the Quarterly Journal of Nuclear Medicine and Molecular Imaging最新文献

{"title":"Is there a role for metabolic imaging in pediatric non-Hodgkin lymphoma?","authors":"Luca Guerra, Domenico Albano","doi":"10.23736/S1824-4785.25.03657-X","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03657-X","url":null,"abstract":"<p><p>Pediatric non-Hodgkin lymphoma (NHL) is an aggressive and heterogeneous malignancy with high rates of extranodal involvement. Accurate staging and response assessment are crucial, yet challenging. While [¹⁸F]FDG PET/CT is a cornerstone in adult NHL management, its role in pediatric cases remains under evaluation. A comprehensive review of the literature, international guidelines, and ongoing clinical trials was conducted, focusing on the diagnostic, prognostic, and therapeutic implications of [¹⁸F]FDG PET/CT in pediatric NHL. [¹⁸F]FDG PET/CT improves staging accuracy by detecting extranodal and bone marrow involvement more sensitively than conventional imaging. Its high negative predictive value supports its use in confirming complete metabolic response, potentially avoiding unnecessary biopsies. However, its positive predictive value is limited, cautioning against treatment escalation based solely on positive PET/CT results. Novel metabolic biomarkers such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) show promise for prognostic stratification but suffer from methodological variability and lack of standardization. Ongoing clinical trials aim to validate PET/CT's role in therapy response evaluation and optimize its clinical application. [¹⁸F]FDG PET/CT is a valuable imaging modality for pediatric NHL, particularly in FDG-avid subtypes. Despite promising results, broader clinical adoption requires standardized imaging protocols and prospective multicenter validation to establish robust diagnostic and prognostic utility.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls and artifacts in [18F]-FDG PET imaging in children with lymphoma.","authors":"Domenico Albano, Alessio Rizzo, Carlo Rodella, Stefano Panareo, Luca Guerra","doi":"10.23736/S1824-4785.25.03650-7","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03650-7","url":null,"abstract":"<p><p>Positron emission tomography/computed tomography (PET/CT) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose ([18F]-FDG) is a well-established imaging tool in adult oncology and is increasingly utilized also in pediatric oncology due to its ability to combine functional and anatomic information, thereby enhancing diagnostic accuracy and improving patient management. However, [18F]-FDG uptake in children differs physiologically from adults, and this radiotracer is not tumor-specific, with uptake occurring in various benign conditions such as inflammation, infection, and trauma. Accurate interpretation of pediatric [18F]-FDG PET/CT requires comprehensive knowledge of the normal distribution of FDG in children, recognition of physiological variants, and awareness of common benign lesions and PET/CT-related artifacts. Misinterpretation can lead to unnecessary follow-up studies, suboptimal treatment decisions, and/or increased radiation exposure. This review discusses the typical patterns of physiologic [18F]-FDG uptake in children, common benign mimics of malignancy, and potential artifacts and pitfalls encountered in pediatric [18F]-FDG PET/CT imaging, focus especially on head and neck (lymph nodes), brown adipose tissue, bone marrow and thymus. By increasing familiarity with these patterns, this review aims to improve diagnostic confidence, reduce interpretive errors, and promote safer and more effective imaging practices in pediatric oncology.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 of FUO/IUO in special populations.","authors":"Domenico Albano, Carlo Rodella, Andrea Guarneri, Elena Romano Gargarella, Lucia Leccisotti","doi":"10.23736/S1824-4785.25.03649-0","DOIUrl":"10.23736/S1824-4785.25.03649-0","url":null,"abstract":"<p><p>¹⁸F fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has established itself as a fundamental non invasive diagnostic technique in the investigation of patients with fever (FUO) and inflammation of unknown origin (IUO). These conditions are for definition challenging due to potential wide underlying causes, including inflammatory disease, infectious disease, malignancies and miscellanea. Sometimes no diagnosis is reached. Data about the diagnostic performances of [¹⁸F]FDG PET/CT in special populations, such as pediatrics, end-stage renal disease, HIV and intensive care unit (ICU) patients, are preliminary and heterogeneous. Our review aims to describe the role of [¹⁸F]FDG PET/CT imaging in these specific populations and focus on the potential clinical impact on diagnosis and patient management. Findings presented in the literature demonstrated a good diagnostic yield of FDG PET/CT in the study of these patients affected by FUO/IUO with performances similar to adult general populations. A positive PET scan is often contributory and, in some cases, even essential to diagnosis, whereas a negative scan may be equally important as it excludes focal disease and predicts a favourable prognosis. Further studies with larger populations would be desirable.