European Journal of Nuclear Medicine and Molecular Imaging最新文献

{"title":"Diagnostic performance of ¹⁸F-FDG PET/CT radiomics-based machine learning models for pancreatic lesion characterisation: Comparison with visual assessment and evaluation of human-radiomics synergy.","authors":"Dilsat Firat Arslan, Zeynep Gozde Ozkan, Ali Bayram, Dilara Denizmen Zorba, Emine Goknur Isık, Yasemin Sanli, Duygu Has Simsek, Sukru Mehmet Erturk, Serkan Kuyumcu","doi":"10.1007/s00259-026-08102-y","DOIUrl":"10.1007/s00259-026-08102-y","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate the diagnostic performance of ¹⁸F-FDG PET/CT-derived radiomics-based machine learning models for differentiating malignant from benign pancreatic lesions, to compare these models with two sequential stages of visual assessment, and to assess whether incorporation of clinician judgement as a model input provides additional diagnostic gain.</p><p><strong>Methods: </strong>In this retrospective single-centre study, 853 consecutive patients who underwent ¹⁸F-FDG PET/CT between April 2009 and February 2025 for known or suspected pancreatic lesions were screened, and 466 were included in the final analysis. Final diagnosis was established by histopathology (76.9%) or clinico-radiological follow-up (23.1%). Diagnostic performance was assessed within a five-stage framework consisting of two visual assessment stages and three progressively expanded machine-learning stages. The visual stages comprised first-look assessment based on PET/CT images alone and comprehensive second-look assessment integrating available clinical, laboratory, and multimodal imaging data. The machine-learning stages comprised a hybrid PET + CT radiomics model, an integrated model additionally incorporating clinical, laboratory, semiquantitative PET, and imaging-derived variables, and a human-radiomics synergistic model including the clinician's second-look binary judgement as an input feature. PET-only and CT-only radiomics models were also evaluated as unimodal comparators. Radiomic features were extracted after manual three-dimensional segmentation using 3D Slicer/PyRadiomics, and Random Forest was selected as the final classifier.</p><p><strong>Results: </strong>Of 466 lesions, 336 (72.1%) were malignant and 130 (27.9%) were benign. First-look visual assessment achieved 93.5% sensitivity, 49.2% specificity, and 81.1% accuracy. Comprehensive second-look assessment improved performance to 97.9% sensitivity, 76.9% specificity, and 92.0% accuracy. Among radiomics-based models, the hybrid PET + CT model outperformed unimodal approaches, achieving 91.1% sensitivity, 66.7% specificity, and 86.8% accuracy. The integrated model did not improve overall accuracy beyond the hybrid model. The human-radiomics synergistic model achieved the highest sensitivity (98.7%) and overall accuracy (93.3%), whereas comprehensive second-look assessment retained slightly higher specificity and NPV.</p><p><strong>Conclusion: </strong>¹⁸F-FDG PET/CT radiomics-based machine learning models improved specificity beyond routine first-look visual PET interpretation, approaching the performance of comprehensive second-look visual assessment without requiring additional clinical data. Incorporation of clinician judgement further increased sensitivity, although comprehensive second-look visual assessment by an experienced reader retained the highest specificity and NPV among all approaches. These findings support a complementary, decision-support role for radiomics-","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"7288-7298"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic PSMA-PET for metastasis profiling in prostate cancer: a potential new approach to predict response to therapy.","authors":"Stefano Fanti, Yongkang Shuai, Andrea Farolfi, Irene Brusa, Riccardo Mei","doi":"10.1007/s00259-026-07952-w","DOIUrl":"10.1007/s00259-026-07952-w","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6722-6723"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of [¹⁸F]FDG PET/CT and PERCIST criteria in patients with HER2-low metastatic breast cancer treated with trastuzumab deruxtecan.","authors":"Juliette Frega, Laura Somme, Tristan Martin, Thierry Petit, Julien Salvadori, Caroline Bund, François Somme","doi":"10.1007/s00259-026-08029-4","DOIUrl":"10.1007/s00259-026-08029-4","url":null,"abstract":"<p><strong>Introduction: </strong>Trastuzumab deruxtecan (T-DXd) has recently reshaped the management of HER2-low metastatic breast cancer. While pivotal trials relied on CT-based RECIST 1.1, [¹⁸F]FDG PET/CT provides high diagnostic sensitivity and valuable semi-quantitative metrics, though its role in monitoring antibody-drug conjugates remains insufficiently defined. This study assessed the prognostic value of PET-derived parameters and PERCIST criteria in patients treated with T-DXd.