Seminars in nuclear medicine最新文献

{"title":"PET/CT Normal Variants and Pitfalls in Paediatric Disorders","authors":"Archi Agrawal,&nbsp;Gopinath Gnanasegran,&nbsp;Kanhaiyalal Agrawal,&nbsp;Pramukh Kulkarni,&nbsp;Pradeep Palanivel,&nbsp;Suchismita Ghosh,&nbsp;Indraja Dev,&nbsp;Manikandan MV,&nbsp;Sayak Choudhury","doi":"10.1053/j.semnuclmed.2026.07.001","DOIUrl":"10.1053/j.semnuclmed.2026.07.001","url":null,"abstract":"<div><div>18F- Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) has become an indispensable imaging modality in the evaluation of paediatric malignancies as well selected infectious and inflammatory disorders. However, the interpretation of paediatric PET/CT is often challenging because of age-dependent physiological tracer distribution, developmental changes, therapy-related alterations and technical artifacts that can mimic disease. Familiarity with normal variants and potential pitfalls specifically seen in paediatric imaging, together with careful corelation of PET findings with CT morphology and clinical history, is essential for accurate image interpretation. This review summarizes the spectrum of physiological FDG uptake patterns, common interpretative pitfalls and practical strategies to improve diagnostic confidence and avoid unnecessary repeat investigations in paediatric PET/CT imaging.</div></div><div>18F- Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) has become an indispensable imaging modality in the evaluation of paediatric malignancies as well selected infectious and inflammatory disorders. However, the interpretation of paediatric PET/CT is often challenging because of age-dependent physiological tracer distribution, developmental changes, therapy-related alterations and technical artifacts that can mimic disease. Familiarity with normal variants and potential pitfalls specifically seen in paediatric imaging, together with careful corelation of PET findings with CT morphology and clinical history, is essential for accurate image interpretation. This review summarizes the spectrum of physiological FDG uptake patterns, common interpretative pitfalls and practical strategies to improve diagnostic confidence and avoid unnecessary repeat investigations in paediatric PET/CT imaging.</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 813-824"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of imaging modalities in coronary heart disease: A comprehensive review","authors":"Elisa Milan,&nbsp;Raffaele Giubbini,&nbsp;Joao Vitola,&nbsp;Thomas N. Pascual,&nbsp;Amir Eskander,&nbsp;Maurizio Dondi,&nbsp;Diana Paez","doi":"10.1053/j.semnuclmed.2026.06.001","DOIUrl":"10.1053/j.semnuclmed.2026.06.001","url":null,"abstract":"<div><div>Cardiovascular diseases (CVDs) remain among the leading causes of both health and economic burdens worldwide. Myocardial Perfusion Imaging (MPI) performed using Single Photon Emission Computed Tomography (SPECT) or, more recently, Positron Emission Tomography (PET), has long served as a cornerstone in the diagnosis and management of coronary heart disease (CHD). However, rising healthcare costs and rapidly advancing imaging technologies have prompted re-evaluation of nuclear cardiology’s cost-effectiveness, making careful selection of imaging modalities essential. In this review, an economic evaluation of imaging in CHD has been undertaken, summarizing the most relevant studies on the cost-effectiveness of various imaging modalities. The heterogeneity in data - largely related to institutional resources, operator expertise, clinical setting (inpatient vs. outpatient), healthcare system, and reimbursement structure - does not yet allow definitive conclusions on the cost-effectiveness of each individual modality. Therefore, a well-structured multimodality imaging approach appears to provide greater diagnostic and economic value, offering both improved clinical outcomes and more efficient resource utilization.</div></div><div>Cardiovascular diseases (CVDs) remain among the leading causes of both health and economic burdens worldwide. Myocardial Perfusion Imaging (MPI) performed using Single Photon Emission Computed Tomography (SPECT) or, more recently, Positron Emission Tomography (PET), has long served as a cornerstone in the diagnosis and management of coronary heart disease (CHD). However, rising healthcare costs and rapidly advancing imaging technologies have prompted re-evaluation of nuclear cardiology’s cost-effectiveness, making careful selection of imaging modalities essential. In this review, an economic evaluation of imaging in CHD has been undertaken, summarizing the most relevant studies on the cost-effectiveness of various imaging modalities. The heterogeneity in data - largely related to institutional resources, operator expertise, clinical setting (inpatient vs. outpatient), healthcare system, and reimbursement structure - does not yet allow definitive conclusions on the cost-effectiveness of each individual modality. Therefore, a well-structured multimodality imaging approach appears to provide greater diagnostic and economic value, offering both improved clinical outcomes and more efficient resource utilization.