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"219-223"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to deal with the major diagnostic challenges in fever of unknown origin: an expert opinion.","authors":"Albrecht Betrains, Steven Vanderschueren, Chantal P Rovers, Catharina M Mulders-Manders","doi":"10.23736/S1824-4785.25.03651-9","DOIUrl":"10.23736/S1824-4785.25.03651-9","url":null,"abstract":"<p><p>In this review we summarize the current knowledge on fever of unknown origin (FUO). Fever of unknown origin remains a diagnostic challenge even despite increasing diagnostic possibilities since its first definition. Uniform definition of FUO is pivotal to correctly select patients that benefit from the extensive workup that may be needed. The number of conditions associated with FUO is still increasing. Epidemiologic differences and differences in diagnostic possibilities are a challenge when comparing outcomes from cohorts with different epidemiologic backgrounds. The diagnostic protocol that was proposed as early as 2007, with a central role for ¹⁸F-FDG-PET/CT, still remains the golden standard for the workup of FUO. Early use of new diagnostic modalities, including the use of metagenomic next generation sequencing and artificial intelligence, may shorten the diagnostic delay. In patients remaining undiagnosed, second opinion in an expert center can be considered, especially when therapeutic trials are considered. An increasing subset of patients presents with absent inflammatory parameters. Correct evaluation within a febrile episode is important in patients with intermittent disease, but these patients may also suffer from habitual or functional hyperthermia. We advise to let go of these terms and introduce the criteria for temperature elevation with missing inflammatory parameters (TEMP) syndrome.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"190-199"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic body radiation therapy for the re-irradiation of local relapse from prostate cancer: results in terms of outcomes and toxicity.","authors":"Ciro Franzese, Raffaella Lucchini, Marco Badalamenti, Davide Baldaccini, Manuele Roghi, Luciana DI Cristina, Beatrice Marini, Mariya Ilieva, Anna Bertolini, Giuseppe Spataro, Giacomo Reggiori, Carmela Galdieri, Stefano Tomatis, Marta Scorsetti","doi":"10.23736/S1824-4785.25.03565-4","DOIUrl":"10.23736/S1824-4785.25.03565-4","url":null,"abstract":"<p><strong>Background: </strong>The aim is to retrospectively evaluate toxicity and outcomes of re-irradiation (re-RT) for macroscopic local relapse in patients with prostate cancer (PCa) treated with previous definitive or postoperative radiotherapy (RT).</p><p><strong>Methods: </strong>Thirty-six patients affected by local relapse after previous definitive or post-operative RT were treated with re-RT in our institute. Treatment dose was 25-30 Gy in 5 fractions. Gastrointestinal (GI) and genitourinary (GU) toxicity was reported according to Common Terminology Criteria for Adverse Events score version 5. Endpoints were Biochemical Relapse Free Survival (BRFS) and Distant Metastases Free Survival (DMFS), assessed with Kaplan-Meier analysis. Univariate and multivariate Cox regression was carried out to evaluate the association between clinical factors and survival outcomes.</p><p><strong>Results: </strong>Twenty-six patients received re-RT after definitive RT and 10 after post-operative RT. At time of re-RT median PSA was 2.57 ng/mL (range 0.23-13.10) and local relapse was detected with choline-Prostate Specific Membrane Antigen (PSMA) - Positron Emission Tomography (PET) or magnetic resonance imagig (MRI) in 18, 17 and one, respectively. Median Clinical Target Volume (CTV) was 17.8 cc (range 1-93.1). In 39% of patients the target corresponds to macroscopic relapse, while in 61% target was the whole prostate or prostate bed. Median follow-up was 28.2 months. No late >2 side effects were collected. Only one patient experienced GI toxicity (G2), while GU side effects were observed in eight patients (six G1 and two G2). Median BRFS survival was 19.0 months, with 1- and 2-year BRFS rates of 63.5% (95% CI 42.5-78.6) and 37.0% (95% CI 17.5-56.8), respectively. At univariate analysis, PSA