搜索结果：EJNMMI reports

BACKGROUND: 99mTc mercaptoacetyltriglycine (MAG3) studies represent a classic of nuclear medicine. We evaluated the quality of MAG3 reports generated by a vision language model (VLM). The mid-term goal to utilize such systems could be the support of nuclear medicine experts, thereby freeing staff resources currently tied up in administrative and documentation tasks. RESULTS: Human raters generally preferred MAG3 reports written by human authors over those generated using the VLM. Scores for VLM-generated reports improved notably in the subset of cases where the urodynamic curves were correctly identified by the model. Half of the raters found statistically significant differences between human and Qwen-generated reports (Wilcoxon signed-rank test, alpha = 0.05). There was a strong correlation between the assessed text quality and the raters’ ability to correctly identify the source of the text (human or Qwen; R2 = 0.998). CONCLUSION: The VLM-based approach successfully generated MAG3 reports that, to some extent, resembled those written by human experts. However, assessed quality varied among raters. It remains to be seen whether future language model advancements will reach a performance level sufficient for integration into clinical practice.

Radiation segmentectomy (RS) has emerged as a promising approach for hepatocellular carcinoma (HCC), particularly when high tumor doses are achieved. While the clinical utility of ablative doses with glass microspheres is well established, data on resin microspheres remain scarce and inconsistent. This state-of-the-art review aims to provide a descriptive, hypothesis-generating overview of the available evidence and to highlight key gaps in the literature. A structured search of PubMed and Embase was conducted to identify clinical studies, technical reports, and reviews evaluating RS using resin microspheres in patients with HCC. Inclusion was limited to studies reporting dosimetric data or clinical outcomes following high-dose delivery. Both published and unpublished sources were considered to ensure a comprehensive overview. Six publications met the inclusion criteria: four studies with primary clinical data and two narrative reviews. Most were retrospective and single-center, with considerable heterogeneity in methodology and outcome reporting. Reported tumor doses varied widely, and no prospective study has validated safety or efficacy thresholds to date. Nevertheless, selected studies suggest that resin microspheres may achieve tumoricidal doses (> 300 Gy), with encouraging response rates and acceptable safety profiles in highly selective settings. The use of resin microspheres in radiation segmentectomy represents a promising, yet underexplored, therapeutic strategy in HCC. However, the current evidence base is limited, heterogeneous, and not suitable for definitive clinical conclusions. This review is intended to frame the current evidence landscape and generate hypotheses, supporting the need for prospective, standardized investigations to define optimal dosimetry and guide future research.

Pulmonary embolism (PE) remains an important cause of cardiovascular death and morbidity worldwide. Conventionally, PE imaging is reported in a binary manner, with reports stating the presence or absence of a thrombus. No generally accepted graduated quantification systems are available to guide management or predict the development of acute or long-term complications. V/Q SPECT is a well-established method for diagnosing PE in acute and chronic settings. The use of volumetric perfusion and ventilation functional images could potentially calculate the volumetric PE burden. This project aimed to develop and optimise a volumetric V/Q SPECT PE quantification technique, utilising V/Q SPECT phantoms, 100 consecutive clinical V/Q SPECT studies, and advanced V/Q SPECT image analysis with semiautomated %PE quantification methods. Lung phantoms with PE defects of known volume demonstrated that the choice of acquisition, reconstruction parameters, and the volumetric cutoff threshold influences %PE results. The V/Q quotient image utilised a semiautomated technique with phantom-derived optimisation parameters, which was found to be the most accurate quantification method. This study, combining phantom and clinical study analysis, developed a successful method for semiautomated V/Q SPECT %PE quantification, which has the potential utility of guiding patient management and outcome prediction.