</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 950-957"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on pediatric nuclear medicine in acute care","authors":"Fatemeh Kaghazchi,&nbsp;Reza Vali,&nbsp;Amer Shammas","doi":"10.1053/j.semnuclmed.2026.07.010","DOIUrl":"10.1053/j.semnuclmed.2026.07.010","url":null,"abstract":"&lt;div&gt;&lt;div&gt;There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel’s diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobiliary scintigraphy provides functional assessment of biliary excretion and is useful for evaluation of acute cholecystitis, choledochal cysts, and bile leaks. 99mTc-DMSA renal cortical scintigraphy is a sensitive method for detecting acute pyelonephritis and renal cortical scarring, while 99mTc-MAG3 renal scintigraphy is used to evaluate early and late complications of renal transplantation. Bone scintigraphy is considered as a valuable imaging modality for evaluation of osteomyelitis, occult fracture, stress injury, sickle cell related bone pain, and selected cases of suspected physical abuse, especially when whole body assessment is needed. 18F-FDG PET/CT has an increasing role in selected children with fever of unknown origin and inflammatory disorders. Moving forward, continued refinement of pediatric administered activities, wider use of SPECT/CT and PET-based imaging and updated pediatric-specific guidelines are expected to further improve the role of nuclear medicine in acute pediatric care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel’s diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobili","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 839-859"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of treating neuroendocrine prostate cancer with anti-SSTR radioligands: A systematic review of imaging and treatment studies","authors":"Parya Valizadeh,&nbsp;Payam Jannatdoust,&nbsp;Mehrnoosh Shahgholianghahfarokhi,&nbsp;Pedram Heidari,&nbsp;Yusuf Menda,&nbsp;Ahmad Shariftabrizi","doi":"10.1053/j.semnuclmed.2026.05.004","DOIUrl":"10.1053/j.semnuclmed.2026.05.004","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Purpose: To review clinical evidence on somatostatin receptor (SSTR) targeted imaging and SSTR directed radioligand therapy in neuroendocrine prostate cancer (NEPC).&lt;/div&gt;&lt;div&gt;Methods: A PRISMA guided search of PubMed, Scopus, and Web of Science was performed on September 14, 2025. Two reviewers screened studies and extracted data. Risk of bias was appraised using Joanna Briggs Institute tools. Synthesis was descriptive.&lt;/div&gt;&lt;div&gt;Results: Of 1937 records, 41 studies were included (4 prospective cohorts and 37 case reports or series). Case reports or series reported 80 patients with SSTR imaging. Cohort studies used 111In based SSTR scintigraphy (three cohorts) or 68Ga-DOTATATE PET/CT (one cohort) and reported SSTR uptake in a minority of patients with heterogeneity across metastatic sites. In patient level reports, SSTR imaging was positive in 61/80 cases (76.3%). Common tracers were 68Ga-DOTATATE (27/80), 68Ga-DOTANOC (17/80), 111In-octreotide or 111In-pentetreotide (14/80), and 18F-AlF-NOTA-octreotide (10/80). PSMA imaging was available in 27 cases; SSTR uptake was present in 11/14 PSMA negative cases. Ten patients in nine reports received SSTR directed PRRT, most often 177Lu-DOTATATE, with symptom benefit and imaging and/or biomarker improvement frequently described; toxicity reporting was limited.&lt;/div&gt;&lt;div&gt;Conclusion: SSTR expression in NEPC is heterogeneous. SSTR imaging can support phenotyping and selection for SSTR directed therapy in selected patients, including PSMA low disease, but prospective validation with standardized reporting is needed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Purpose: To review clinical evidence on somatostatin receptor (SSTR) targeted imaging and SSTR directed radioligand therapy in neuroendocrine prostate cancer (NEPC).&lt;/div&gt;&lt;div&gt;Methods: A PRISMA guided search of PubMed, Scopus, and Web of Science was performed on September 14, 2025. Two reviewers screened studies and extracted data. Risk of bias was appraised using Joanna Briggs Institute tools. Synthesis was descriptive.