</p><p><strong>Methods: </strong>This retrospective study included all HER2-low metastatic breast cancer patients treated with T-DXd between 2022 and 2025 at the Strasbourg Europe Cancer Institute (ICANS) who underwent [¹⁸F]FDG PET/CT. Semi-quantitative parameters (SUVmax, SULpeak) and metabolic response according to PERCIST 1.0 were collected. Their association with overall survival (OS), metabolic progression-free survival (mPFS) and time-to-treatment change (TTT) was analyzed using Cox models and Kaplan-Meier curves.</p><p><strong>Results: </strong>Forty-three patients were included. Baseline SULpeak of the most hypermetabolic lesion was an independent prognostic factor for OS, mPFS and TTT (p < 0.05). A ROC-derived cutoff of 6 identified two prognostic groups, with SULpeak < 6 associated with significantly improved outcomes. Early metabolic response was also linked to longer OS and PFS (p< 0.05), with median PFS of 9.2 vs. 4.2 months (HR 2.67; 95% CI 1.30-5.47). Combining baseline SULpeak and metabolic response (complete or partial metabolic response) defined three risk groups with significantly different OS and PFS.</p><p><strong>Conclusion: </strong>[¹⁸F]FDG PET/CT provides significant prognostic information in HER2-low metastatic breast cancer treated with T-DXd. Baseline SULpeak and early PERCIST response enable meaningful risk stratification. The proposed prognostic model requires prospective validation before clinical implementation.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6870-6880"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional brain metabolism and metabolic connectivity alterations in corticobasal syndrome assessed with [¹⁸F]FDG-PET.","authors":"Matilde Nerattini, Andrea Leo, Valentina Bessi, Anna De Rosa, Giovanna De Michele, Valeria Gaudieri, Giulia Giacomucci, Alberto Cuocolo, Giuseppe De Michele, Valentina Berti, Sabina Pappatà","doi":"10.1007/s00259-026-08108-6","DOIUrl":"10.1007/s00259-026-08108-6","url":null,"abstract":"<p><strong>Purpose: </strong>Corticobasal syndrome (CBS) is a clinically defined phenotype with different underlying neuropathological substrates most commonly the 4-repeat tauopathy corticobasal degeneration (CBD). 2-[¹⁸F] fluoro-2-deoxy-D-glucose Positron Emission Tomography ([¹⁸F]FDG-PET) studies have described regional metabolic abnormalities but detailed subcortical and cerebellar structures involvement is less known and metabolic connectivity remains unexplored. This study combined voxel-based, region-of-interest (ROI) analyses and connectivity approaches to further characterize metabolic alterations and to provide a network-level framework in CBS.</p><p><strong>Methods: </strong>Thirty-nine CBS patients underwent [¹⁸F]FDG-PET at two sites, with images flipped to align the most affected hemisphere; 99 controls were drawn from a national normative database. Voxel-based SPM method and ROIs analysis were performed. Thirty-six bilateral cortical and subcortical regions of interest were processed to perform interregional correlation and network-based analyses within five functional networks. Pairwise Spearman correlations were computed from normalized regional signals. Group differences were assessed at regional and network levels using Fisher-transformed correlations, Cohen's q, permutation testing (10,000 iterations), and graph-theoretical metrics (node strength, clustering coefficient; threshold ρ > 0.25).</p><p><strong>Results: </strong>CBS patients showed asymmetric hypometabolism predominantly in frontal, parietal, and temporal cortices, caudate and thalamus of the predominantly affected hemisphere, with additional contralateral involvement, notably in the cerebellum and caudate. Metabolic connectivity analyses revealed widespread intra- and inter-network disconnection, particularly involving frontal, parietal, and sensorimotor cortices, and thalamo-cortical pathways, with significant lateralization toward the affected hemisphere. Graph analysis showed decreased cortical node strength with relative increases in subcortical hubs and mixed changes in clustering coefficients, suggesting network reorganization.