Nuclear medicine procedures are increasingly integrated into routine clinical practice worldwide, including in low- and middle-income settings. Although radiopharmaceuticals have a well-established safety profile, the growing volume of diagnostic and therapeutic procedures means that acute adverse events, while uncommon, are encountered with sufficient frequency to present to emergency departments. Emergency physicians are often the first clinicians to assess patients with post-procedural symptoms, yet guidance tailored to emergency care remains limited. This review aims to provide an emergency medicine-focused synthesis of the incidence, clinical presentation, and acute management of adverse events associated with nuclear medicine procedures.We conducted a narrative review using a systematic search strategy across PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library, covering publications from January 2020 to December 2024. Studies reporting acute events related to radiopharmaceutical administration, including extravasation, allergic reactions, maladministration, and radiation contamination, were included. Evidence from cohort studies, surveillance registries, systematic reviews, and relevant case reports was synthesized narratively due to methodological heterogeneity. Sixty-eight studies encompassing over two million radiopharmaceutical administrations were included. Diagnostic radiopharmaceutical extravasation was common when systematically assessed but rarely resulted in clinically significant harm. Severe allergic reactions and anaphylaxis were exceedingly rare. Maladministration events occurred infrequently and were predominantly associated with diagnostic procedures, with minimal patient harm in most cases. In contrast, extravasation and toxicity related to therapeutic radiopharmaceuticals, particularly high-energy beta emitters, carried greater clinical significance. Newer agents such as lutetium-177-labelled therapies demonstrated predictable toxicity profiles, with hematologic adverse events representing the primary emergency care concern.Emerging alpha-emitting theranostic agents such as actinium-225-PSMA-617 demonstrate promising efficacy but may be associated with clinically relevant xerostomia and hematologic toxicity. Acute events related to nuclear medicine procedures are uncommon but clinically relevant in emergency practice. Diagnostic radiopharmaceuticals are generally safe and require supportive management, whereas therapeutic radiopharmaceutical complications warrant heightened vigilance and specialist consultation. Familiarity with these presentations can support timely, appropriate emergency care, particularly in settings with limited on-site nuclear medicine expertise.

AIM: The sensitivity of PSMA-PET/CT for the detection of recurrent prostate cancer (rPC) is good at low PSA values and rapidly rises to > 80% in patients with PSA > 1.5 ng/mL. Currently, there are no general rules on how to manage PSMA-PET-negative patients with rPC and PSA levels at which a pathological PSMA-PET must be considered very likely. The aim of this evaluation was to assess the value of a choline-PET/CT in such a clinical context. MATERIALS AND METHODS: We conducted a retrospective analysis incorporating data from 01/2017–09/2023 from two Swiss institutions. Eligible patients included those with rPC following radical prostatectomy (RP) who had a negative or equivocal [6 8 Ga]Ga-PSMA-11 or [1 8 F]F-PSMA-1007 PET/CT despite a PSA level ≥1.5 ng/mL, and were subsequently referred for [18F]F-Fluorocholine-PET/CT within two months. Two experienced nuclear medicine physicians reviewed both scans (choline and PSMA-PET/CTs) in a blinded consensus read. RESULTS: Eleven patients met all inclusion criteria. The median PSA level was 2.8 ng/mL (range: 1.7–16.0). Following [18F]F-Fluorocholine-PET/CT 6 out of 11 patients (54.5%) demonstrated pathologic choline positive findings indicative of rPC: 4 patients with local recurrence, 1 with distant metastasis only, and 1 with concomitant pelvic lymph node and distant metastases. CONCLUSION: More than 50% of patients with a negative or equivocal PSMA-PET/CT showed pathologic [18F]F-Fluorocholine-PET/CT. These results indicate that [18F]F-Fluorocholine-PET/CT may serve as a valuable complementary imaging modality in patients with rPC after RP who present with a negative PSMA-PET/CT at PSA levels ≥1.5 ng/mL.

Common venous malformations ("hemangiomas") are slow-growing, non-aggressive tumors consisting of small and large caliber vascular channels which can be found throughout the body, including within the musculoskeletal system. In cases where these masses do not present with the typical hallmark X-Ray, CT, or MRI findings, Technetium-99 m labeled Red Blood Cell (RBC) scintigraphy may be performed to confirm the diagnosis. A retrospective chart review was performed of a single patient with an indeterminate lesion of the calvarium. Relevant clinical history and imaging findings were reviewed. Current literature regarding the use of technetium-99 m labeled RBC scintigraphy in the diagnosis of intraosseous hemangiomas was also reviewed. A 25-year-old female initially presented to a neurologist in 2016 for new onset of seizures and intermittent panic attacks, at which time a non-contrast MRI Brain was obtained, revealing a T2 hyperintense and mildly T1 hyperintense mass within the occipital bone, which was suspected to represent an intraosseous hemangioma. She underwent a repeat non-contrast MRI Brain examination 8 years later for headaches, which found an increase in size of the calvarial lesion from 1.6 cm to 2.4 cm. While this lesion was still suspected to represent an intraosseous hemangioma, Technetium-99 m labeled RBC scintigraphy was performed as a confirmatory examination, which revealed normal initial blood flow but abnormal pooling of tagged RBCs within the lesion, thus compatible with a calvarial intraosseous hemangioma. Technetium-99 m labeled RBC scintigraphy can be an effective problem-solving tool in the diagnosis of intraosseous hemangiomas, and may be considered as a confirmatory examination or when results of conventional imaging techniques are felt to be indeterminate, and thus avoiding histologic correlation.