&lt;/div&gt;&lt;div&gt;Results: Of 1937 records, 41 studies were included (4 prospective cohorts and 37 case reports or series). Case reports or series reported 80 patients with SSTR imaging. Cohort studies used 111In based SSTR scintigraphy (three cohorts) or 68Ga-DOTATATE PET/CT (one cohort) and reported SSTR uptake in a minority of patients with heterogeneity across metastatic sites. In patient level reports, SSTR imaging was positive in 61/80 cases (76.3%). Common tracers were 68Ga-DOTATATE (27/80), 68Ga-DOTANOC (17/80), 111In-octreotide or 111In-pentetreotide (14/80), and 18F-AlF-NOTA-octreotide (10/80). PSMA imaging was available in 27 cases; SSTR uptake was present in 11/14 PSMA negative cases. Ten patients in nine reports received SSTR directed PRRT, most often 177Lu-DOTATATE, with symptom benefit and imaging and/or biomarker improvement frequently described; toxicity reporting was limited.&lt;/div&gt;&lt;div&gt;Conclusion: SSTR expression in NEPC is heterogeneous. SSTR ","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 975-1011"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric nephro-urology imaging: updates in renal scintigraphy and pitfalls","authors":"Khanyisile Hlongwa,&nbsp;Anita Brink,&nbsp;Stuart More","doi":"10.1053/j.semnuclmed.2026.08.002","DOIUrl":"10.1053/j.semnuclmed.2026.08.002","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Paediatric nephro-urology imaging plays a central role in the evaluation of congenital renal abnormalities, with renal scintigraphy remaining the reference standard for functional assessment of drainage, differential renal function, and cortical integrity. Despite advances in ultrasound and cross-sectional imaging, nuclear medicine techniques continue to provide unique quantitative and physiological information that directly influences clinical decision-making.&lt;/div&gt;&lt;div&gt;Recent developments include improved standardisation of paediatric renography protocols, optimised use of &lt;sup&gt;99m&lt;/sup&gt;Tc-labeled radiopharmaceuticals such as [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-MAG3, [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-EC and [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-DMSA, and increasing incorporation of hybrid SPECT/CT imaging for problem-solving in equivocal cases. Interpretation of diuretic renography has also evolved, with greater emphasis on integrated analysis rather than reliance on single quantitative indices.&lt;/div&gt;&lt;div&gt;Paediatric renal scintigraphy, however, remains prone to interpretative pitfalls due to developmental renal physiology, technical variability, and overlapping imaging appearances between obstructive and non-obstructive systems. False-positive obstruction, misinterpretation of drainage patterns, and challenges in cortical defect characterisation remain significant issues.&lt;/div&gt;&lt;div&gt;This review summarises current advances in paediatric renal scintigraphy, highlights optimised imaging protocols, and discusses common interpretative pitfalls with strategies to improve diagnostic accuracy in clinical practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Paediatric nephro-urology imaging plays a central role in the evaluation of congenital renal abnormalities, with renal scintigraphy remaining the reference standard for functional assessment of drainage, differential renal function, and cortical integrity. Despite advances in ultrasound and cross-sectional imaging, nuclear medicine techniques continue to provide unique quantitative and physiological information that directly influences clinical decision-making.&lt;/div&gt;&lt;div&gt;Recent developments include improved standardisation of paediatric renography protocols, optimised use of &lt;sup&gt;99m&lt;/sup&gt;Tc-labeled radiopharmaceuticals such as [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-MAG3, [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-EC and [&lt;sup&gt;99m&lt;/sup&gt;Tc]Tc-DMSA, and increasing incorporation of hybrid SPECT/CT imaging for problem-solving in equivocal cases. Interpretation of diuretic renography has also evolved, with greater emphasis on integrated analysis rather than reliance on single quantitative indices.&lt;/div&gt;&lt;div&gt;Paediatric renal scintigraphy, however, remains prone to interpretative pitfalls due to developmental renal physiology, technical variability, and overlapping imaging appearances between obstructive and non-obstructive systems. False-positive obstruction, misinterpretation of drainage patterns, and challenges in cortical defect characterisation remain significant issues.