</p><p><strong>Conclusion: </strong>This first [¹⁸F]FDG-PET metabolic connectivity study in CBS demonstrates asymmetric and bilateral regional hypometabolism, widespread and lateralized network disconnection, and subcortical reorganization. These findings reflect both degenerative, functional and compensatory mechanisms and highlight metabolic connectivity as a sensitive marker of network-level alterations in neurodegenerative disease.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"7548-7559"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eryhtropoetin induced ¹⁸F-PSMA-11 bone marrow sink effect.","authors":"Justine Maes, Alex Maes, Kristoff Muylle, Sezgin Ustmert, Christophe Van de Wiele","doi":"10.1007/s00259-026-07957-5","DOIUrl":"10.1007/s00259-026-07957-5","url":null,"abstract":"<p><p>A patient with metastasized prostate adenocarcinoma underwent ¹⁸F-PSMA-11 PET/CT restaging following ¹⁷⁷Lu-PSMA-617 treatment and rising PSA-level. The maximum intensity projection image (right-side of the figure) demonstrated an intense homogenous tracer uptake throughout the bone marrow containing skeleton, whereas CT images showed specific bone metastases but no diffuse involvement, and previously known lymph node and liver metastases exhibited significantly reduced or absent uptake (see also left-side of the image, ¹⁸F-PSMA-11 MIP prior to ¹⁷⁷Lu-PSMA-617 therapy). None of the patients that underwent imaging with the same tracer-batch demonstrated similar findings excluding free ¹⁸F as a potential cause for the imaging findings. Furthermore, the patient did not suffer from any bone marrow disorder previously reported to present with diffuse bone marrow uptake on PSMA-targeting PET/CT imaging [1, 2]. Of interest, the patient had received recombinant human erythropoietin, 100 µg of Aranesp, 24 h prior to imaging to treat his renal failure associated anemia. At this dose, Aranesp reaches a nanomolar concentration in the bone marrow resulting in stimulation of the Tissue Protective Receptor on endothelial cells leading to the creation of a massive systemic reservoir of PSMA-positive neovasculature that outcompetes PSMA-expressing prostate carcinoma lesions for radiotracer availability [3, 4]. This may explain the diffuse marrow uptake and the decreased visibility of known metastases [4]. The effect of erythropoietin on bone marrow mobilization and neovascularization can persist for 7-10 days [5]. This should be taken into consideration in order to avoid erroneous interpretation of ¹⁸F-PMSA-11 PET/CT imaging and unnecessary bone marrow toxicity of ¹⁷⁷Lu-PSMA-617 treatment.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6724-6725"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The deep learning radiomics nomogram for risk stratification in multiple myeloma using automatic whole-body [¹⁸F]FDG PET/CT segmentation approach.","authors":"Meiling Xiao, Yan Zhong, Han Hao, Xinhe Yu, Daoyan Hu, Jing Wang, Chentao Jin, Rui Zhou, Rong Tian, Lixiang Yang, Congcong Yu, Xiaofeng Dou, Chunlei Han, Riku Klén, Xiaohui Zhang, Mei Tian, Hong Zhang","doi":"10.1007/s00259-026-08095-8","DOIUrl":"10.1007/s00259-026-08095-8","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a deep learning (DL) approach for automatic segmentation and accurate risk stratification in multiple myeloma (MM) using whole-body [¹⁸F]FDG PET/CT.</p><p><strong>Methods: </strong>This retrospective study included MM patients who underwent [¹⁸F]FDG PET/CT between August 2013 and December 2023. To automatically segment focal lesions, an nnU-Net architecture was trained using dual-channel PET/CT inputs. For diffuse/mixed patterns, the tumor was automatically identified via bone segmentation using liver SUVmedian thresholds. Subsequently, DL and radiomics features were extracted using Pyradiomics and the STU-Net encoder. Then a deep learning radiomics nomogram (DLRN) was constructed using the Cox proportional hazards model and evaluated using the calibration curve, the receiver operating characteristic (ROC) curve, the Kaplan-Meier curve, and decision curve analysis.</p><p><strong>Results: </strong>The study included 345 patients (median age, 59 years [IQR, 35-67 years], 198 male). The nnU-Net achieved a median DSC of 0.64-0.77 for focal lesions segmentation across cohorts. The DLRN was constructed by integrating deep learning radiomics score (DLRS), lactate dehydrogenase (LDH), and β2-microglobulin (β2-MG). The DLRN achieved an area under ROC curve (AUC) of 0.87 (95% confidence interval [CI]: 0.82-0.93), 0.84 (95% CI: 0.73-0.96), and 0.88 (95% CI: 0.76-0.99) for 3-year overall survival (OS) status prediction in the training, internal and external testing cohorts, which outperformed the International Staging System (ISS) (all P < 0.05). Furthermore, the DLRN can effectively identify high-risk individuals (all P < 0.05), demonstrated good agreement between predicted and observed survival probabilities, and provided clinical net benefit.