Annals of Nuclear Medicine最新文献

{"title":"Baseline Ga-68 PSMA PET/CT-derived volumetric parameters as predictors of biochemical recurrence following radical prostatectomy.","authors":"Ali Çelik, Aziz Gültekin, Tarık Şengöz, Fikri Selçuk Şimşek, Yusuf Özlülerden","doi":"10.1007/s12149-026-02292-z","DOIUrl":"https://doi.org/10.1007/s12149-026-02292-z","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the prognostic value of volumetric parameters derived from staging Ga-68 PSMA PET/CT imaging in predicting biochemical recurrence (BCR) among prostate cancer patients treated with radical prostatectomy.</p><p><strong>Methods: </strong>This retrospective study included 217 patients diagnosed with prostate cancer between March 2018 and October 2024 who underwent preoperative Ga-68 PSMA PET/CT, subsequent radical prostatectomy, and had regular follow-up data available. Semiquantitative (SUVmax, SUVmean) and volumetric (PSMA-TV, TL-PSMA, wbPSMA-TV, wbTL-PSMA) parameters for both the primary prostate lesion and the whole body were calculated from the images. The primary endpoint was defined as biochemical progression-free survival (bPFS). ROC curve, Kaplan-Meier, and Cox regression analyses were utilized to evaluate prognostic performance.</p><p><strong>Results: </strong>Ga-68 PSMA PET/CT volumetric parameters, particularly wbPSMA-TV and wbTL-PSMA, were found to be significantly higher in patients who developed BCR. Univariate Cox regression analysis revealed that both volumetric and semiquantitative parameters were significantly associated with biochemical progression. However, in the multivariate analysis, volumetric parameters did not emerge as independent predictors; instead, prostate SUVmean, ISUP grade group, and positive surgical margin status were identified as independent prognostic factors. Addition of prostate SUVmean to a clinical model modestly improved discrimination (C-index: 0.587 vs. 0.608) and significantly improved model fit (p = 0.004). Furthermore, prostate SUVmax and SUVmean values demonstrated significant performance in predicting early biochemical progression occurring within the first year post-surgery.</p><p><strong>Conclusions: </strong>Although Ga-68 PSMA PET/CT-derived volumetric parameters were associated with biochemical progression, they were not validated as independent prognostic factors. Conversely, semiquantitative parameters-most notably prostate SUVmean-demonstrated independent prognostic value and may be significant indicators for predicting early biochemical progression. These findings suggest that prostate SUVmean and SUVmax could serve as complementary, preoperatively available indicators of early BCR risk when integrated with established clinicopathological factors, although their modest discriminative performance warrants external validation before clinical application.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103075","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":"Quantitative and comparative assessment of Tc-99 m MIBI imaging in parathyroid adenomas: associations with biochemical, morphological, and histopathological.","authors":"Semra Demirtas Senlik, Derya Cayir, Aysenur Erdem Karaoglu, Tugba Taskin Turkmenoglu, Nur Aydinbelge Dizdar, Ozlem Ozmen","doi":"10.1007/s12149-026-02291-0","DOIUrl":"https://doi.org/10.1007/s12149-026-02291-0","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the relationships between Tc-99 m methoxyisobutylisonitrile (MIBI) SPECT/CT-derived SUVmax values and adenoma volume, histopathological characteristics, and biochemical parameters in patients with primary hyperparathyroidism (PHPT), and to compare the localization performance of ultrasonography (USG), planar scintigraphy, pinhole imaging, and SPECT/CT.</p><p><strong>Methods: </strong>Sixty patients with histopathologically confirmed solitary parathyroid adenomas who underwent preoperative Tc-99 m MIBI scintigraphy and subsequent surgery were retrospectively included. SUVmax values were obtained from quantitative SPECT/CT images using manually defined volumetric regions of interest. Associations between SUVmax and continuous clinicopathological variables were evaluated using Spearman correlation analysis, while comparisons among predominant cell-type groups were performed using the Kruskal-Wallis test. Detection rates of the imaging modalities were compared using Cochran's Q test.