overall, contemporary guidelines support a precision medicine approach to differentiated thyroid cancer while underscoring the need for contextual interpretation and critical appraisal. European recommendations offer a practical framework for everyday clinical use, whereas ATA 2025 contributes methodological refinement through dynamic reassessment. The findings highlight the importance of combining evidence-based recommendations with physician judgment to optimize individualized patient care.
Quantitative imaging in nuclear medicine has evolved from simple photon counting to the estimation of absolute physical quantities such as activity concentration. This transition enhances diagnostic accuracy and supports personalized treatment planning. The present work reviews the principles of quantitative imaging in SPECT and PET, highlighting major degrading factors and correction techniques. Emphasis is placed on clinical applications including dosimetry, theranostics, and functional organ assessment, as well as on dynamic imaging approaches. Finally, current developments and future perspectives toward standardized and automated quantification are discussed.
Gallium-68 (68Ga)-pentixafor, a novel positron emission tomography (PET) tracer with high affinity for C-X-C motif chemokine receptor 4 (CXCR4), has recently been introduced in order to assess the CXCR4 expression status in vivo. This study is to investigate the role of 68Ga-pentixafor in detecting various tumors with mice models and to provide references to clinical studies. Gallium-68-pentixafor and fluorine-18-fluorodeoxyglucose (18F-FDG) PET was performed in opm-2 (lymphoma), daudi (myeloma) and panc1 (pancreatic cancer)-bearing mice. Tumor and background tissue uptake between 68Ga-pentixafor and 18F-FDG PET were compared. Gallium-68-pentixafor PET/computed tomography (CT) was performed in four patients with lymphoma and three patients with multiple myeloma, and 18F-FDG PET/CT was performed as a reference. The uptake of 68Ga-pentixafor in background tissues including muscle, liver and kidneys were all lower than those of 18F-FDG. The uptake of 68Ga-pentixafor in the tumors of lymphoma and myeloma-bearing xenografts was comparable or higher than those of 18F-FDG. However, the tumors of panc-1 xenografts had much lower uptake of 68Ga-pentixafor than those in lymphoma and myeloma-bearing mice, and it was also significantly lower than those of 18F-FDG. The high uptake of 68Ga-pentixafor in vivo was confirmed by the high expression of CXCR4 in tumors with immunochemical analysis. Gallium-68-pentixafor PET/CT in patients with marginal zone lymphoma (MZL) and myeloma showed more intense uptake and more extensive involvement than 18F-FDG PET/CT did. Gallium-68-pentixafor and 18F-FDG PET/CT showed comparable uptake in the patient with follicular lymphoma. Gallium-68-pentixafor is a promising agent for the evaluation of lymphoproliferative diseases.
Gated myocardial perfusion imaging (GMPI) is a cornerstone non-invasive tool for diagnosing and risk stratifying patients with suspected or known coronary artery disease (CAD). Stress-only protocols are advocated in guidelines due to reduced radiation exposure and cost, but long-term data on the absence of major adverse cardiac events (MACE) in a large cohort is valuable. This study aimed to evaluate the long-term outcomes in a large cohort of patients who underwent a normal stress-only myocardial perfusion imaging (MPI) and had no major adverse cardiac events over a 5-year follow-up period. We retrospectively analyzed data from 1000 consecutive patients referred for MPI due to symptoms of stable CAD between 21/05/2018 and 21/7/2025. All patients underwent a stress-only MPI protocol. Only patients with visually interpreted normal stress scans were included in the analysis. The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as cardiac death or non-fatal myocardial infarction (MI), as ascertained through telephone interview and standardized follow-up over a median of 5 years. The study population included 1000 patients (mean age: 65.4±10.7 years), (43.4% male). All patients had normal stress-only myocardial perfusion scans. During the median 5-year follow-up period, no major adverse cardiac events (cardiac death or MI) were recorded using telephone interviews across the entire cohort. The annualized cardiac event rate was 0%, reinforcing previously reported low event rates of less than 1% per year for normal studies. In this large cohort of patients presenting with symptoms of stable CAD who had normal findings on GMPI, the complete absence of major adverse cardiac events over a 5-year follow-up period (only one experienced 1 vessel coronary artery disease 6 years post GMPI) confirms the robust negative predictive value of this imaging modality. These findings support the use of a normal stress-only protocol for identifying a very low-risk patient population in whom further aggressive diagnostic workup may not be necessary.
To investigate the determinants of cure after radioactive iodine (RAI), a treatment frequently used to treat Graves' thyrotoxicosis. We conducted a retrospective analysis of data from 160 consecutive patients with Graves' thyrotoxicosis who received 370MBq of iodine-131 (131I) at one centre between 2009 and 2018. Data included gender, age, cause of thyrotoxicosis, and number of RAI doses administered. Free thyroxine (fT4) and triiodothyronine (fT3) level at diagnosis, thyroid stimulating hormone (TSH), fT4 and fT3 levels on the day of RAI, and TSH, fT4 and fT3 at 3, 6, and 12-months post RAI treatment were reviewed. Cure was defined as achieving a euthyroid or hypothyroid state within one year of RAI administration. Eighty one percent of the total cohort achieved cure at one year. Sixty one point eight percent of patients developed hypothyroidism within one year necessitating lifelong thyroxine replacement. fT4 at diagnosis (P=0.02), fT3:fT4 ratio at diagnosis (P=0.05) and the ratio of fT4 at diagnosis to fT4 pre-RAI ratio (P=0.05) and fT4 pre-RAI (P=0.002) were independent variables associated with cure after one year. Radioactive iodine is a highly effective treatment for Graves' thyrotoxicosis. It is more likely to be successful in patients with lower fT4 at diagnosis and pre-RAI.
