The Journal of Nuclear Medicine最新文献

{"title":"Large Language Models and Large Multimodal Models in Medical Imaging: A Primer for Physicians","authors":"Tyler J. Bradshaw, Xin Tie, Joshua Warner, Junjie Hu, Quanzheng Li, Xiang Li","doi":"10.2967/jnumed.124.268072","DOIUrl":"https://doi.org/10.2967/jnumed.124.268072","url":null,"abstract":"<p>Large language models (LLMs) are poised to have a disruptive impact on health care. Numerous studies have demonstrated promising applications of LLMs in medical imaging, and this number will grow as LLMs further evolve into large multimodal models (LMMs) capable of processing both text and images. Given the substantial roles that LLMs and LMMs will have in health care, it is important for physicians to understand the underlying principles of these technologies so they can use them more effectively and responsibly and help guide their development. This article explains the key concepts behind the development and application of LLMs, including token embeddings, transformer networks, self-supervised pretraining, fine-tuning, and others. It also describes the technical process of creating LMMs and discusses use cases for both LLMs and LMMs in medical imaging.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET-Based Risk Stratification in Primary Mediastinal B-Cell Lymphoma: A Comparative Analysis of Different Segmentation Methods in the IELSG37 Trial Patient Cohort","authors":"Luca Ceriani, Lisa Milan, Maria Cristina Pirosa, Maurizio Martelli, Teresa Ruberto, Luciano Cascione, Peter W.M. Johnson, Andrew J. Davies, Giovannino Ciccone, Emanuele Zucca","doi":"10.2967/jnumed.124.268874","DOIUrl":"https://doi.org/10.2967/jnumed.124.268874","url":null,"abstract":"<p>Standardizing tumor measurement on ¹⁸F-FDG PET is crucial for the routine clinical use of powerful PET-derived lymphoma prognostic factors such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The recent proposal of an SUV of 4 as a new reference segmentation threshold for most aggressive lymphomas may homogenize volume-based metrics and facilitate their clinical application. <strong>Methods:</strong> This study compared MTV and TLG in primary mediastinal B-cell lymphoma (PMBCL) patients estimated using an SUV of 4 and the current threshold at 25% of SUV_max. Baseline PET metrics were evaluated in 501 PMBCL patients from the IELSG37 trial. <strong>Results:</strong> Median MTV and TLG estimated with the 25% of SUV_max threshold were significantly lower than those obtained with the new reference threshold; however, an extremely high correlation was observed between the methods for both MTV (<em>r</em> = 0.95) and TLG (<em>r</em> = 0.99), resulting in superimposable prognostic power. <strong>Conclusion:</strong> These findings support the routine use of an SUV of 4 for volumetric measurements in PMBCL.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical Outcomes","authors":"Nikil Prasad, Erin Harris, Ersilia M. DeFilippis, Gabriel Sayer, Margarita Chernovolenko, Paolo C. Colombo, Justin Fried, David Bae, Kyung Taek Oh, Jayant Raikhelkar, Sambhavi Sneha Kumar, Melana Yuzefpolskaya, Veli K. Topkara, Michelle Castillo, Elaine Y. Lam, Farhana Latif, Koji Takeda, Nir Uriel, Andrew J. Einstein, Kevin J. Clerkin","doi":"10.2967/jnumed.124.268713","DOIUrl":"https://doi.org/10.2967/jnumed.124.268713","url":null,"abstract":"<p>Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial vessels and microvasculature and remains a leading cause of posttransplant morbidity and mortality. This study examined the prognostic value and outcomes of CAV, assessed by ¹³N-ammonia PET/CT myocardial perfusion imaging in heart transplant recipients. <strong>Methods:</strong> PET/CT and invasive coronary angiography (ICA) were graded using validated scales. CAV progression was assessed using intrapatient sequences: baseline ICA, interval PET/CT with myocardial blood flow reserve, and subsequent ICA. Intervals between ICAs of 600, 900, and 1200 d were included, and for each, the negative predictive value (NPV) of CAV development was assessed. <strong>Results:</strong> In total, 344 heart transplant recipients underwent PET/CT for CAV assessment with a median follow-up of 4.8 y. PET CAV grade 