Fibroblast activation protein (FAP)-targeted tracers have emerged as promising agents for breast cancer imaging, with recent studies demonstrating PET performance comparable to or surpassing, that of [18F]FDG. Nevertheless, data comparing [68Ga]Ga-FAPI-46 and [18F]FDG uptake in hormone receptor and/or HER2-positive breast cancer (luminal-like vs HER2-positive) remain scarce. Aim of this study was to investigate the diagnostic performance of [68Ga]Ga-FAPI-46 versus [18F]FDG PET/CT in patients with hormone-receptor and/or HER2-positive breast cancer, and to evaluate the uptake of both tracers stratified by molecular subtypes (luminal-like vs HER2-positive). A sub-analysis of a prospective observational trial (NCT04571086) was conducted. Patients with histologically confirmed, hormone receptor- and/or HER2-positive breast cancer who underwent whole-body [68Ga]Ga-FAPI-46 and [18F]FDG PET/CT in the same week for initial staging or follow-up were included. [68Ga]Ga-FAPI-46 or [18F]FDG PET-positive lesions were defined as visually increased lesion uptake compared to adjacent organ background. Semi-automatic segmentation was performed to determine SUVmax, SUVpeak, TLRpeak, total number of lesions, total tumour volume, and total tumour SUV mean. Data were compared between molecular subtypes (luminal-like vs HER2-positive). Thirteen patients were included. Overall, the detection performance was comparable between [68Ga]Ga-FAPI-46 and [18F]FDG PET. The semi-quantitative analysis showed comparable mean uptake values in breast cancer lesions on [68Ga]Ga-FAPI-46 and [18F]FDG PET/CT (SUVmax: 13.4 vs. 12.9; TLRpeak: 5.6 vs. 4.5) and revealed no significant differences in the median lesion count (4.5 vs. 5), mean total tumour volume (71.5 vs. 73.2 mL), or mean total tumour SUVmean (5.4 vs. 5.4). No substantial differences between molecular subtypes (luminal-like vs. HER2-positive) were observed. In this small exploratory cohort, comparable uptake patterns in [68Ga]Ga-FAPI-46- and [18F]FDG-positive breast cancer lesions were observed across subtypes, underscoring the potential of [68Ga]Ga-FAPI-46 as a versatile imaging tool. Future studies in larger cohorts are warranted to explore the potential of FAP-targeted theranostics in different breast cancer subtypes. 68-Ga-FAPI-PET for Tumor Detection: A Prospective Observational Trial, NCT04571086, 09-15-2020, https://clinicaltrials.gov/study/NCT04571086 .

BACKGROUND: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) enables sensitive detection and staging of prostate cancer, yet its relationship with long-term survival remains unclear. This study aimed to assess whether total lesion volume (TLV) measured on [18F]PSMA-1007 PET/CT predicts overall survival (OS) in prostate cancer patients. METHODS: A cohort of 282 patients scanned between 2019 and 2021 was retrospectively studied, including both patients undergoing primary staging and imaging for biochemical recurrence (BCR). Tumour lesions in the prostate/prostate bed, lymph nodes and bone were manually segmented and TLV was calculated for each compartment and as total of all lesions. Based on TLV, patients were categorized into three groups for each compartment: no detectable tumour, TLV ≤ median, and TLV > median. Bone analyses were dichotomised into any vs. no detectable tumour. The association with OS was assessed using age-adjusted Cox proportional-hazards models and Kaplan–Meier analysis, separately for the primary staging subgroup and the BCR subgroup. RESULTS: Over a mean follow-up of almost 5 years, 49 patients (17%) died. In the primary staging subgroup (n = 171), detectable bone metastases on PSMA PET-CT predicted poorer survival compared to no detectable bone metastasis (HR 2.39, p = 0.031). Among patients with BCR (n = 111), total TLV above the median and a prostate TLV above the median both predicted an almost 5 times increased risk of death. CONCLUSION: Total lesion volume on [18F]PSMA-1007 PET/CT was associated with OS, with different prognostic patterns in primary staging and BCR. The results support future incorporation of volumetric PSMA PET metrics into personalized staging and therapeutic decision-making.