Using radiolabeled prostate-specific membrane antigen (PSMA) ligands for the treatment of metastatic prostate cancer is a promising therapeutic approach. This systematic review and meta-analysis aims to assess the efficacy and safety of actinium-225 (225Ac)-PSMA radioligand therapy (RLT) for prostate cancer. The systematic review and meta-analysis adheres to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Searches were conducted in databases including PubMed, Web of Science, Medline, CNKI, and VIP, for studies related to 225Ac-PSMA RLT for prostate cancer from inception until April 2024. The primary endpoint was the therapeutic effect as measured by post-treatment biochemical response evaluation criteria, while secondary endpoints included evaluating overall survival (OS), progression-free survival (PFS), molecular responses. A total of 17 studies involving 1042 patients were included. The pooled proportion of patients with PSA reduction was 85% (95% confidence interval [CI]: 80%-91%), and the pooled rate of PSA reduction >50% was 66% (95% CI: 58%-75%). The combined values for OS and PFS were 13.79 months (95% CI: 11.11-16.48 months) and 9.67 months (95% CI: 6.99-12.35 months), respectively. The molecular response rate was 71% (95% CI: 56-87%). The most common side effect of 225Ac-PSMA RLT was xerostomia, accounting for 63.5%. Anemia, leukopenia, thrombocytopenia, and renal toxicity were observed in 54.3%, 30.4%, 31.8%, 32.0%, respectively. Actinium-225 -PSMA RLT is an effective and safe treatment for metastatic castration-resistant prostate cancer (mCRPC) patients, with a low incidence of treatment-related adverse reactions. Additionally, a history of lutetium-177 (177Lu) treatment may have an impact on PSA reduction in mCRPC patients.
Brain metastases occur in 40%-60% of melanoma patients and represent a major clinical challenge with historically poor prognosis. While conventional neuroimaging modalities such as magnetic resonance imaging (MRI) delineate metastases with high specificity, they cannot capture the widespread cerebral metabolic disruptions that underlie neurological impairment associated with infiltrative lesions. This case report demonstrates the utility of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in characterizing regional brain metabolic changes in metastatic melanoma. We present a case of a 78-year-old female diagnosed with metastatic melanoma who underwent 18F-FDG PET/CT restaging. The imaging findings revealed hypometabolism in regions adjacent to hypoattenuation in the left occipital area, which was subsequently confirmed as a discrete parietal lobe metastasis on MRI. Quantitative assessment using MIMneuro software across 84 brain regions revealed diffuse metabolic disturbances extending beyond the focal lesion. The most pronounced hypometabolism was observed in the cingulate gyri (z=-4.47), cerebellum (z=-2.29), pons (z=-2.22), and temporal regions (z=-2.18). In contrast, marked hypermetabolism was noted in occipital and parietal regions (z=5.71). These widespread patterns support the concept that brain metastases can result in systemic neurological defects, disrupting mechanisms related to diaschisis, vascular regulation, and immune-mediated pathways. These findings highlight the utility of 18F-FDG PET/CT in uncovering functional brain alterations not visible on conventional imaging, offering potential value in clinical decision making and disease assessment of melanoma patients with brain metastases.
Primary hepatic extraskeletal osteosarcoma (PHOS) is an extremely rare and aggressive malignant tumor originating in the liver with no primary skeletal lesion. Less than 1% of all extraskeletal osteosarcomas occur in the liver, often presenting as a large abdominal mass with poor prognosis. We report a rare case of a 64-year-old man diagnosed with a giant PHOS (163×128×160mm) accompanied by pulmonary and lymph node metastases. Multimodal imaging magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, positron emission tomography (PET)/CT demonstrated a heterogeneous hepatic mass with extensive calcifications, rim enhancement, restricted diffusion, and elevated fluorine-18-fluorodeoxyglucose (18F-FDG) uptake. Histopathological analysis confirmed the diagnosis, showing atypical mesenchymal cells producing osteoid matrix with strong special AT-rich sequence-binding protein 2 (SATB2) positivity and negative epithelial markers. Imaging characteristics and immunohistochemical profiling were crucial in differentiating PHOS from hepatocellular carcinoma and metastatic osteosarcoma. The case supports the metaplasia theory of PHOS pathogenesis and highlights its radiologic-pathologic correlation, especially the "cloud-like" enhancement on imaging corresponding to unmineralized osteoid and vascular proliferation. This case highlights the diagnostic challenge and clinical significance of PHOS. Comprehensive imaging and pathological evaluation are essential for accurate diagnosis. Due to its rarity and aggressiveness, PHOS requires individualized management strategies, typically involving surgery and adjuvant therapies despite limited evidence-based guidelines.
The low mortality of papillary thyroid carcinoma (PTC) has led to progressively less aggressive therapeutic approaches according to the latest 2025 guidelines. However, morbidity associated with persistent disease and cervical lymph node metastases remains a significant clinical challenge. The presence of undetected "occult" metastases and the occurrence of nodal recurrences following apparently adequate treatment raise concerns regarding the effectiveness of current diagnostic and therapeutic strategies. Improving preoperative diagnostic accuracy in assessing both the extent and aggressiveness of the disease could play a decisive role in selecting the most appropriate surgical approach and the need for adjuvant radioactive iodine (RAI) therapy. Precise topographical localization of the tumor represents an additional risk factor that should be incorporated into therapeutic decision-making.