0/1 had an NPV of 0.93, 0.95, and 0.95 at each respective time point for developing an International Society for Heart and Lung Transplantation CAV 2/3 on subsequent ICA. Compared with PET CAV 0, PET CAV 2/3 was associated with a 2.9-fold increased risk of all-cause mortality (hazard ratio, 2.86; 95% CI, 1.36–6.00; <em>P</em> = 0.006). PET CAV 1 had a numerically increased risk (hazard ratio, 2.03; 95% CI, 0.99–4.15; <em>P</em> = 0.054). In a sensitivity analysis of 135 patients with stable International Society for Heart and Lung Transplantation CAV over successive ICA, PET CAV 2/3 remained associated with increased risk of death or retransplantation (hazard ratio, 3.20; 95% CI, 1.18–8.69; <em>P</em> = 0.03). <strong>Conclusion:</strong> Noninvasive CAV assessment by PET/CT and myocardial blood flow reserve provides prognostic information and robust NPVs for development of moderate to severe CAV over intervals up to 4 y. These data suggest that, for certain patients, intervals between invasive screenings may be extended.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, Biodistribution, and Radiation Dosimetry of the 68Ga-Labeled Minigastrin Analog DOTA-MGS5 in Patients with Advanced Medullary Thyroid Cancer and Other Neuroendocrine Tumors","authors":"Elisabeth von Guggenberg, Gianpaolo di Santo, Christian Uprimny, Steffen Bayerschmidt, Boris Warwitz, Anton A. Hörmann, Taraneh S. Zavvar, Christine Rangger, Clemens Decristoforo, Anna Sviridenko, Bernhard Nilica, Giulia Santo, Irene J. Virgolini","doi":"10.2967/jnumed.124.268877","DOIUrl":"https://doi.org/10.2967/jnumed.124.268877","url":null,"abstract":"<p>Several exploratory studies have demonstrated the feasibility of cholecystokinin-2 receptor (CCK2R) targeting in patients with medullary thyroid carcinoma (MTC) and other neuroendocrine tumors (NETs). We report the results of a prospective phase I/IIA pilot study (clinicaltrials.gov NCT06155994) conducted at our center with the ⁶⁸Ga-labeled peptide analog DOTA-DGlu-Ala-Tyr-Gly-Trp-(N-Me)Nle-Asp-1-Nal-Phe-NH₂ (⁶⁸Ga-DOTA-MGS5). <strong>Methods:</strong> Six patients with advanced MTC and 6 patients with gastroenteropancreatic and bronchopulmonary NETs confirmed by previous PET/CT imaging with other PET tracers received a single dose of 180 MBq of ⁶⁸Ga-DOTA-MGS5. The first 6 patients enrolled in the study were included in the dosimetry evaluation, and safety was assessed in all 12 patients. PET/CT imaging was performed at different time points after injection to perform dosimetric calculations and to determine the optimal imaging time window. In addition, blood and urine samples were collected for pharmacokinetic assessments. <strong>Results:</strong> The administration of ⁶⁸Ga-DOTA-MGS5 was well tolerated, with minor adverse drug reactions occurring only in 3 patients. ⁶⁸Ga-DOTA-MGS5 was cleared rapidly from the blood, with less than 21% of the injected activity present in blood 215 ± 10 min after injection. Tracer elimination occurred mainly through the kidneys, with a cumulative urinary excretion greater than 40% 3 h after injection. A high percentage of intact radiopeptide was confirmed in plasma. The highest absorbed dose was found for the urinary bladder wall, the stomach wall, and the kidneys, with an effective dose of 0.023 ± 0.007 mSv/MBq. The time points of 1 and 2 h after injection proved to be optimal for PET/CT imaging. In the 6 patients included in the dosimetry evaluation, local metastasis was confirmed in 2 patients with advanced MTC, whereas only 1 of 4 patients with gastroenteropancreatic NETs was positive in ⁶⁸Ga-DOTA-MGS5 PET/CT. <strong>Conclusion:</strong> Besides confirming the safety of administration, within the phase I part of the prospective clinical trial, an acceptable effective whole-body dose, an overall favorable biodistribution, and the feasibility of cholecystokinin-2 receptor imaging could be shown for ⁶⁸Ga-DOTA-MGS5.