PURPOSE: Patients with liver metastases from gallbladder carcinoma have limited treatment options. This retrospective multicenter study evaluated overall survival, tumor control and safety after transarterial radioembolization in this rare patient group. MATERIALS AND METHODS: Patients with histologically confirmed gallbladder carcinoma and liver-dominant metastatic disease treated with yttrium-90 or holmium-166 radioembolization at five tertiary centres were retrospectively identified. Baseline clinical and imaging data, details of the radioembolization procedure and follow-up imaging were collected. Tumor response was assessed locally using RECIST 1.1. Overall survival was analysed descriptively using Kaplan–Meier curves. RESULTS: Sixteen patients (9 women, mean age 65.7 ± 5.5 years) were included; 93.8% had received prior systemic chemotherapy and 75.0% had extrahepatic metastases. At approximately 3 months, hepatic disease control was achieved in 81.8% (9/11) of patients with available imaging, whereas global disease control was 36.4% (4/11). Median overall survival was 7.1 months (95% confidence interval 1.7–12.3). The median time to hepatic progression was 115 days and the median time to global progression was 112 days. Procedure-related complications were limited to one coil dislocation, one contrast reaction and one liver abscess. CONCLUSION: Radioembolization was feasible and well tolerated in patients with liver-dominant metastases from gallbladder carcinoma and provided intrahepatic disease control in a heavily pretreated population. Given the small sample size, these exploratory findings require confirmation in prospective studies.

BACKGROUND: This study evaluated the diagnostic and prognostic values of Technetium- 99m pyrophosphate (99mTc-PYP) scintigraphy using single-photon emission computed tomography/ computed tomography (SPECT/CT) in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). METHODS: Among 206 consecutive patients with suspected cardiac amyloidosis who underwent 99mTc-PYP scintigraphy using SPECT/CT and had no evidence of monoclonal protein, 20 patients were diagnosed with ATTR-CM based on SPECT/CT interpretation, whereas183 had no diagnostic findings on SPECT/CT interpretation. We calculated 99mTc-PYP activity in the volume of interest (VOI) for the myocardium and upper aorta for the blood pool as a reference. The heart-to-blood ratio (HBR) was calculated by dividing the mean activity in the VOI of the myocardium by that in the VOI of the upper aorta. Receiver-operating-characteristic (ROC) analysis was used to assess the diagnostic value of the Perugini grade, HBR, and heart-to-contralateral ratio (H/CL). A multivariate Cox model was used to assess whether the parameters, including HBR, were associated with all-cause mortality, cardiac death, and hospitalization for heart failure. RESULTS: By ROC analysis, HBR had the most diagnostic value (HBR area under the curve [AUC]: 0.997, 95% confidence interval [CI] 0.990–1.000 vs. H/CL AUC: 0.9617, 95% CI 0.942–0.981 vs. Perugini grade AUC: 0.918, 95% CI 0.891–0.945). During a mean follow-up period of 531 days, 38 major adverse cardiac events occurred. Multivariable Cox models showed that HBR was the most significant prognostic factor (hazard ratio 2.715, 95% CI 1.185–6.221, p = 0.018). CONCLUSIONS: This study demonstrated that HBR calculated by 99mTc-PYP scintigraphy using SPECT/CT could have potential diagnostic and prognostic value in patients with ATTR-CM.

