European Journal of Nuclear Medicine and Molecular Imaging最新文献

{"title":"Preclinical evaluation of DOTAGA.Glu.(FAPI)2 and DO3A.Glu.(FAPI)2 as theranostics with human dosimetry extrapolation to lutetium-177 and terbium-161 analogs.","authors":"Adrianna Bilinska,Naveen Kumar,Silvano Gnesin,Tilman Läppchen,Elena Menéndez,Marcel Martin,Frank Rösch,Axel Rominger,Eleni Gourni","doi":"10.1007/s00259-025-07565-9","DOIUrl":"https://doi.org/10.1007/s00259-025-07565-9","url":null,"abstract":"PURPOSEThis study aims to assess DOTAGA.Glu.(FAPI)2 and DO3A.Glu.(FAPI)2, specifically engineered as precursors for the development of theranostic FAPI-targeted radioligands.METHODSDOTAGA.Glu.(FAPI)2 and DO3A.Glu.(FAPI)2 were radiolabeled with gallium-68 and lutetium-177, followed by in vitro (lipophilicity, protein binding, saturation, internalization and externalization) studies on FAP+ CAFs. In vivo (biodistribution, metabolic stability, blood kinetics, PET/SPECT/CT imaging) and ex vivo, (autoradiography, immunohistochemistry) conducted on PC3-mice. Murine dosimetry data were extrapolated to human estimates.RESULTSAll radioligands achievied > 98% radiochemical purity, demonstrating high FAP affinity (Kd:0.7-0.9 nM) and rapid internalization in CAFs, with differences in lipophilicity and serum protein binding. In vivo studies, for [68Ga]Ga-DOTAGA.Glu.(FAPI)2 and [68Ga]Ga-DO3A.Glu.(FAPI)2 showed high and sustained tumor uptake up to 3 h p.i. (18-19%I.A./g). For [177Lu]Lu-DOTAGA.Glu.(FAPI)2 and [177Lu]Lu-DO3A.Glu.(FAPI)2 tumor uptake was 16.2 ± 2.5 and 15 ± 1.2% IA/g at 4 h p.i., reaching 5.1 ± 0.1 and 2.8 ± 0.4%IA/g at 48 h, respectively. All radioligands exhibited low blood retention levels. PET/SPECT/CT imaging confirmed high tumor-to-background ratios. Uptake patterns correlate well with autoradiography images of heterogeneous FAP distribution in PC3-mice, while the detection of both murine and human FAP in PC3-tumors was demonstrated through immunohistochemistry. The extrapolated human absorbed dose estimates (Gy/GBq) for [177Lu]Lu-DOTAGA.Glu.(FAPI)2 were generally higher across most organs compared to [177Lu]Lu-DO3A.Glu.(FAPI)2. Human extrapolation of the 161Tb-labeled radioligands delivered on average ~ 38% higher absorbed doses in tissues as compared to their 177Lu-labeled counterparts.CONCLUSIONThese results support the potential clinical translation of DOTAGA.Glu.(FAPI)2 and DO3A.Glu.(FAPI)2, as promising candidates for precise diagnosis and treatment of FAP-expressing malignancies.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"6 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305764","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":"PET scout: A valuable technology in pediatric 18F-FDG PET/CT imaging.","authors":"Keke Zhu,Xiemei Ruan,Xin Bai,Biying Zhang,Ha Wu,Hongcheng Shi","doi":"10.1007/s00259-025-07554-y","DOIUrl":"https://doi.org/10.1007/s00259-025-07554-y","url":null,"abstract":"PURPOSETo explore the potential value of PET Scout technology for optimizing the examination workflow of pediatric ¹⁸F-FDG PET/CT.METHODSA total of 527 children who underwent PET/CT imaging were prospectively divided into a standard-dose group (3.7 MBq/kg, n = 391) and a low-dose group (2.5 MBq/kg, n = 136). A body PET Scout scan (10 s/bed) was performed before PET/CT scan. Visual analysis of Scout MIP images identified improper positioning, radioactive contamination, and lesions outside the normal range (skull base to mid-thigh) as abnormal findings. Abnormal detection rates and lesion detection performance were compared between the two groups.RESULTSPET Scout identified abnormal detections in 9.7% (51/527) of patients, including out-of-range lesions (27 cases), contamination (19 cases), and postural abnormalities (5 cases). There was no significant difference in the abnormal detection rate (9.2% vs. 11.0%, χ² = 0.383, P = 0.536) and in the area under the ROC curve (AUC) of lesion detection performance (0.9086 vs. 0.9104; Z = -0.0953, P = 0.924) between the standard-dose group and the low-dose group. Optimal SUVmax cut-offs were 3.05 (sensitivity 82.9%; specificity 85.4%) and 3.25 (sensitivity 81.6%; specificity 87.0%) for the standard and low-dose groups, respectively.CONCLUSIONPET Scout enables early detection of abnormalities and real-time workflow optimization. The technology is comparable in lesion detectability at low-dose and standard-dose imaging, and supports flexible application under different dose strategies.