&lt;/div&gt;&lt;div&gt;This review summarises","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 825-838"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare subcutaneous metastases of papillary thyroid carcinoma revealed by 18F-FDG PET/CT","authors":"Semra Demirtaş Şenlik,&nbsp;Barış Yılmaztekin,&nbsp;Ayşegül Erol,&nbsp;Bedriye Büşra Demirel,&nbsp;Gülin Uçmak","doi":"10.1053/j.semnuclmed.2026.07.006","DOIUrl":"10.1053/j.semnuclmed.2026.07.006","url":null,"abstract":"<div><div>A 76-year-old woman underwent thyroidectomy in 2010 for a 5-cm papillary thyroid carcinoma (PTC), oncocytic variant, with extrathyroidal extension, followed by 150 mCi radioactive iodine therapy (RIT). During follow-up, locoregional recurrence, pulmonary metastases, and a paraesophageal metastatic lesion developed without significant thyroglobulin elevation under TSH suppression. After additional RIT, repeat surgery, and external beam radiotherapy thyroglobulin became undetectable; however, two consecutive increases in 2026, from 1.98 to 3.57 ng/mL, prompted ¹⁸F-FDG PET/CT, which demonstrated multiple FDG-avid subcutaneous lesions (Figure 1). Punch biopsy of a shoulder lesion confirmed metastatic PTC with a focal tall-cell component and BRAF positivity (Figure 2).</div></div><div>A 76-year-old woman underwent thyroidectomy in 2010 for a 5-cm papillary thyroid carcinoma (PTC), oncocytic variant, with extrathyroidal extension, followed by 150 mCi radioactive iodine therapy (RIT). During follow-up, locoregional recurrence, pulmonary metastases, and a paraesophageal metastatic lesion developed without significant thyroglobulin elevation under TSH suppression. After additional RIT, repeat surgery, and external beam radiotherapy thyroglobulin became undetectable; however, two consecutive increases in 2026, from 1.98 to 3.57 ng/mL, prompted ¹⁸F-FDG PET/CT, which demonstrated multiple FDG-avid subcutaneous lesions (Figure 1). Punch biopsy of a shoulder lesion confirmed metastatic PTC with a focal tall-cell component and BRAF positivity (Figure 2).</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 1042-1043"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on nuclear medicine in end-of-life care of infants and children: radionuclide perfusion studies in the determination of death by neurological criteria (DNC)","authors":"S. Masood,&nbsp;N.K. McKinnon,&nbsp;L.J. States,&nbsp;L.S. Zuckier","doi":"10.1053/j.semnuclmed.2026.08.005","DOIUrl":"10.1053/j.semnuclmed.2026.08.005","url":null,"abstract":"<div><div>“Death by neurologic criteria” (DNC), a condition previously described as “brain death”, accounts for approximately 21% of deaths in the pediatric intensive care unit (PICU). DNC is primarily a clinical assessment, defined by the irreversible cessation of all functions of the entire brain including the brainstem. When physical examination and apnea testing, the standard components of DNC assessment, cannot be completed in full, ancillary investigations are required to complement and complete the process. Amongst accepted ancillary tests, radionuclide perfusion studies exhibit some of the highest levels of accuracy in adult and pediatric populations and have been favored in recent clinical and imaging guidelines. The goal of this review is to discuss radionuclide perfusion studies performed as ancillary studies in the determination of DNC in children, highlighting recent research, physiologic differences in pediatric brain and skull development, and differences in performing and interpreting radionuclide ancillary studies in this population.</div></div><div>“Death by neurologic criteria” (DNC), a condition previously described as “brain death”, accounts for approximately 21% of deaths in the pediatric intensive care unit (PICU). DNC is primarily a clinical assessment, defined by the irreversible cessation of all functions of the entire brain including the brainstem. When physical examination and apnea testing, the standard components of DNC assessment, cannot be completed in full, ancillary investigations are required to complement and complete the process. Amongst accepted ancillary tests, radionuclide perfusion studies exhibit some of the highest levels of accuracy in adult and pediatric populations and have been favored in recent clinical and imaging guidelines. The goal of this review is to discuss radionuclide perfusion studies performed as ancillary studies in the determination of DNC in children, highlighting recent research, physiologic differences in pediatric brain and skull development, and differences in performing and interpreting radionuclide ancillary studies in this population.