Breast cancer metastasis to the colon is rare, occurring in less than 1% of patients with metastatic breast cancer. Invasive lobular carcinoma (ILC) exhibits a distinct tropism for the gastrointestinal tract and adnexa, often presenting with atypical imaging features that mimic primary tumors. We report a case of a 58-year-old woman with a history of right breast ILC who presented with incidental pelvic masses on ultrasound five years after mastectomy. 2-[¹⁸F]FDG PET/CT revealed multifocal hypermetabolic lesions in the transverse colon wall and bilateral adnexa. CT enterography and colonoscopy confirmed a stenotic colonic lesion with smooth mucosa. Postoperative pathology following right hemicolectomy, hysterectomy, and bilateral salpingo-oophorectomy confirmed metastatic breast carcinoma involving the right colon and bilateral adnexa. This case highlights the critical role of PET/CT in detecting occult gastrointestinal metastases in patients with ILC and underscores the importance of considering metastatic disease in the differential diagnosis of colonic lesions in this population.

Quantitative 177Lu-SPECT allows for patient specific dosimetry, but due to the limited spatial resolution absorbed doses (AD) can be underestimated. Implementation of the Lucy-Richardson deconvolution (LRD) algorithm for spill-over correction in PET has been investigated. Therefore, the aim of this study was to extend the potential application of LRD to 177Lu-SPECT based tumor dosimetry. The NEMA IEC Body Phantom (foreground-to-background ratio 8:1, 237:30 kBq/mL) was measured according to the local imaging and reconstruction protocol. The two main parameters of LRD, sigma and number of iterations, were determined in two steps. First, a matched filter resolution analysis was conducted on the ground truth activity distribution as segmented from the NEMA IEC Body Phantom data to define the sigma of a 3D Gaussian point-spread-function, which describes the system's spatial resolution. Secondly, using this sigma, a suitable number of LRD iterations was determined by comparing sphere recovery coefficients (RC) and signal-to-noise ratios. The selected parameters were then applied to the reconstructed SPECT series (24, 48, and 72 h post-injection) of 20 patients who received either [177Lu]Lu-DOTA-TATE (n = 10) or [177Lu]Lu-PSMA-I&T (y = 10) treatment, in order to evaluate its impact on AD estimates. Lesion AD from the original reconstruction (OR) and OR + LRD were estimated using MIM SurePlan™ MRT. The AD from OR, OR + LRD, and OR + RC (phantom-based recovery correction based on volume) were compared. A sigma of 6.0 mm and four iterations resulted in an average improvement of 18.9 ± 4.7% and 17.4 ± 7.6% in the sphere recovery coefficients and the signal to noise ratio, respectively. In total, 98 lesions were evaluated ([177Lu]Lu-DOTA-TATE: n = 42) ([177Lu]Lu-PSMA-I&T: y = 56). For OR + LRD and OR + RC an average increase of 22 ± 12% and 57 ± 36% of tumor AD was found. OR + LRD increased AD compared to OR, independent of administered radiopharmaceutical and lesion location. This study suggests that implementing LRD may be a promising option for image-based spill-over correction in 177Lu-SPECT based dosimetry. Further studies are necessary to investigate the effect of different PVC methods, such as LRD or phantom-based correction factors, on overall uncertainty of lesion ADs.

Primary aldosteronism (PA) is the most common cause of secondary hypertension, where accurate subtype differentiation between unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) determines therapeutic strategy. Adrenal venous sampling (AVS) remains the reference standard but is invasive, technically demanding, and not widely available. Recent advances in molecular imaging have introduced CXCR4-targeted positron emission tomography using ⁶⁸Ga-Pentixafor as a promising non-invasive tool for functional characterization and lateralization of aldosterone-producing lesions. CXCR4 is highly expressed in the zona glomerulosa and in aldosterone-producing adenomas, and it closely correlates with CYP11B2 (aldosterone synthase) expression. Across multiple clinical studies, ⁶⁸Ga-Pentixafor PET/CT has demonstrated high diagnostic accuracy, with reported sensitivities ranging from 74% to 98% and specificities from 84% to 100%, showing substantial concordance with AVS findings. In addition, PET-guided adrenalectomy yields biochemical and clinical outcomes comparable to AVS-guided management while avoiding procedural risks. By targeting CXCR4 expression, ⁶⁸Ga-Pentixafor PET/CT offers reliable lateralization with good agreement to AVS and strong clinicopathological correlation. Ongoing studies will further clarify its diagnostic role and integration into routine evaluation of primary aldosteronism.