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"28 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296112","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":"Safety and efficacy of 177Lu-FAPI-XT radioligand therapy in patients with advanced sarcoma and other cancer entities: first-in-human, dose-escalation study.","authors":"Honghong Liu,Rui Guo,Xiaojun Zhang,Huijuan Ji,Shuwei Sun,Shasha Sun,Jiayong Liu,Zhi Yang,Ruimin Wang","doi":"10.1007/s00259-025-07617-0","DOIUrl":"https://doi.org/10.1007/s00259-025-07617-0","url":null,"abstract":"‌PURPOSE‌: This phase I, first-in-human study evaluated the safety, dosimetry, and preliminary efficacy of 177Lu-FAPI-XT, a novel fibroblast activation protein (FAP)-targeted radioligand, in patients with advanced solid tumors refractory to standard therapies. ‌METHODS‌: This open-label, non-randomized, dose-escalation, investigator-initiated trial had a \"accelerated titration\" and \"3 + 3\" design involved a 6-week 177Lu-FAPI-XT treatment cycle in patients with advanced-stage solid tumors at 3.7GBq initially, with subsequent cohorts receiving an incremental 1.85GBq dose increase until dose limiting toxicity (DLT) was observed. ‌RESULTS‌: 177Lu-FAPI-XT was well tolerated and no DLT or grade ≥ 3 treatment-related adverse events (TRAE) were observed. The whole-body effective dose was 0.039 ± 0.013 Sv/GBq. The mean effective half-lives for the whole-body and tumor lesions were 52.13 ± 12.33 h and 31.78 ± 15.03 h, respectively. According to RECIST stable disease (SD) were observed in 5 (5/14, 35.7%) patients, with the highest benefit observed in fibroblastic sarcoma subtypes with SD presented in 4 (4/8, 50%) patients. The median progression-free survival (PFS) was 4.63 m (95%CI: 1.25, NE). Metabolic reductions on PET/CT were observed in 2 sarcoma cases. (URL: hclinicaltrials.gov . Trial registration: NCT06211647, NCT06197139. Registered 4 January 2024.) ‌CONCLUSION‌: 177Lu-FAPI-XT demonstrated a favorable safety profile, with preliminary signs of tumor response observed. Complete/partial response deficiency in 177Lu-FAPI-XT therapy necessitate optimized strategies for efficacy improvement.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"9 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288377","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":"Clinical evaluation of deep learning-based CT-free PET reconstruction image: a dual-center study.","authors":"Hangxing Chunyu,Yizhou Chen,Song Xue,Xinyu Zhang,Ying Miao,Rui Guo,Biao Li,Kuangyu Shi","doi":"10.1007/s00259-025-07618-z","DOIUrl":"https://doi.org/10.1007/s00259-025-07618-z","url":null,"abstract":"PURPOSEEfforts to reduce the radiation burden of PET/CT have driven the increasing development of AI-based CT-less PET imaging techniques. However, comprehensive clinical evaluations of these approaches remain limited. This study aimed to rigorously assess whether deep learning (DL)-based PET reconstruction can eliminate the need for CT-derived attenuation and scatter correction while maintaining image quality sufficient for reliable clinical diagnosis.METHODSIn this dual-center retrospective analysis, raw PET/CT data from 359 patients were evaluated across 4 scanners and 4 tracers. Each dataset underwent four reconstruction approaches: (1) CT-based attenuation and scatter correction (CT-ASC, reference standard); (2) conventional 2D-DL; (3) conventional 3D-DL; and (4) our novel Decomposition-based DL algorithm. Diagnostic quality of reconstructed images was systematically assessed via visual scoring (5-point Likert scale), diagnostic accuracy (lesion-based false-positive/negative rates), and semi-quantitative metrics (SUVmax consistency).RESULTSVisual analysis demonstrated the superior performance of Decomposition-based DL compared to conventional 2D-DL and 3D-DL (p < 0.001 for all comparisons). Furthermore, the proposed method exhibited the lowest false-negative and