Chabi Sathekge MD , Justine Maes MD , Alex Maes MD, PhD , Christophe Van de Wiele MD, PhD
{"title":"FDG PET/CT for Staging Lung Carcinoma: An Update","authors":"Chabi Sathekge MD , Justine Maes MD , Alex Maes MD, PhD , Christophe Van de Wiele MD, PhD","doi":"10.1053/j.semnuclmed.2025.01.002","DOIUrl":"10.1053/j.semnuclmed.2025.01.002","url":null,"abstract":"<div><div>In non-small cell lung carcinoma (NSCLC) carcinoma, the CT-part of the FDG PET/CT examination is of primary importance for T (tumor)-status assessment, while information derived from the primary tumor on the FDG-part of the examination may provide additional information on N- (lymph node) status. FDG PET/CT imaging was shown to have an overall sensitivity of 85% and a specificity of 84% for identifying LN involvement in NSCLC. Parameters that may predict the presence and quantify the risk of LN-involvement in NSCLC missed on FDG PET/CT imaging are tumor size and its increase over time, tumor differentiation degree, the number of days elapsed from the time of initial diagnosis, an adenocarcinoma subtype, a central versus peripheral location of the primary tumor and a solid versus mixed solid-ground glass radiologic character. Nomograms incorporating several of these variables have been published and made available for clinical usage. Furthermore, FDG PET/CT imaging was shown to have an overall higher sensitivity for identifying extra-thoracic metastases than convential morphological imaging and this especially for bone and adrenal lesions. In small cell lung carcinoma (SCLC), limited available data have shown FDG PET/CT imaging to be systematically more accurate for staging purposes when compared to conventional staging and to lead to a change in disease stage (limited versus extensive disease) in up to 15% of SCLC-patients.</div></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"55 2","pages":"Pages 167-174"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537669","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}
Anne-Leen Deleu MD , Qaid Ahmed Shagera MD, PhD , Sophie Veldhuijzen van Zanten MD, PhD , Patrick Flamen MD, PhD , Olivier Gheysens MD, PhD , Hubertus Hautzel MD, PhD
{"title":"FAPI PET in the Management of Lung Tumors","authors":"Anne-Leen Deleu MD , Qaid Ahmed Shagera MD, PhD , Sophie Veldhuijzen van Zanten MD, PhD , Patrick Flamen MD, PhD , Olivier Gheysens MD, PhD , Hubertus Hautzel MD, PhD","doi":"10.1053/j.semnuclmed.2025.02.011","DOIUrl":"10.1053/j.semnuclmed.2025.02.011","url":null,"abstract":"<div><div>Fibroblast activation protein (FAP), selectively expressed on activated fibroblasts in proliferating tissues, is emerging as a promising target in oncology. In lung cancer, the leading cause of cancer-related deaths worldwide, [<sup>18</sup>F]FDG PET/CT has set the bar high and earned widespread recognition in clinical guidelines for its essential role in staging and follow-up. Yet, FAP-targeted imaging agents like FAPI PET/CT have demonstrated significant potential due to their high tumor specificity, rapid tracer uptake, and low background activity. This review focuses on the role of FAPI PET/CT in lung cancer, highlighting its applications in staging, biomarker evaluation, and clinical management. FAP expression correlates with cancer associated fibroblast-driven tumorigenesis in lung cancer, showing higher expression in nonsmall cell lung cancer (NSCLC) than in small cell lung cancer (SCLC) subtypes. Studies reveal that FAPI PET/CT provides comparable or superior detection rates for primary tumors and metastases compared to [<sup>18</sup>F]FDG PET/CT, particularly in brain, pleural, and bone lesions. It also enhances accuracy in lymph node staging, influencing disease management by enabling surgical resection in cases misclassified by [<sup>18</sup>F]FDG PET/CT. Despite these advantages, several challenges remain, such as differentiating benign from malignant lesions, assessing FAPI's prognostic implications or its role in treatment response monitoring. Future directions include exploring FAPI-based theranostics, standardizing radiopharmaceuticals, and conducting well-designed, adequately powered prospective trials. FAPI PET/CT represents a transformative diagnostic tool, complementing or potentially surpassing [<sup>18</sup>F]FDG PET/CT in precision lung cancer care.</div></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"55 2","pages":"Pages 202-211"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557439","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}
Tugce Telli MD , Mélanie Desaulniers MD, FRCPC , Thomas Pyka MD , Federico Caobelli MD, FEBNM , Sophia Forstmann MD , Lale Umutlu MD , Wolfgang P. Fendler MD , Axel Rominger MD , Ken Herrmann MD, MBA , Robert Seifert MD, MBA