</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 930-942"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET/CT in acute and time-sensitive non-oncological conditions: Current evidence, clinical applications, and emerging roles","authors":"Raghad Mohammad Al-houwari,&nbsp;Soud Al-Qasem,&nbsp;Serin Moghrabi,&nbsp;Laith Ashour,&nbsp;Ahmed Abdlkadir,&nbsp;Maha Talal Mohammed,&nbsp;Zeidan Zeidan,&nbsp;Dragi Stanimirović,&nbsp;Hongcheng Shi,&nbsp;Kanhaiyalal Agrawal,&nbsp;Parthiban Arumugam,&nbsp;Sharjeel Usmani,&nbsp;Gopinath Gnanasegaran,&nbsp;Akram Al-Ibraheem","doi":"10.1053/j.semnuclmed.2026.08.003","DOIUrl":"10.1053/j.semnuclmed.2026.08.003","url":null,"abstract":"<div><div>Acute medical conditions represent a significant and heterogeneous clinical burden, often requiring rapid and accurate diagnosis to guide timely management. Positron emission tomography/computed tomography (PET/CT), which integrates functional PET imaging with CT's anatomical detail, has expanded beyond its traditional oncologic applications and is being increasingly explored in acute or emergency settings. PET/CT, particularly with but not limited to ¹⁸F-fluorodeoxyglucose, represents a promising adjunct, offering unique pathophysiological insights that can complement conventional imaging, supporting diagnostic decision-making and patient management in select non-oncologic contexts. This review examines the evolving role of PET/CT in acute clinical scenarios, highlighting its ability to detect early metabolic or inflammatory changes that may precede structural abnormalities on conventional imaging modalities such as CT or MRI. It also highlights how further evidence is, nonetheless, still required to better define optimal clinical integration.</div></div><div>Acute medical conditions represent a significant and heterogeneous clinical burden, often requiring rapid and accurate diagnosis to guide timely management. Positron emission tomography/computed tomography (PET/CT), which integrates functional PET imaging with CT's anatomical detail, has expanded beyond its traditional oncologic applications and is being increasingly explored in acute or emergency settings. PET/CT, particularly with but not limited to ¹⁸F-fluorodeoxyglucose, represents a promising adjunct, offering unique pathophysiological insights that can complement conventional imaging, supporting diagnostic decision-making and patient management in select non-oncologic contexts. This review examines the evolving role of PET/CT in acute clinical scenarios, highlighting its ability to detect early metabolic or inflammatory changes that may precede structural abnormalities on conventional imaging modalities such as CT or MRI. It also highlights how further evidence is, nonetheless, still required to better define optimal clinical integration.</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 958-974"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparation of children for nuclear medicine examinations: A chronological, multi-modal approach to sedationless care","authors":"Christophe Van de Wiele,&nbsp;Chabi Sathekge,&nbsp;Justine Maes,&nbsp;Shaobo Li,&nbsp;Laurence Beels,&nbsp;Alex Maes","doi":"10.1053/j.semnuclmed.2026.08.008","DOIUrl":"10.1053/j.semnuclmed.2026.08.008","url":null,"abstract":"<div><div>Positron Emission Tomography (PET) and Single-Photon Emission Computerized tomography (SPECT), pose unique challenges when considering pediatric patient populations. Because both modalities require prolonged acquisition times, often ranging from 20 min to over an hour, minimizing patient motion is critical to prevent motion-related image quality degradation and ensuring diagnostic accuracy. While pharmacological sedation may avoid both problems, it carries inherent clinical risks, operational bottlenecks and comes with increased healthcare costs to society. In this paper, we assess the role of evidence-based, non-pharmacological strategies chronologically across the pediatric patient’s journey in the nuclear medicine department. By combining pre-visit psychological preparation, camera familiarization, optimized intravenous (IV) cannulation protocols, tailored physical and modality-specific positioning, and positive aftercare reinforcement, the nuclear medicine staff can optimize diagnostic image quality while prioritizing pediatric patient comfort and safety.