false-positive rates (0.56% false positives with SIEMENS Vision 600; zero rates in other cases). Semi-quantitative analysis showed that although Decomposition-based DL did not consistently yield the lowest mean absolute percentage error values compared to controls, it maintained strong agreement with CT-ASC in most cases.CONCLUSIONThis dual-center study demonstrates that decomposition-based DL CT-free PET imaging outperforms conventional DL methods, achieving diagnostic accuracy comparable to CT-based attenuation correction in most cases. This clinical evaluation provides valuable insights to guide further methodological development and support clinical translation of CT-free PET imaging.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"58 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288375","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":"18F-FDG PET/CT and contrast-enhanced CT evaluation of lymph node status after neoadjuvant immunochemotherapy in patients with esophageal squamous cell carcinoma.","authors":"Yuhong Wang,Xin Hu,Tianhong Yang,Zhen Guo,Hui Luo,Xiangsong Zhang,Chao Cheng,Xiaoyan Wang","doi":"10.1007/s00259-025-07603-6","DOIUrl":"https://doi.org/10.1007/s00259-025-07603-6","url":null,"abstract":"PURPOSETo assess the detectability of residual tumor-involved lymph nodes (LNs) using 18F-FDG PET/CT and contrast-enhanced CT (CECT) parameters in patients with esophageal squamous cell carcinoma (ESCC) following neoadjuvant immunochemotherapy (NICT).METHODSThis retrospective study analyzed 161 ESCC patients who received esophagectomy following NICT. All patients underwent preoperative 18F-FDG PET/CT, and 137 also received CECT. Metastatic and nonmetastatic LNs, confirmed pathologically, were evaluated according to the Japanese Esophageal Society (JES) staging system. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis and logistic regression was used to integrate metrics for the prediction of LNs status.RESULTSFor overall lymph node analysis, there was no significant difference in diagnostic performance between the optimal PET parameter, total lesion glycolysis (TLG), and the best CECT parameter, short-axis diameter (SAD) (AUC: 0.830 vs. 0.797, P = 0.08). Nevertheless, a combined model incorporating TLG and SAD of PET/CT demonstrated significantly superior diagnostic performance compared to SAD of CECT (AUC: 0.863 vs. 0.797, P < 0.001). In subregional analyses, TLG performed best in the paraesophageal group and abdominal area, with AUCs of 0.824 and 0.857. The SUVmax ratio of lymph nodes to liver blood pool (LLR) demonstrated the highest diagnostic performance in the recurrent nerve group and subcarinal area, with AUCs of 0.885 and 0.884, respectively.CONCLUSION18F-FDG PET/CT is superior to CECT in assessing LNs status in ESCC patients after NICT. The optimal predictive parameters and thresholds vary across LN regions, underscoring the importance of region-specific diagnostic criteria.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"352 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288376","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":"Association between metabolic tumor burden and health-related quality of life in patients with classic Hodgkin lymphoma.","authors":"Marie Lommen,Jasmin J Weindler,Janina Jablonski,Johannes Rosenbrock,Peter Borchmann,Karolin Behringer,Katrin S Roth,Dominic Ufton,Markus Dietlein,Carsten Kobe,Justin Ferdinandus","doi":"10.1007/s00259-025-07569-5","DOIUrl":"https://doi.org/10.1007/s00259-025-07569-5","url":null,"abstract":"INTRODUCTIONStaging with [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET) is standard of care in classic Hodgkin lymphoma (cHL). Metabolic tumor volume (MTV) is a quantitative biomarker of tumor burden and has been shown to predict treatment response. This study investigates the association between MTV at baseline PET and health-related quality of life (HRQoL) across different disease stages.METHODSThis post-hoc analysis included 441 patients with newly diagnosed cHL and available baseline PET imaging, enrolled in the GHSG trials HD16, HD17, and HD18. MTV was quantified using a fixed threshold of SUV ≥ 4.0 (SUV4.0) via the LifeX Analytics