{"title":"What Role Does PET/MRI Play in Musculoskeletal Disorders?","authors":"Tugce Telli MD , Mélanie Desaulniers MD, FRCPC , Thomas Pyka MD , Federico Caobelli MD, FEBNM , Sophia Forstmann MD , Lale Umutlu MD , Wolfgang P. Fendler MD , Axel Rominger MD , Ken Herrmann MD, MBA , Robert Seifert MD, MBA","doi":"10.1053/j.semnuclmed.2023.11.004","DOIUrl":"10.1053/j.semnuclmed.2023.11.004","url":null,"abstract":"<div><div><span>Musculoskeletal disorders<span> of nononcological origin are one of the most frequent reasons for consultation. Patients suffering from musculoskeletal disorders also consult more than once for the same reason. This results in multiple clinical follow-ups after several radiological and serum examinations, the main ones including X-rays targeting the painful anatomical region and inflammatory serum parameters. As part of their work up, patients suffering from musculoskeletal disorders often require multisequence, multi-parameter MRI. PET/MRI is a promising imaging modality for their diagnosis, with the added advantage of being able to be performed in a single visit. PET/MRI is particularly useful for diagnosing osteomyelitis, </span></span>spondylodiscitis<span>, arthritis, many pediatric pathologies<span>, and a wide range of other musculoskeletal pathologies. PET/MRI is already used to diagnose malignant bone tumors such as osteosarcoma. However, current knowledge of the indications for PET/MRI in nononcological musculoskeletal disorders is based on studies involving only a few patients. This review focuses on the usefulness of PET/MRI for diagnosing nononcological musculoskeletal disorders.</span></span></div></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"55 2","pages":"Pages 277-289"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478517","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}
Fawziah Alorfi MD , Jamshed Bomanji MD, PhD , Linda Bertoletti MD , Francesco Fraioli MD
{"title":"PET/MRI in Non-Small Cell Lung Cancer (NSCLC)","authors":"Fawziah Alorfi MD , Jamshed Bomanji MD, PhD , Linda Bertoletti MD , Francesco Fraioli MD","doi":"10.1053/j.semnuclmed.2025.02.009","DOIUrl":"10.1053/j.semnuclmed.2025.02.009","url":null,"abstract":"<div><div>Lung cancer remains the leading cause of cancer-related deaths worldwide, with nonsmall cell lung cancer (NSCLC) accounting for 80%-85% of cases. Accurate imaging is critical for staging, treatment planning, and follow-up. While CT and PET/CT are standard imaging modalities, PET/MR is a relatively new and promising radiation free technique combining the potentiality of MRI with the metabolic information of PET scans, allowing undeniable advantages including: superior contrast resolution, particularly in soft tissues; functional information through specific MRI sequences (eg, diffusion-weighted and perfusion sequences), reflecting changes at a cellular level; and more superior sensitivity compared to CT and PET/CT for detecting metastases in common metastatic sites such as the brain, liver, adrenal glands, and bone. These advantages position PET/MR as a valuable tool in comprehensive lung cancer staging. While it is not yet a routine clinical tool, ongoing advancements in imaging technology, protocol optimization, and large-scale studies may establish PET/MR as a key component in the personalized management of lung cancer.</div></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"55 2","pages":"Pages 234-239"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573731","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":"Evolving Paradigms in Lung Cancer: Latest Trends in Diagnosis, Management, and Radiopharmaceuticals","authors":"Busra Cangut MD, MS, Rahman Akinlusi MD, Ava Mohseny MD, Nasrin Ghesani MD, Munir Ghesani MD","doi":"10.1053/j.semnuclmed.2025.02.005","DOIUrl":"10.1053/j.semnuclmed.2025.02.005","url":null,"abstract":"<div><div>Lung cancer is one of the most common and deadliest forms of cancer worldwide. Over the past two decades, significant changes have occurred in the classification of lung cancer, involving multidisciplinary input and emphasizing the growing contribution of immunohistochemistry and molecular techniques to morphology in the classification scheme. This comprehensive review will cover the background and epidemiology of lung cancer as well as advancements in its staging and management, including discussions of new surgical techniques, targeted therapies, and immunotherapy. The review will detail the role of 18F-FDG-PET-CT in lung cancer, highlighting its importance in staging, treatment response assessment, and recurrence detection. While immunotherapy has transformed lung cancer management and improved patient outcomes, it presents major challenges and opportunities for optimal assessment of treatment response in lung cancer patients using 18F-FDG-PET-CT. This review will also explore future directions, including a discussion of promising new targeted diagnostic radiopharmaceuticals for PET/CT imaging. Additionally, there will be a brief discussion of evolving and exciting treatment options for lung cancer using targeted therapeutic radiopharmaceuticals. Several case-based illustrations are included to exemplify the role of 18F-FDG-PET-CT in various clinical scenarios.</div></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":"55 2","pages":"Pages 264-276"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586781","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}