value at time of re-RT was a predictive factor for BRFS (HR 1.43, 95% CI 1.19-1.73; P=0.000). DMFS rates at 1 and 2 years were 88.0% (95% CI 66.8-96.0) and 72.4% (95% CI 48.1-86.8), respectively. Median DMFS was 19.6 months in with re-RT of the relapsing nodule, while was not reached in patients treated on the whole prostate gland or surgical bed. At univariate analysis, irradiation of the macroscopic relapse vs the whole gland/bed (HR 5.91, 95% CI 1.35-25.80; P=0.018) and increasing PSA at time of re-RT (HR 1.20, 95% CI 1.01-1.41; P=0.030) were negative predictive factors. At multivariate analysis, treatment of the macroscopic relapse only remained an independent predictive factor of distant metastases free survival (DMFS) (HR 4.48, 95% CI 1.09-18.37; P=0.037).</p><p><strong>Conclusions: </strong>Re-RT in patients treated previously with definitive or postoperative RT was safe and showed promising results in terms of toxicity and biochemical outcomes.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"238-242"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pre-scan patient-related factors on diagnostic yield of 18F FDG PET/CT in fever of unknown origin.","authors":"Ayah A Nawwar, Christopher Green, Julie Searle, Soren Hess, Iain D Lyburn","doi":"10.23736/S1824-4785.25.03669-6","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03669-6","url":null,"abstract":"<p><p>¹⁸F FDG PET/CT plays an important role in the investigation of fever of unknown origin (FUO), particularly after failure of conventional investigations to identify the source. However, its diagnostic yield is highly influenced by a wide range of factors including patient preparation, physiological variant, and treatment related factors. This review aims to provide an overview of the most common causes experienced in clinical practice, and how to avoid common pitfalls that may affect scan interpretation. For instance, elevated blood glucose levels, prolonged steroid therapy and recent interventions may reduce scan sensitivity, while artefacts from injection sites and brown fat uptake may mimic sites of disease. Careful preparation - including dietary modification, activity restriction and appropriate access selection - combined with clinical correlation and review of non-attenuation corrected images enhances interpretation, and as always, multidisciplinary discussions remain key.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":"69 3","pages":"200-207"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield and impact on patient management from [18F]FDG-PET/CT in FUO/IUO in the adult population.","authors":"Edel Noriega-Álvarez, Ayah Nawwar","doi":"10.23736/S1824-4785.25.03660-X","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03660-X","url":null,"abstract":"<p><p>Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are diagnostically challenging conditions due to their diverse etiologies and non-specific presentations. Despite advances in diagnostic techniques, a significant proportion of cases remain unexplained, often leading to delays in treatment and increased healthcare burden. In recent years, [¹⁸F]FDG-PET/CT has emerged as a powerful diagnostic tool offering whole-body metabolic imaging, particularly valuable in the early stages of disease when structural changes may be absent. In this review a literature search was conducted in PubMed and Web of Science for original studies on the use of FDG-PET/CT in adults with FUO/IUO published between January 2005 and June 2025. The authors evaluated the diagnostic yield and clinical impact of [¹⁸F]FDG-PET/CT in adults with FUO/IUO based on 56 studies comprising over 7,400 patients. The [¹⁸F]FDG-PET/CT was helpful in up to 90% of cases when both true-positive and true-negative results were considered. Furthermore, [¹⁸F]FDG-PET/CT led to changes in patient management in a substantial proportion of cases, particularly when used early in the diagnostic algorithm. It demonstrates robust diagnostic performance, guiding therapeutic decisions, and guide subsequent interventions hereby avoiding futile examinations. Despite its growing recognition, standardization in study design and outcome reporting is needed to further consolidate its role in clinical guidelines.