</p><p><strong>Results: </strong>SUVmax demonstrated significant positive correlations with adenoma volume (ρ = 0.523, p < 0.001), lesion diameter (ρ = 0.459, p < 0.001), and serum parathyroid hormone levels (ρ = 0.360, p = 0.005). Adenoma volume was also positively correlated with serum PTH (ρ = 0.356, p = 0.005) and calcium levels (ρ = 0.407, p = 0.001). Median SUVmax was numerically highest in oxyphil-predominant adenomas; however, the difference among cellular subtypes was not statistically significant (p = 0.441). When positive and suspicious findings were considered together, lesion detection rates were 88.3% for USG, 96.7% for planar scintigraphy, 95.0% for pinhole imaging, and 98.3% for SPECT/CT, without a statistically significant difference among modalities (Cochran's Q = 7.545, p = 0.056). All lesions that were negative on USG were localized by planar and pinhole imaging, while SPECT/CT identified six of seven such lesions.</p><p><strong>Conclusion: </strong>Tc-99 m MIBI SPECT/CT-derived SUVmax was significantly associated with adenoma volume in patients with PHPT. Oxyphil-predominant adenomas showed numerically higher SUVmax values, although differences among cellular subtypes were not statistically significant. Scintigraphic techniques provided complementary localization information in lesions not identified by ultrasonography. The clinical utility of quantitative SPECT/CT and its potential relationships with histopathological characteristics require further validation in larger prospective studies.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103097","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 heart-to-contralateral lung ratios in virtual planar images derived from SPECT using ^99mTc-pyrophosphate scintigraphy.","authors":"Daichi Ogura, Megumi Kanou, Takuji Toyama, Keiko Koyama, Koichi Okuda, Kenichi Nakajima","doi":"10.1007/s12149-026-02294-x","DOIUrl":"https://doi.org/10.1007/s12149-026-02294-x","url":null,"abstract":"<p><strong>Objective: </strong>A new AutoPlanar imaging technique can generate virtual planar images from SPECT data. We aimed to determine whether AutoPlanar images can provide accurate heart-to-contralateral lung ratio (H/CL) from ^99mTc-pyrophosphate (PYP) scintigrams and subsequently to identify optimal reconstruction conditions for these images.</p><p><strong>Methods: </strong>This retrospective study assessed 41 patients with suspected transthyretin cardiac amyloidosis using ^99mTc-PYP scintigraphy followed by planar and SPECT imaging three hours later. We reconstructed SPECT images using ordered subset expectation maximization (OSEM) and ordered subset conjugate-gradient minimizer (OSCGM) combined with resolution recovery (RR), attenuation (AC), and scatter (SC) correction. Cardiac tracer uptake on planar and AutoPlanar images was visually assessed using a 4-point scale (0 to 3) and H/CL ratios were compared between the planar and AutoPlanar methods.</p><p><strong>Results: </strong>Visual assessment demonstrated good to excellent agreement, with exact agreement ranging from 73.2% to 97.6%. The H/CL ratios derived from AutoPlanar and planar images were highly correlated (r ≥ 0.97). Bland-Altman analysis demonstrated small negative biases (- 0.087 to - 0.027); the 95% limits of agreement were - 0.130 to 0.051 for Flash3D+ with ACRR and - 0.123 to 0.061 for Flash3D+ with ACSCRR. Equivalence testing demonstrated statistical equivalence between planar and AutoPlanar H/CL ratios with ACRR and ACSCRR, whereas equivalence was not demonstrated with RR.</p><p><strong>Conclusions: </strong>The H/CL ratios derived from AutoPlanar and planar images were comparable. AutoPlanar images were more strongly influenced by correction conditions than by the reconstruction method, with Flash3D+ using ACRR or ACSCRR showing favorable overall results.