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Method for Validating PET and SPECT Cameras for Quantitative Clinical Imaging Trials Using Novel Radionuclides","authors":"Dale L. Bailey, Kathy P. Willowson, Graeme O’Keefe, Steven Goodman, Shaun Patford, George McGill, David A. Pattison, Andrew M. Scott","doi":"10.2967/jnumed.124.268578","DOIUrl":"https://doi.org/10.2967/jnumed.124.268578","url":null,"abstract":"<p>Our aim is to report methodology that has been developed to calibrate and verify PET and SPECT quantitative image accuracy and quality assurance for use with nonstandard radionuclides, especially with longer half-lives, in clinical imaging trials. <strong>Methods:</strong> Procedures have been developed for quantitative PET and SPECT image calibration for use in clinical trials. The protocol uses a 3-step approach: check quantitative accuracy with a previously calibrated radionuclide in a simple geometry, check the novel trial radionuclide in the same geometry, and check the novel radionuclide in a more challenging, complex geometry (the National Electrical Manufacturers Association [NEMA] NU-2 International Electrotechnical Commission [IEC] image-quality phantom). The radionuclides used in the trial as an example are ¹²⁴I (PET) and ¹³¹I (SPECT). In both cases, whole-body tomographic SPECT and PET imaging with accompanying low-dose CT are required. PET accuracy is based on calibrating the dose calibrator to produce quantitative images for radionuclides other than ¹⁸F, with all images reconstructed on each individual site’s PET systems. For SPECT, an independent sensitivity measurement is made and then used to calibrate the SPECT images reconstructed at the core laboratory. After calibration, the final testing for both PET and SPECT uses the NEMA NU-2 IEC image-quality phantom to derive several metrics including quantitative accuracy based on an average SUV (SUV_avg). <strong>Results:</strong> Using the method described, 7 sites in Australia have been qualified for 10 PET/CT scanners using ¹²⁴I imaging and 8 SPECT/CT systems for ¹³¹I. One PET/CT system was found to give a result outside the specification of an SUV_avg of 1.0 ± 0.05. All SPECT/CT systems gave an SUV_avg accurate to within ±10% (SUV_mean, 1.0 ± 0.1) of the true value for reconstructed radioactivity concentration in Bq/cm³. <strong>Conclusion:</strong> A general methodology has been developed to calibrate and validate PET and SPECT systems for quantitative imaging in clinical trials. The preparation of the test objects and the procedures is relatively simple and can generally be implemented by the staff at the site of the imaging center with the equipment supplied by the clinical trials organization.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Demyelinated Axons After Spinal Cord Injuries with PET Tracer [18F]3F4AP","authors":"Karla M. Ramos-Torres, Sara Conti, Yu-Peng Zhou, Amal Tiss, Celine Caravagna, Kazue Takahashi, Miao He, Moses Q. Wilks, Sophie Eckl, Yang Sun, Jason Biundo, Kuang Gong, Zhigang He, Clas Linnman, Pedro Brugarolas","doi":"10.2967/jnumed.124.268242","DOIUrl":"https://doi.org/10.2967/jnumed.124.268242","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.268242absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Borderline Findings in O-(2-[18F]-Fluoroethyl)-l-Tyrosine PET of Patients with Suspected Glioma Relapse: Role in Clinical Practice","authors":"Karl-Josef Langen, Gabriele Stoffels, Christian P. Filss, Martin Kocher, Christoph Lerche, Michael Sabel, Marion Rapp, Hosai Noltemeier, Jan-Michael Werner, Garry Ceccon, Michael M. Wollring, Jurij Rosen, Joachim P. Steinbach, Elke Hattingen, Martin R. Weinzierl, Michael Stoffel, Hans Clusmann, N. Jon Shah, Felix M. Mottaghy, Norbert Galldiks, Philipp Lohmann","doi":"10.2967/jnumed.124.268768","DOIUrl":"https://doi.org/10.2967/jnumed.124.268768","url":null,"abstract":"<p>One of the most common clinical indications for amino acid PET using the tracer <em>O</em>-(2-[¹⁸F]-fluoroethyl)-<span>l</span>-tyrosine (¹⁸F-FET) is the differentiation of tumor relapse from treatment-related changes in patients with gliomas. A subset of patients may present with an uptake of ¹⁸F-FET close to recommended threshold values. The goal of this study was to investigate the frequency of borderline cases and the role of quantitative ¹⁸F-FET PET parameters in this situation. <strong>Methods:</strong> We retrospectively identified 439 patients with pretreated gliomas who underwent ¹⁸F-FET PET for suspected tumor relapse and in whom