workstation. HRQoL was assessed using the EORTC QLQ-C30 questionnaire at baseline and, for HD18 patients, again at 2-year follow-up. Multiple regression models adjusted for sex, age, and trial/stage were used for statistical analyses.RESULTSHigher MTV was associated with higher baseline HRQoL burden across several domains: fatigue (β = 0.14, 95% CI [0.05; 0.24]), dyspnea (β = 0.21, 95% CI [0.11; 0.30]), appetite loss (β = 0.13, 95% CI [0.03; 0.23]), and sleep disturbance (β = 0.12, 95% CI [0.02; 0.22]). In contrast, higher MTV was negatively associated with physical functioning (β = -0.18, 95% CI [-0.27; -0.08]) and global health status (β = -0.15, 95% CI [-0.25; -0.06]). The strongest associations were observed in patients with advanced-stage disease (HD18). At 2-year follow-up in HD18, no associations between MTV at baseline and HRQoL were found, with the exception of pain, which remained the only associated domain (β = 0.15, 95% CI [0.00; 0.30]).CONCLUSIONBaseline MTV is strongly associated with HRQoL before therapy in patients with newly diagnosed cHL, particularly in those with advanced-stage disease. Reassuringly, there seems to be no major influence of initial disease burden on HRQoL within the second year of recovery.TRIAL REGISTRATIONClinicalTrials.gov: HD16 (NCT00736320; first posted August 15, 2008), HD17 (NCT01356680; first posted May 19, 2011), HD18 (NCT00515554; first posted August 13, 2007).","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"10 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261158","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":"Association of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) with survival in patients with oligometastatic non-small-cell lung cancer treated with immunotherapy: a multicentre retrospective study.","authors":"Francesca Rita Ogliari,Mandy Jongbloed,Rianne D W Vaes,Ruud M A Houben,Valentina Bartolomeo,Ben E E M van den Borne,Juliette Degens,Jarno W J Huijs,Cordula Pitz,Michelle Steens,Magdolen Youssef-El Soud,Martina Sollini,Dirk K M De Ruysscher,Cristina Mitea,Lizza E L Hendriks","doi":"10.1007/s00259-025-07557-9","DOIUrl":"https://doi.org/10.1007/s00259-025-07557-9","url":null,"abstract":"PURPOSECurrent guidelines recommend adding local radical therapy (LRT) to systemic treatment in synchronous oligometastatic non-small-cell lung cancer (sOM-NSCLC), but survival data on immunotherapy-based regimens are limited. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are prognostic in NSCLC, with higher values linked to worse outcomes. This study examines their association with survival in sOM-NSCLC patients treated with immunotherapy.METHODSWe conducted a multicenter retrospective study including all consecutive patients with [18F]FDG-PET and brain imaging-staged sOM-NSCLC, between 2015 and 2022, who received first-line (chemo)-immunotherapy and had baseline PET-scan available for review. Subgroups were analyzed based on median MTV and TLG values (high vs. low: H-MTV vs. L-MTV, H-TLG vs. L-TLG). Study endpoints were progression-free survival (PFS) and overall survival (OS), according to MTV and TLG distribution (high vs. low), in the overall population (primary endpoint) and in relation to LRT and systemic treatment type (secondary endpoints).RESULTS105 patients were included, 50% were male and 73% had non-squamous histology, median age was 64.9 years. Median PFS was significantly longer for L-MTV vs. H-MTV (14.73 months (95%CI, 7.06-22.40) vs. 7.63 months (95%CI, 5.73-9.52), p = 0.028), but also LRT was associated with PFS (19.04 months (95%CI, 8.47-29.60) versus 7.46 months (95%CI, 5.25-9.67), p = 0.045), while neither MTV nor TLG had impact on OS. In multivariate analysis, only PD-L1 < 50% and soft tissue metastases remained significantly associated with shorter PFS.CONCLUSIONSBaseline MTV is preliminarily associated with PFS in sOM-NSCLC patients treated with immunotherapy, but results are exploratory and need prospective validation in larger cohorts.