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079466","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":"Comparative diagnostic performance of ¹⁸F-FLT and ¹⁸F-FDG PET for differentiating primary CNS lymphoma from glioblastoma, IDH-wildtype.","authors":"Riku Morita, Takashi Norikane, Noriyuki Yamato, Yuka Yamamoto, Yuri Manabe, Mitsumasa Murao, Katsuya Mitamura, Masaki Tatano, Tetsuhiro Hatakeyama, Keisuke Miyake, Yoshihiro Nishiyama","doi":"10.1007/s12149-026-02295-w","DOIUrl":"https://doi.org/10.1007/s12149-026-02295-w","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the diagnostic performance of 3'-deoxy-3'-¹⁸F-fluorothymidine (FLT) positron emission tomography (PET) with that of ¹⁸F-fluorodeoxyglucose (FDG) PET for differentiating primary central nervous system lymphoma (PCNSL) from glioblastoma, isocitrate dehydrogenase (IDH)-wildtype, in patients who underwent both examinations before treatment.</p><p><strong>Methods: </strong>We retrospectively evaluated 58 patients with histologically confirmed tumors: 40 with glioblastoma, IDH-wildtype, and 18 with PCNSL. Maximum standardized uptake values of the tumors were normalized to the mean standardized uptake values of the contralateral normal-appearing brain to calculate the tumor-to-normal brain (T/N) ratio. The paired areas under the receiver operating characteristic curves (AUCs) were compared.</p><p><strong>Results: </strong>FLT PET findings were positive for all tumors, whereas FDG PET findings were positive in 17 of 18 PCNSLs (94%) and 25 of 40 glioblastomas (63%). The mean FLT T/N ratio was 30.14 ± 15.02 for PCNSLs and 12.80 ± 7.37 for glioblastomas (P < 0.001), and the mean FDG T/N ratios were 3.01 ± 1.45 and 1.50 ± 1.22, respectively (P < 0.001). The AUC was 0.885 (95% confidence interval [CI], 0.794-0.976) for FLT and 0.826 (95% CI, 0.713-0.940) for FDG. Using cutoff values of 20.43 for FLT and 1.96 for FDG, the sensitivity was 77.8% and 77.8%, whereas specificity was 90.0% and 80.0%, respectively. The paired AUCs did not differ significantly (P = 0.380).</p><p><strong>Conclusions: </strong>Both FLT and FDG PET differentiated PCNSL from glioblastoma, IDH-wildtype, with no significant difference between the paired AUCs. Minimal physiological FLT uptake in the normal brain enabled conspicuous tumor visualization. FLT PET may therefore serve as a useful complementary imaging approach in selected patients for whom FDG PET is less suitable.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069376","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":"Comparison of metabolic variables in FDG PET/CT in rectal cancer patients who achieved a complete or incomplete response following neoadjuvant chemoradiotherapy.","authors":"Kaique Moraes do Amaral, Rayama Moreira Siqueira, Nájua Abou Arab, Elba Etchebehere, Mariana da Cunha Lopes de Lima, Allan de Oliveira Santos, Celso Dario Ramos, Thiago Ferreira de Souza, Sérgio Quirino Brunetto, Edna Marina de Souza, Cleide Aparecida Moreira Silva, Carlos Augusto Real Martinez, Bárbara Juarez Amorim","doi":"10.1007/s12149-026-02285-y","DOIUrl":"https://doi.org/10.1007/s12149-026-02285-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate qualitative and quantitative metabolic parameters on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography [FDG PET/CT] for differentiating complete from incomplete response in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy.</p><p><strong>Materials and methods: </strong>This retrospective single-center study included 74 patients with locally advanced rectal cancer who underwent FDG PET/CT before and after neoadjuvant chemoradiotherapy. Patients were classified as good responders [complete clinical response, n = 34] or poor responders [n = 40]. Visual response was assessed using a five-point visual response score. Quantitative parameters included SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis, using a fixed 41% threshold and best visual fit segmentation. Group comparisons, receiver operating characteristic analysis, and logistic regression were performed.