</div></div><div>Positron Emission Tomography (PET) and Single-Photon Emission Computerized tomography (SPECT), pose unique challenges when considering pediatric patient populations. Because both modalities require prolonged acquisition times, often ranging from 20 min to over an hour, minimizing patient motion is critical to prevent motion-related image quality degradation and ensuring diagnostic accuracy. While pharmacological sedation may avoid both problems, it carries inherent clinical risks, operational bottlenecks and comes with increased healthcare costs to society. In this paper, we assess the role of evidence-based, non-pharmacological strategies chronologically across the pediatric patient’s journey in the nuclear medicine department. By combining pre-visit psychological preparation, camera familiarization, optimized intravenous (IV) cannulation protocols, tailored physical and modality-specific positioning, and positive aftercare reinforcement, the nuclear medicine staff can optimize diagnostic image quality while prioritizing pediatric patient comfort and safety.</div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 943-949"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation dose optimization and dosimetry in pediatric nuclear medicine: Current concepts and future directions","authors":"Serin Moghrabi,&nbsp;Kamo Ramonaheng,&nbsp;Raghad Mohammad Al-houwari,&nbsp;Ali Mohamedkhair,&nbsp;Nouraldeen Alzorgan,&nbsp;Abdullah Amro,&nbsp;Ahmed Abdlkadir,&nbsp;Mike Sathekge,&nbsp;Akram Al-Ibraheem","doi":"10.1053/j.semnuclmed.2026.07.005","DOIUrl":"10.1053/j.semnuclmed.2026.07.005","url":null,"abstract":"&lt;div&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;Reviews current strategies for radiation dose optimization in pediatric nuclear medicine.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;Summarizes international pediatric activity guidelines and ALARA-based imaging.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;Explores patient-specific dosimetry using quantitative PET/SPECT and Monte Carlo methods.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;Discusses AI, voxel-based dosimetry, and advanced computational imaging technologies.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;Highlights future directions toward precision pediatric imaging and theranostics.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Pediatric nuclear medicine plays an essential role in the diagnosis and treatment of a wide range of oncologic and non-oncologic diseases while requiring particular attention to radiation safety because of children's greater radiosensitivity, ongoing growth, and longer life expectancy. Over the past decade, substantial advances in quantitative imaging, detector technology, hybrid imaging, computational dosimetry, and theranostics have transformed radiation management from standardized activity administration toward increasingly individualized approaches. This review summarizes the biological basis of radiation risk in children, fundamental principles of internal dosimetry, and the unique anatomical and physiological factors influencing radiation dose estimation in pediatric patients. Current international recommendations for pediatric administered activities are discussed alongside practical strategies for radiation dose optimization across common nuclear medicine procedures and hybrid PET/CT and SPECT/CT imaging. The review further examines the growing role of quantitative PET and SPECT, patient-specific dosimetry, voxel-based dose calculation, Monte Carlo simulation, and advanced computational phantoms in improving absorbed-dose estimation and supporting personalized imaging and radionuclide therapy. Emerging applications of artificial intelligence, including image reconstruction, automated organ segmentation, predictive dosimetry, and low-count imaging, are also highlighted. Finally, current challenges, radiation protection principles, and future directions are discussed, emphasizing the transition toward precision pediatric nuclear medicine. Continued technological innovation, standardized quantitative methodologies, and prospective pediatric validation studies will be essential to optimize radiation safety while maximizing the diagnostic and therapeutic benefits of molecular imaging and theranostics in children.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Pediatric nuclear medicine plays an essential role in the diagnosis and treatment of a wide range of oncologic and non-oncologic diseases while requiring particular attention to radiation safety because of children's greater radiosensitivity, ongoing growth, and longer life expectancy. Over the past decade, substantial advances in quantitative","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"56 5","pages":"Pages 793-812"},"PeriodicalIF":6.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}