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"121 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261387","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":"Revealing the hidden: A systematic review and meta-analysis of FAPI-based tracers imaging for brain metastatic lesions.","authors":"Sajjad Sadeghpour,Atena Aghaee,Hojjat Ahmadzadehfar,Alessio Rizzo,Giorgio Treglia,Ramin Sadeghi","doi":"10.1007/s00259-025-07576-6","DOIUrl":"https://doi.org/10.1007/s00259-025-07576-6","url":null,"abstract":"BACKGROUNDRegarding the assessment of brain metastatic lesions, [18F]FDG PET/CT encounters challenges due to heightened physiological uptake in normal brain tissue, resulting in poor tumor-to-background ratios (TBR). Detecting brain metastases accurately has long been a challenge with standard imaging methods. The elevated physiological uptake of [18F]FDG in normal brain parenchyma limits its ability to distinguish metastatic lesions owing to poor tumor-to-background contrast. On the other hand, radiolabeled fibroblast activation protein inhibitors (FAPI) have emerged as a newer imaging tracer, showing promise. This study aimed to collect available literature to assess FAPI's ability to detect brain metastases across various cancer types.METHODSWe reviewed studies published up to April 2025, utilizing different databases, including Google Scholar, PubMed, and Scopus, primarily examining the performance of FAPI based on standardized uptake values (SUVs) and TBRs. Studies focusing on the diagnostic performance of FAPI-based PET for brain metastasis were included. The primary endpoint was the detection rate of FAPI-based tracers.RESULTSIn 24 studies involving over 115 patients and more than 291 lesions, FAPI-based imaging detected of 87.9% lesions (95% CI: 76.1-94.3%, p < 0.001) compared to [18F]FDG by the detection rate of 46.3% (95% CI: 30.6-62.8%, p = 0.667). The comparison of detection rates of these modalities showed an OR of 10.78 (95% CI: 5.15-22.55, p < 0.001). FAPI radiotracers exhibited higher TBR compared to [18F]FDG PET/CT (SMD: 1.51, 95% CI: 0.86-2.16, p < 0.001).CONCLUSIONIn conclusion, FAPI-based tracers seem to surpass [18F]FDG PET in identifying brain metastases. FAPI imaging can potentially serve as a diagnostic tool that offers benefits over traditional methods. Further research is needed to verify its clinical effectiveness.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"18 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235626","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":"AIMN, ITANET, SIE joint position paper for the recognition, prevention and management of NET carcinoid syndrome and crises during peptide receptor radionuclide therapy.","authors":"Riccardo Laudicella,Antongiulio Faggiano,Valeria Pirro,Rexhep Durmo,Pierpaolo Salsi,Roberta Modica,Luca Urso,Chiara Maria Grana,Daniele Sances,Maria Rinzivillo,Manuela Albertelli,Francesca Spada,Stefano Partelli,Francesco Ferraù,Nicola Fazio,Salvatore Tafuto,Marco Maccauro,Mirco Bartolomei,Francesco Panzuto,Maria Luisa De Rimini,Secondo Lastoria,Angelina Filice","doi":"10.1007/s00259-025-07596-2","DOIUrl":"https://doi.org/10.1007/s00259-025-07596-2","url":null,"abstract":"PURPOSECarcinoid syndrome (CS) is the most frequent neuroendocrine tumor (NET)-related syndrome with variable presentations related to hormonal discharge and long-term complications, such as carcinoid heart disease (CHD). Carcinoid crisis (CC) is an acute and serious CS complication, due to a massive release of vasoactive hormones and biologically active substances, which may occur during stressogenic procedures such as peptide receptor radionuclide therapy (PRRT). CC is an emergency and life-threatening condition that needs to be prevented, promptly recognized, and managed. The purpose of this joint Italian multidisciplinary position paper is to support the involved personnel in delivering [177Lu]Lu-based PRRT to syndromic NET patients, focusing on CC management.METHODSThe literature evidence regarding CS, CHD, and CC during/after PRRT and the knowledge of 22 Italian NET experts in Anesthesiology, Endocrinology, Gastroenterology, Nuclear Medicine, Oncology, and Surgery involved in PRRT were the basis for the present document.RESULTSThe expert panel expressed several recommendations regarding: 1) CC high-risk patients identification; 2) CC prevention, including considerations of the behavioral and nutritional status, and somatostatin analogue therapy; 3) how to implement PRRT premedication in CC high-risk patients; 4) how to manage CC during PRRT, including post-PRRT monitoring, and radiation protection considerations.CONCLUSIONThis practical guide summarizes the views and experience in CS, CHD, and CC in relation to PRRT of a joint NET-dedicated Italian multidisciplinary team. These recommendations should be taken into the context of Nuclear Medicine good practice and do not substitute any national and International legal or regulatory provisions.