</p><p><strong>Conclusion: </strong>The pattern-specific DL approach achieved automated whole-body tumor segmentation in MM, and the established DLRN demonstrated improved risk stratification capability.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"7274-7287"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From reflex to reason: rethinking pelvic lymph node dissection in the PSMA PET Era.","authors":"Gamze Beydagi, Gianluca Giannarini, Alessandro Crestani, Luca Urso","doi":"10.1007/s00259-026-08096-7","DOIUrl":"10.1007/s00259-026-08096-7","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6738-6743"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context-dependent efficacy of fibroblast activation protein-targeted radionuclide therapy (FAP-TRT): the dual role of CAFs.","authors":"Chunhui Wu, Ahmad Kurniawan, Ge Li, Zihe Ming, Maarten W Nijkamp, Evert van den Broek, Walter Noordzij, Andor W J M Glaudemans, Ines F Antunes, Bart Cornelissen","doi":"10.1007/s00259-026-08099-4","DOIUrl":"10.1007/s00259-026-08099-4","url":null,"abstract":"<p><p>Fibroblast activation protein-targeted radionuclide therapy (FAP-TRT) shows promise across multiple cancers, but clinical responses remain variable. Here, we aim to investigate how the presence, abundance, and spatial organisation of FAP-expressing cancer-associated fibroblasts (CAFs) relative to tumour cells influence the efficacy of FAP-TRT, to further optimisation.</p><p><strong>Methods: </strong>Spatial heterogeneity of FAP expression and radioligand uptake was assessed in human pancreatic ductal adenocarcinoma (PDAC) tissues using immunofluorescence and autoradiography with [¹⁶¹ Tb]Tb-FAPI-46. Mechanistic studies were conducted in vitro using PSN-1 tumour cells and FAP-expressing CAFs in 2D cultures and 3D spheroids, including mono- and co-culture systems with defined tumour-to-CAF ratios and spatial configurations. Cellular uptake and nuclear absorbed dose were quantified, and radiobiological effects were evaluated using DNA damage (γH2AX), clonogenic survival, spheroid growth, and cytokine profiling.</p><p><strong>Results: </strong>PDAC tissues exhibited pronounced spatial heterogeneity in FAP expression and radioligand uptake. In vitro, uptake alone did not predict absorbed dose or biological response. In 2D models, [¹⁶¹ Tb]Tb-FAPI-46 did not significantly reduce clonogenic survival or increase DNA damage response. In 3D spheroids, FAP-TRT induced dose-dependent DNA damage and growth inhibition. Mixed tumour-CAF spheroids showed more uniform DNA damage and stronger growth suppression than layered models. CAF-containing models attenuated tumour-cell DNA damage and growth inhibition compared to models without CAFs (P < 0.001), associated with increased IL-6 and TGF-β secretion.</p><p><strong>Conclusion: </strong>FAP-expressing CAFs have a dual, context-dependent role in FAP-TRT, enhancing tumour irradiation through crossfire while also limiting tumour control potentially through radioligand partitioning towards the stromal compartment and CAF-derived paracrine signalling. These findings identify spatial organisation and CAF radiobiology as key determinants of FAP-TRT efficacy.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"7313-7326"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical performance of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT in detecting recurrent disease in medullary thyroid carcinoma: a comparative analysis with [¹⁸F]F-FDG and [⁶⁸Ga]Ga-DOTATATE PET/CT, alongside identification of suitable candidates for targeted radionuclide therapy.","authors":"Shyam Kumar Ravada, Rahul Vithalrao Parghane, Anuja Deshmukh, Minit Shah, Gouri Pantvaidya, Sandip Basu","doi":"10.1007/s00259-026-08031-w","DOIUrl":"10.1007/s00259-026-08031-w","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate and compare the diagnostic performance of [⁶⁸Ga]Ga-DOTA-FAPI-04 with [¹⁸F]F-FDG and [⁶⁸Ga]Ga-DOTATATE PET/CT for detecting recurrent disease in patients with medullary thyroid carcinoma (MTC) and additionally evaluate their role for prognostication and theranostics in management of MTC.