Felipe Lopez-Ramirez, Mohammad Yasrab, Florent Tixier, Satomi Kawamoto, Elliot K Fishman, Linda C Chu
{"title":"The Role of AI in the Evaluation of Neuroendocrine Tumors: Current State of the Art.","authors":"Felipe Lopez-Ramirez, Mohammad Yasrab, Florent Tixier, Satomi Kawamoto, Elliot K Fishman, Linda C Chu","doi":"10.1053/j.semnuclmed.2025.02.003","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2025.02.003","url":null,"abstract":"<p><p>Advancements in Artificial Intelligence (AI) are driving a paradigm shift in the field of medical diagnostics, integrating new developments into various aspects of the clinical workflow. Neuroendocrine neoplasms are a diverse and heterogeneous group of tumors that pose significant diagnostic and management challenges due to their variable clinical presentations and biological behavior. Innovative approaches are essential to overcome these challenges and improve the current standard of care. AI-driven applications, particularly in imaging workflows, hold promise for enhancing tumor detection, classification, and grading by leveraging advanced radiomics and deep learning techniques. This article reviews the current and emerging applications of AI computer vision in the care of neuroendocrine neoplasms, focusing on its integration into imaging workflows, diagnostics, prognostic modeling, and therapeutic planning.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537678","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}
Yizhou Chen, Xiaoliang Shao, Kuangyu Shi, Axel Rominger, Federico Caobelli
{"title":"AI in Breast Cancer Imaging: An Update and Future Trends.","authors":"Yizhou Chen, Xiaoliang Shao, Kuangyu Shi, Axel Rominger, Federico Caobelli","doi":"10.1053/j.semnuclmed.2025.01.008","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2025.01.008","url":null,"abstract":"<p><p>Breast cancer is one of the most common types of cancer affecting women worldwide. Artificial intelligence (AI) is transforming breast cancer imaging by enhancing diagnostic capabilities across multiple imaging modalities including mammography, digital breast tomosynthesis, ultrasound, magnetic resonance imaging, and nuclear medicines techniques. AI is being applied to diverse tasks such as breast lesion detection and classification, risk stratification, molecular subtyping, gene mutation status prediction, and treatment response assessment, with emerging research demonstrating performance levels comparable to or potentially exceeding those of radiologists. The large foundation models are showing remarkable potential in different breast cancer imaging tasks. Self-supervised learning gives an insight into data inherent correlation, and federated learning is an alternative way to maintain data privacy. While promising results have been obtained so far, data standardization from source, large-scale annotated multimodal datasets, and extensive prospective clinical trials are still needed to fully explore and validate deep learning's clinical utility and address the legal and ethical considerations, which will ultimately determine its widespread adoption in breast cancer care. We hereby provide a review of the most up-to-date knowledge on AI in breast cancer imaging.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516707","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":"Potential of Technetium and Rhenium Theranostics.","authors":"Geoffrey M Currie, Eric M Rohren","doi":"10.1053/j.semnuclmed.2025.01.005","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2025.01.005","url":null,"abstract":"<p><p>While theranostics has transformed the precision medicine landscape over the last decade, there is scope for the development of true theranostic pairs, e.g. diagnostic and therapeutic partners in which any physical, chemical, and biological differences are negligible to in vivo application. Although simple to state in theory, there are, in fact, limited options exhibiting optimal physical characteristics and wholly shared elements. Further compounding real-world application of the traditional theranostic method are additional barriers. The use of PET/CT as the cornerstone of the diagnostic pair in theranostics creates inequity of access and opportunity based on socioeconomic and geographic factors, and the growing demand for both <sup>68</sup>Ga and <sup>177</sup>Lu is straining production capabilities globally. Improving access to theranostics globally will require novel thinking and infrastructure investment to ensure that