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":"69 3","pages":"208-218"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review on potential of novel developments in fever of unknown origin and inflammation of unknown origin: long-axial-field-of-view positron emission tomography/computed tomography and novel radiotracers.","authors":"Martina DI Franco, Andrea DI Giorgio, Andrea Farolfi, Michelle Amon, Clemens Mingels, Lorenzo Nardo, Elizabeth K Triumbari","doi":"10.23736/S1824-4785.25.03656-8","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03656-8","url":null,"abstract":"<p><strong>Introduction: </strong>Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are among the most challenging diagnoses in clinical routine. [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) is a valuable diagnostic tool, particularly when conventional imaging and laboratory investigations fail to identify the root cause. While its diagnostic accuracy in FUO/IUO settings is high, several issues still remain to be addressed. Long axial field of view PET/CT and the availability of novel radiopharmaceuticals for molecular imaging may significantly advance the field of nuclear medicine and molecular imaging in FUO/IUO.</p><p><strong>Evidence acquisition: </strong>This scoping review conforms to the \"Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist\". An extensive literature search of PubMed/MEDLINE database was performed to find relevant published articles on the use of LAFOV PET/CT and novel radiotracers in FUO/IUO settings.</p><p><strong>Evidence synthesis: </strong>LAFOV PET/CT provides faster whole-body imaging, improved sensitivity, and the ability to perform ultra-low-dose scans. These benefits are particularly valuable for special populations, such as pediatric patients, ICU patients, and pregnant women, where motion artifacts, radiation exposure, and procedural complexity are major concerns. Additionally, novel radiotracers, including FAPI and CXCR4-targeted agents, offer promising specificity for inflammatory or infectious etiologies beyond FDG, potentially improving diagnostic accuracy and reducing false positives.</p><p><strong>Conclusions: </strong>LAFOV PET/CT and emerging radiopharmaceuticals represent major advancements in the diagnostic workup of FUO/IUO. They enhance lesion detection, reduce scan burden, and may improve outcomes, particularly in vulnerable populations. Further clinical studies are needed to standardize protocols and validate these tools in broader clinical practice.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":"69 3","pages":"224-237"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 in fever and inflammation of unknown origin: time to raise the bar.","authors":"Søren Hess, Olivier Gheysens","doi":"10.23736/S1824-4785.25.03684-2","DOIUrl":"https://doi.org/10.23736/S1824-4785.25.03684-2","url":null,"abstract":"","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":"69 3","pages":"187-189"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the interobserver and the intraobserver reproducibility for the detection of renal cortical defects in adults and children using [99mTc]Tc-MAG3.","authors":"Mohammed Hashlan, Stuart More, Elton Mukonda, Anita Brink","doi":"10.23736/S1824-4785.24.03567-2","DOIUrl":"10.23736/S1824-4785.24.03567-2","url":null,"abstract":"<p><strong>Background: </strong>One can assess cortical defects on the early images of [99mTc]Tc-MAG3 renography. We aimed to assess interobserver and intraobserver reproducibility for detecting renal cortical defects using [99mTc]Tc-MAG3 for adults and children; identify causes for poor inter- and intraobserver reproducibility and to assess the effect of the kidney to background ratio (KTBR) on reproducibility.</p><p><strong>Methods: </strong>One hundred adult and 200 pediatric renograms were included. The observers reviewed the summed 1-minute posterior images for the first four minutes to detect cortical defects. Interobserver reproducibility between three observers and intra-observer reproducibility for two observers were determined. Agreement was tested using percentage agreement, Krippendorff's reliability coefficient alpha and Cohen's kappa statistic. The association between KTBR and agreement was evaluated.</p><p><strong>Results: </strong>Interobserver agreement on the 1-2 minutes images was 78 (95% CI: 74.8-82.7%) and 79.7 (95% CI: 75.9-83.5%) for left and right kidneys respectively. Intraobserver percentage was 89.7% (95% CI: 86.2-93.1%) for the senior and 80.7% (95% CI: 76.2-85.2%) for the junior observer. In 13.5% (27) of the adult and 4.5% (19) of the pediatric kidneys the difference in image interpretation between the observers would have had a clinical impact. If the KTBR is ≤2, the percentage agreement was between 61.5% and 64.8%. In cases with a KTBR >2, the percentage agreement was between 83.6% and 87.1%.</p><p><strong>Conclusions: </strong>The percentage interobserver agreement was moderate. Disagreement between normal and abnormal cases were infrequent. The interobserver reproducibility was decreased when the KTBR was ≤2.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"243-250"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}