the final diagnoses were confirmed by histopathology (<em>n</em> = 175) or clinical course (<em>n</em> = 264). Two experienced nuclear medicine physicians, masked to the final diagnoses, evaluated visually the PET scans by consensus. The findings were classified into 3 categories: clearly positive findings, borderline findings, or clearly negative findings. The diagnostic performance of established ¹⁸F-FET PET parameters (i.e., tumor-to-brain ratio [TBR], time-to-peak ratio, slope, intercept) was evaluated separately for these 3 groups using receiver operating characteristics analyses. <strong>Results:</strong> In the visual analysis, ¹⁸F-FET uptake was classified as clearly negative in 67 patients (15%), clearly positive in 234 patients (53%), and borderline in 136 patients (31%), with averaged mean TBR values of 1.5, 2.3, and 1.9, respectively. Receiver operating characteristics analysis showed a high accuracy for TBR values in patients rated as clearly positive or negative in visual rating (area under curve [AUC], 0.84–0.86), whereas the diagnostic performance of TBR values in borderline cases according to visual analysis was significantly lower (AUC, &lt;0.60). Using TBR values ± 10% above or below the cutoff values increased the AUC by approximately 10% (AUC, 0.82–0.84). <strong>Conclusion:</strong> A considerable number of patients may present with borderline findings in ¹⁸F-FET PET. In these patients, quantitative parameters should be used with caution for decision-making. The use of TBR values above or below the range of the cutoff values ±10% may increase the reliability of quantitative parameters to differentiate between tumor relapse and treatment-related changes.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Characterization via Molecular Imaging, Longitudinal Multisite Sampling, and Autoptic Work-up in Advanced Small Cell Lung Cancer Undergoing SSTR-Directed Radiopharmaceutical Therapy","authors":"Johanna S. Enke, Nic G. Reitsam, Sebastian Dintner, Friederike Liesche-Starnecker, Tina Schaller, Josua A. Decker, Angela Langer, Eva Sipos, Ana Antic Nikolic, Thomas Kröncke, Martin Trepel, Constantin Lapa, Rainer Claus, Bruno Märkl, Ralph A. Bundschuh","doi":"10.2967/jnumed.124.268513","DOIUrl":"https://doi.org/10.2967/jnumed.124.268513","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.268513absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetry Software for Theranostic Applications: Current Capabilities and Future Prospects","authors":"Adam L. Kesner, Julia Brosch-Lenz, Jonathan Gear, Michael Lassmann","doi":"10.2967/jnumed.124.268998","DOIUrl":"https://doi.org/10.2967/jnumed.124.268998","url":null,"abstract":"<p>Dosimetry is integral to informed implementation of radiopharmaceutical therapies, enabling personalized treatment planning and ensuring patient safety by calculating absorbed doses to organs and tumors. As the therapeutic radiopharmaceutical field continues to expand, dosimetry software has emerged as a crucial tool for optimization of treatment efficacy. This review discusses key features and capabilities that current dosimetry software solutions have or should have in the future. We highlight the need for standardization across platforms to support consistent and accurate dose calculations. Furthermore, we explore opportunities for advancing software, such as incorporating biologically effective dose modeling and improving uncertainty quantification. Looking ahead, we advocate for expanding infrastructure for open data sets and fostering ongoing collaboration between vendors and end users to guide the field toward greater integration and efficacy.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Head-to-Head Comparison of 18F-PSMA PET/CT and 18F-NaF PET/CT for Assessing Bone Metastases in 160 Patients with Newly Diagnosed High-Risk Prostate Cancer","authors":"Claus Madsen, Dan Fuglø, Maria Pedersen, Rikke Broholm, Peter B. Østergren, Rasmus Bisbjerg, Per Kongsted, Kayalvili Nielsen, Christian Haarmark, Helle Zacho","doi":"10.2967/jnumed.124.268275","DOIUrl":"https://doi.org/10.2967/jnumed.124.268275","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.268275absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}