patients of all economic and social backgrounds have access to this transformative technology. An approach which is underdeveloped, but which may address gaps in health inequities and improve outcomes, is the application of the widely available generator-produced <sup>99m</sup>Tc for imaging and <sup>188</sup>Re for therapy. Despite favourable and near identical radiochemistry, the search for the next generation of theranostic radionuclide pairs seldom references technetium or rhenium radionuclides. Advances in SPECT/CT instrumentation and radiochemistry provide an opportunity to deliver theranostics to communities not serviced by PET-based theranostics. The <sup>188</sup>Re and <sup>99m</sup>Tc supply by daily elution of a generator affords significant convenience, flexibility and delayed biomolecule imaging. Low abundance gamma emissions of <sup>188</sup>Re allow serial imaging and dosimetry calculations. <sup>99m</sup>Tc / <sup>188</sup>Re theranostics could address inequity in access and opportunity to cutting edge theranostics.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503570","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":"Sharpening the Blade of Precision Theranostics.","authors":"Geoffrey M Currie, Eric M Rohren","doi":"10.1053/j.semnuclmed.2025.01.007","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2025.01.007","url":null,"abstract":"<p><p>While theranostics is a new term for long-standing principles in nuclear medicine, recent advances have facilitated more personalized healthcare and precision medicine. Despite the widespread enthusiasm for theranostics and well established and standardized procedures, there are a number of opportunities to enhance practice and sharpen the blade of precision theranostics. A clear understanding of the requisites of an authentic theranostic pair reveals limitations in current approaches. Indeed, standardized dosing regimes based on activity dose as opposed to absorbed dose highlight the potential enhancements to outcomes and precision medicine that predictive dosimetry could bring. Such advances increase the demand for closer matching of biological and chemical properties of theranostic pairs. In turn, the need for more authentic or true theranostic pairs is revealed. While theranostics has provided a revolutionary toolkit for cancer management, advances in instrumentation, radiochemistry or clinical domains requires similar advances in the remaining domains. This discussion explores key considerations for an evolving theranostics landscape, recognising current best practice may fall short of precision medicine over coming years.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503572","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}
Harrison J Howell, Jeremy P McGale, Aurélie Choucair, Dorsa Shirini, Nicolas Aide, Michael A Postow, Lucy Wang, Mickael Tordjman, Egesta Lopci, Augustin Lecler, Stéphane Champiat, Delphine L Chen, Désirée Deandreis, Laurent Dercle
{"title":"Artificial Intelligence for Drug Discovery: An Update and Future Prospects.","authors":"Harrison J Howell, Jeremy P McGale, Aurélie Choucair, Dorsa Shirini, Nicolas Aide, Michael A Postow, Lucy Wang, Mickael Tordjman, Egesta Lopci, Augustin Lecler, Stéphane Champiat, Delphine L Chen, Désirée Deandreis, Laurent Dercle","doi":"10.1053/j.semnuclmed.2025.01.004","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2025.01.004","url":null,"abstract":"<p><p>Artificial intelligence (AI) has become a pivotal tool for medical image analysis, significantly enhancing drug discovery through improved diagnostics, staging, prognostication, and response assessment. At a high level, AI-driven image analysis enables the quantification and synthesis of previously qualitative imaging characteristics, facilitating the identification of novel disease-specific biomarkers, patient risk stratification, prognostication, and adverse event prediction. In addition, AI can assist in response assessment by capturing changes in imaging \"phenotype\" over time, allowing for optimized treatment plans based on real-time analysis. Integrating this emerging technology into drug discovery pipelines has the potential to accelerate the identification and development of new pharmaceuticals by assisting in target identification and patient selection, as well as reducing the incidence, and therefore cost, of failed trials through high-throughput, reproducible, and data-driven insights. Continued progress in AI applications will shape the future of medical imaging, ultimately fostering more efficient, accurate, and tailored drug discovery processes. Herein, we offer a comprehensive overview of how AI enhances medical imaging to inform drug development and therapeutic strategies.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449799","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}
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