</p><p><strong>Methods: </strong>In this prospective single-centre study, 56 patients with suspected recurrent MTC underwent [⁶⁸Ga]Ga-DOTA-Fibroblast activation protein inhibitor (FAPI)-04, [¹⁸F]F-FDG, and [⁶⁸Ga]Ga-DOTATATE PET/CT. The primary endpoint was patient-based diagnostic accuracy for recurrent disease. Secondary endpoints included lesion-based detection rates across pre-defined anatomical regions, correlation with biochemical and clinicopathological parameters, prognostic assessment for progression-free survival, and a novel exploratory FAPI-SSTR Theranostic (FAST) score was developed to guide personalized radiopharmaceutical therapy (RPT).</p><p><strong>Results: </strong>[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT demonstrated higher sensitivity 95.92% and accuracy 94.64% compared to [¹⁸F]F-FDG-PET/CT (sensitivity: 89.80%, accuracy: 89.29%) and [⁶⁸Ga]Ga-DOTATATE (sensitivity: 77.55%, accuracy: 76.79%) on patient-based analysis for detecting recurrent disease. [⁶⁸Ga]Ga-DOTA-FAPI-04 was showed high detection rates for disease recurrence in mediastinal nodal (91.9%), liver (91.7%), and skeletal (86.5%) metastases.[⁶⁸Ga]Ga-DOTA-FAPI-04 uptake was associated with a modestly shorter mean progression-free survival and altered clinical management in 35.7% of total patients. Additionally, the pre-defined exploratory FAST scoring system stratified 34 patients (60.7%) for [¹⁷⁷Lu]Lu-FAPI-RPT, 8 (14.3%) for [¹⁷⁷Lu]Lu-DOTATATE PRRT, and 9 (16.1%) for either or combined RPT.</p><p><strong>Conclusion: </strong>[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT showed higher diagnostic accuracy for the identification of recurrent MTC over standard [¹⁸F]F-FDG and [⁶⁸Ga]Ga-DOTATATE PET/CT, with higher regional detection rates for liver and osteoblastic skeletal metastases. Furthermore, while the exploratory FAST score provides a framework for patient stratification and personalizing targeted theranostic strategies, it requires future validation through larger multicentre trials prior to clinical adoption.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6881-6896"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular phenotyping with ¹⁸F-FDG and ¹⁸F-FAPI PET/CT: advancing risk stratification in in-stent restenosis.","authors":"Lei Jia, Ke Wang, Zhangyu Lin, Dong Yin, Wanjie Ren, Zongyao Zhang, Wei Fang, Lei Wang, Kefei Dou","doi":"10.1007/s00259-026-08036-5","DOIUrl":"10.1007/s00259-026-08036-5","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the potential of ¹⁸F-FDG and ¹⁸F-FAPI PET/CT for characterizing the pathophysiological heterogeneity of in-stent stenosis (ISR) and to assess their ability to differentiate between its clinically subtypes.</p><p><strong>Methods: </strong>This prospective study enrolled participants with ISR selected from a cohort registry between December 2024 to August 2025, which was categorized into rapid recurrent ISR (R-ISR) and ordinary ISR (O-ISR) based on recurrence time interval. For vessel-level analysis, coronary arteries without intervention served as control. All participants underwent both ¹⁸F-FDG and ¹⁸F-FAPI PET/CT to assess coronary uptake and evaluated the performance of maximum standardized uptake value (SUV_max) and maximum target-to-background ratio (TBR_max) in differentiating ISR from control vessels, as well as R-ISR from O-ISR. All patients were followed-up. The primary endpoint was a composite of cardiovascular death, target-vessel-related myocardial infarction, or target-vessel-related revascularization. Differences in the diagnostic performance of PET parameters and associations with outcomes were assessed.</p><p><strong>Results: </strong>Thirty-one participants and 84 vessels were included. ISR vessels (n = 39) demonstrated higher uptake in ¹⁸F-FDG and ¹⁸F-FAPI than control (n = 45). R-ISR exhibited higher uptake compared to O-ISR on both patient-level (TBR_max: ¹⁸F-FAPI, 4.10 ± 1.41 vs. 1.75 ± 0.50; ¹⁸F-FDG, 1.18 ± 0.32 vs. 0.86 ± 0.19) and vessel-level (TBR_max: ¹⁸F-FAPI, 4.07 ± 1.29 vs. 1.65 ± 0.50; ¹⁸F-FDG, 1.16 ± 0.31 vs. 0.90 ± 0.28) (all P ≤ 0.01). ¹⁸F-FAPI showed better diagnostic efficacy compared to ¹⁸F-FDG (AUC of TBR_max: 0.97 [0.92-1.00] vs. 0.75 [0.58-0.91], P = 0.01]. Six of 31 participants within R-ISR group reached the endpoint. Baseline PET uptake was associated with subsequent outcome (¹⁸F-FAPI SUV_max, HR, 2.28 [95%CI: 1.25-5.09], P = 0.02; ¹⁸F-FDG SUV_max, HR, 33.2 [95%CI: 4.93-509], P = 0.002).</p><p><strong>Conclusion: </strong>¹⁸F-FAPI and ¹⁸F-FDG PET/CT reveals the molecular heterogeneity of ISR, with ¹⁸F-FAPI better identifying the rapid-recurrence subtype for advancing risk stratification.</p><p><strong>Trial registration: </strong>NCT05437965. Registered 24 June 2022.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"6897-6908"},"PeriodicalIF":7.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}