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"15 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235646","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 clinical utility of total-body [68 Ga]Ga-PSMA-11 PET/CT in prostate cancer: identifying extra-regional bone metastases and informing treatment strategies.","authors":"Qiaochu Chen,Wei Wang,Yining Wang,Liang Dong,Haitao Zhao,Lianghua Li,Gang Huang,Liu Liu,Ruohua Chen,Jianjun Liu","doi":"10.1007/s00259-025-07581-9","DOIUrl":"https://doi.org/10.1007/s00259-025-07581-9","url":null,"abstract":"BACKGROUND AND PURPOSEBone metastasis significantly impacts morbidity and mortality in prostate cancer patients, necessitating accurate detection and monitoring. Although [68 Ga]Ga-PSMA-11 PET/CT imaging provides superior sensitivity compared with conventional imaging, the conventional field of view (CFOV; skull to proximal femur) obtained with short axial field of view (SAFOV) PET/CT scanners may underestimate the extent of disease. This study aimed to evaluate the prevalence and characteristics of bone metastases outside the CFOV scan range (distal to the proximal one-third of the femur) using total-body [68 Ga]Ga-PSMA-11 PET/CT imaging and its impact on tumor burden, staging and subsequent treatment in prostate cancer patients.METHODSThis retrospective study included 1211 prostate cancer patients who underwent total-body [68 Ga]Ga-PSMA-11 PET/CT imaging. Imaging results were independently evaluated by three nuclear medicine physicians. Positive findings were validated through histopathology, treatment response, prostate-specific antigen (PSA) changes, or follow-up imaging. We further characterized the clinical and imaging characteristics of lesions located beyond the CFOV scan range. We also assessed the impact of total-body imaging on tumor burden biomarkers (PSMA-TV and TL-PSMA) and disease staging, and constructed a nomogram to predict the risk of extra-CFOV lesions.RESULTSApart from bone metastases, total-body [68 Ga]Ga-PSMA-11 PET/CT imaging did not identify any other types of lesions outside the CFOV scan range. Among the 1211 patients, 5.12% (62 patients) had bone metastases outside the CFOV scan range. Multivariable regression analysis revealed that patients in the castration-resistant prostate cancer (CRPC) stage, with higher Gleason scores (≥ 8), and higher PSA levels (≥ 12.57 ng/mL) were independent predictors of bone metastases outside the CFOV scan range. We developed a nomogram to predict bone metastases outside the CFOV scan range, in which the patient's disease stage demonstrated greater predictive value than the Gleason score and PSA level. In the subset of 62 patients with lesions outside the CFOV scan range, tumor burden metrics were significantly increased (P < 0.001). Treatment plans were altered in 20 patients (32.3% of the subgroup; 1.65% of the total cohort).CONCLUSIONSSAFOV PET/CT scanners with CFOV scan range may underestimate the true extent of bone metastasis. Total-body scan range using total-body PET/CT scanners revealed occult bone metastases in 5.12% of patients, particularly in those with higher PSA, Gleason scores, and CRPC stage. This extended view significantly impacts tumor burden quantification, leads to disease upstaging, and influences treatment planning. The developed nomogram can guide clinicians at centers with SAFOV PET/CT scanners in identifying patients who would most benefit from extended field-of-view imaging.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"63 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229105","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}