AIM: PET/CT with radiolabelled PSMA-ligands has become the mainstay of diagnostic imaging for prostate cancer. The several available PSMA tracers differ modestly with respect to their avidity for lesions, but show distinct patterns of off-target uptake and routes of excretion. We sought to compare urinary bladder activity from [68Ga]Ga-PSMA-11 and [18F]PSMA-1007 with regard to their differing renal elimination, which can interfere in the detection of perivesical lesions. MATERIALS AND METHODS: We retrospectively compared urine activity in patients undergoing PET/CT after injection of either [68Ga]Ga-PSMA-11 patients in combination with hydration and diuresis (n = 132) or [18F]PSMA-1007 patients without hydration and diuresis (n = 100). Furthermore, we compared urinary bladder uptake from [18F]PSMA-1007 with lesional uptake in locally recurrent prostate cancer and locoregional lymph node metastasis, and performed an exploratory analysis of urine activity from [18F]PSMA-1007 relative to patient characteristics. RESULTS: Urine activity from [68Ga]Ga-PSMA-11 was normally distributed, being lowest in acquisitions 90 min p.i. with oral hydration and a single dose of furosemide injected 60 min after the tracer. In contrast, urine activity from [18F]PSMA-1007 followed an exponential distribution in the population, with approximately one quarter of cases exceeding an SUVmean threshold of 7. Urine activity of [18F]PSMA-1007 exceeded the uptake in prostate cancer lesions in more than 20% of patients. CONCLUSIONS: Urinary uptake from [18F]PSMA-1007 was in the range of that seen in [68Ga]Ga-PSMA-11 patients with hydration and diuretics. Some 25% of the [18F]PSMA-1007 cases showed problematic urinary uptake, which would potentially eclipse the uptake in prostate cancer lesions.

This review examines Marine-Lenhart syndrome (MLS), an uncommon thyroid disorder that combines Graves' disease with autonomously functioning thyroid nodules (AFTNs) and demonstrates why nuclear medicine imaging is essential for accurate diagnosis and treatment planning. We reviewed case reports and case series published over the past three decades and analyzed clinical presentation, diagnostic approaches, prevalence rates, disease mechanisms, and treatment outcomes of MLS. This relatively rare syndrome occurs in approximately 0.8-4.3% of patients with Graves' disease, though rates vary depending on the diagnostic criteria and imaging methods used. It presents a diagnostic challenge because AFTNs often remain suppressed and appear "cold" on initial scans, only becoming visible after treatment - the characteristic "unmasking effect". Thyroid scintigraphy with either 99mTc-pertechnetate or 123I provides functional information that structural imaging cannot show. Treatment differs from standard Graves' disease management as MLS requires higher radioiodine activities because nodules may escape radiation damage, and patients may need radioiodine re-ablation. Type 3 MLS, which includes cold nodules, requires careful cancer risk evaluation with ultrasound and fine-needle aspiration when appropriate. Nuclear medicine imaging is crucial for MLS diagnosis and treatment planning. Functional imaging identifies AFTNs, guides appropriate radioiodine treatment, and prevents treatment failure. Routine thyroid scintigraphy is recommended in all patients with hyperthyroidism and thyroid nodules before starting therapy.

Clinically accurate detection of prostate cancer (PCa) metastases is crucial for management of high-risk PCa patients scheduled for radical prostatectomy. We determine the safety and diagnostic accuracy of pre-operative 68Ga-PSMA-11 PET/CT imaging in newly diagnosed high-risk PCa and assess its impact on patient management. Investigator-initiated prospective multi-center multinational single-arm open-label phase 1/2 imaging trial (EuRadCT 2016-001815-19). Patients with high-risk PCa scheduled for prostatectomy were enrolled at 9 institutions in Germany, Austria, and Switzerland to undergo 68Ga-PSMA-11 PET/CT for primary staging. The primary objectives were the evaluation of 68Ga-PSMA-11 PET/CT imaging to detect the primary tumor and lymph node disease and safety assessment. Secondary objectives included detection of distant metastases, correlation of 68Ga-PSMA-11 uptake with Gleason Score, and determining the impact on clinical management. Impact of pre-operative 68Ga-PSMA-11 PET/CT imaging on target volume definition for radiation therapy was assessed. 173 patients underwent 68Ga-PSMA-11 PET/CT for primary staging. Histopathologic correlation was available in 139 patients (imaging dataset), with lymph node metastases in 55 patients (39.6%). 20 treatment-emergent AEs unrelated to the test item were reported in 14 of 173 (8.1%) patients and no SAE occurred. On a per-patient basis, sensitivity of 68Ga-PSMA-11 PET for local disease was 0.971 (95% CI, 0.928-0.992). Sensitivity, specificity, PPV, NPV and accuracy to detect local lymph node disease on a per-patient basis were 0.400 (95% CI 0.271-0.529), 0.988 (95%CI 0.965-1.000), 0.957 (95% CI 0.873-1.000), 0.716 (95% CI 0.633-0.798) and 0.755 (95% CI 0.684-0.827), respectively. Considering the intrinsic PET resolution of 3-5 mm, the exclusion of lesions smaller than 3 or 5 mm on histopathology from the analysis led to increased sensitivity of 56.4% and 69.0%, respectively. Median SUVpeak of local disease was 6.4 (range 1.7-13.6), 8.4 (range 2.3-39.4), 10.7 (range 5.6-23.0), and 13.4 (range 3.8-56.9) for Gleason Score 7a, 7b, 8 and 9, respectively. Based on the results of 68Ga-PSMA-11 PET/CT, surgical intervention was canceled in 23 patients (13.2%). 68Ga-PSMA-11 PET/CT resulted in a change of target volume delineation for radiation therapy planning in 29 patients (20.9%). In high-risk primary PCa, 68Ga-PSMA-11 is safe and effective in local staging, resulting in changes in both surgical and radiation management. Moreover, 68Ga-PSMA-11 uptake is positively correlated with tumor grade and its efficacy is dependent on the size of nodal lesions. 68Ga-PSMA-11 PET/CT will be highly impactful in the management of newly diagnosed high risk prostate cancer patients. The study was funded by the German Cancer Consortium (DKTK).

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To study dynamic flow data in patients with severe obesity undergoing PET myocardial perfusion imaging given that certain dynamic flow parameters are associated with adverse cardiovascular outcomes and can carry prognostic significance. Cross-sectional study of patients with severe obesity (BMI&#x2009;&#x2265;&#x2009;35&#xa0;kg/m2) who underwent Rb82 stress/rest PET myocardial perfusion imaging(MPI) in 2022-2023. Absolute myocardial blood flow(MBF) in mL/g/min was computed from the dynamic rest and stress images. MFR was calculated as the ratio of stress to rest MBF. Global MFR&#x2009;<&#x2009;1.7 was considered significantly reduced and a rest MBF&#x2009;>&#x2009;1.1 mL/g/min was considered elevated. Linear regression was used to investigate an association of patient characteristics with MBF. Out of 123 patients, 78(63.4%) were male, 38% had reduced MFR, and 30% had an increased rest MBF, whereas 18% had both reduced MFR and increased rest MBF. After adjusting for age and BMI, there was a statistically significant difference in mean rest MBF in female (1.04 mL/g/min; 95%CI 0.96-1.12) versus male (0.85 mL/g/min; 95%CI 0.79-0.91) patients(P&#x2009;=&#x2009;0.0004). There was a significant association between female sex and rest MBF&#x2009;>&#x2009;1.1(P&#x2009;=&#x2009;0.031). Adjusted for sex and BMI, linear regression analysis showed older age was associated with decreasing MFR by 0.14 (95% CI 0.06-0.22) per 10 years of age (P&#x2009;=&#x2009;0.001). In a sample of patients with severe obesity undergoing Rb82 PET, there is a high prevalence of reduced MFR and increased rest MBF. Increasing age and female sex are associated with adverse physiologic alterations based on dynamic flow data within this at-risk patient population.

Fibroblast activation protein (FAP)-targeted PET imaging is an emerging technique that images the tumor stroma by targeting cancer-associated fibroblasts, offering high tumor-to-background contrast and improved lesion detection in tumors with low [&#xb9;&#x2078;F]FDG avidity. Given the central role of CAFs in tumor progression and therapy response, FAPI PET has gained interest in neuroendocrine neoplasms (NENs), where stromal imaging may provide complementary information to conventional modalities. This review evaluates the biological rationale, current evidence, and potential clinical role of FAPI PET in the imaging and management of NENs.