</p><p><strong>Results: </strong>VRS grade 4 [no uptake post-treatment] demonstrated high specificity [95%] and positive predictive value [90.9%] for identifying good responders, with a sensitivity of 58.8%. Two false positives were observed [carcinoma in situ and mucinous tumor]. Significant quantitative differentiators included post-treatment SUVmax41% [p < 0.0001], SUVmaxBVF [p < 0.0001], SUVmean41% [p < 0.0001], SUVmeanBVF [p < 0.0001], post-treatment TLGBVF [p = 0.0164], ΔSUVmax [p = 0.0306], and ΔSUVmean41% [p = 0.0072]. Post-treatment SUVmax showed the highest accuracy, with an area under the curve [AUC] of 0.917.</p><p><strong>Conclusions: </strong>The present study suggests that FDG-PET/CT provides valuable complementary information for response assessment after nCRT in rectal cancer and may assist multidisciplinary decision-making regarding organ-preserving strategies. Absence of residual uptake on post-treatment imaging and post-treatment SUVmax demonstrated high diagnostic accuracy for identifying complete responders.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057321","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":"Is early imaging a pitfall? Effect of [⁶⁸Ga]Ga-PSMA PET/CT timing after biopsy on SUVmax and adverse pathology prediction in low-to-intermediate risk prostate cancer.","authors":"Enes Mustafa Kaya, Burcu Esen Akkaş, Mehmetcan Uluçay, Fuad Aghazada, Halil Lütfi Canat, Harun Özdemir, Merve Şam Özdemir, Nilsen Yıldırım Erdoğan, Meryem Kaya","doi":"10.1007/s12149-026-02288-9","DOIUrl":"https://doi.org/10.1007/s12149-026-02288-9","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of the biopsy-to-imaging interval on intraprostatic maximum standardized uptake value (SUVmax) and adverse pathology (AP) prediction in patients with low-to-intermediate risk prostate cancer (PCa) undergoing [⁶⁸Ga]Ga-PSMA PET/CT.</p><p><strong>Methods: </strong>In this retrospective study, 120 patients with ISUP grade 1-2 PCa who underwent [⁶⁸Ga]Ga-PSMA PET/CT followed by radical prostatectomy between February 2022 and June 2025 were analyzed. Patients were classified into an early (≤ 6 weeks, n = 68) and a late group (> 6 weeks, n = 52) by the biopsy-to-PET/CT interval. AP was defined as ISUP grade ≥ 3 or extracapsular disease on the surgical specimen. Predictors of AP were assessed by binary logistic regression.</p><p><strong>Results: </strong>AP was detected in 47 patients (39.2%). The median biopsy-to-PET/CT interval was 39 days (range 10-198). Intraprostatic SUVmax was significantly higher and more variable in the early than the late group (5.9 ± 3.4 vs. 4.7 ± 2.2; p = 0.014; Levene p = 0.026). On univariable analysis, SUVmax (OR 1.19 per unit, 95% CI 1.04-1.36; p = 0.010), PSA density (OR 1.53 per 0.1 ng/mL/cc; p = 0.018), PI-RADS (OR 1.69 per point; p = 0.009) and non-fulfillment of NCCN active-surveillance (AS) criteria (OR 2.59; p = 0.013) were associated with AP, but none of these variables retained significance in the multivariable model, in which SUVmax showed the strongest trend (OR 1.13; p = 0.080). In subgroup analysis, SUVmax significantly predicted AP in the late group (OR 1.36 per unit; p = 0.038) but not in the early group (OR 1.13 per unit; p = 0.099) suggesting that delayed imaging may improve the prediction of AP.</p><p><strong>Conclusion: </strong>Biopsy-to-PET/CT timing may influence the distribution and predictive performance of SUVmax in low-to-intermediate-risk prostate cancer. The association between SUVmax and adverse pathology was evident only beyond 6 weeks after biopsy, suggesting that delayed imaging may improve the clinical interpretability of SUVmax, although prospective validation is warranted.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057311","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":"Incremental diagnostic yield and tracer discordance of [18 F]FDOPA relative to [68Ga]Ga-DOTA-peptide PET in well-differentiated intestinal neuroendocrine tumors: a systematic review.","authors":"Agostino Chiaravalloti, Orazio Schillaci","doi":"10.1007/s12149-026-02289-8","DOIUrl":"https://doi.org/10.1007/s12149-026-02289-8","url":null,"abstract":"<p><p>Somatostatin receptor positron emission tomography (SSTR PET) characterizes receptor expression and supports peptide receptor radionuclide therapy (PRRT) eligibility, whereas [18 F]fluorodihydroxyphenylalanine ([18 F]FDOPA) reflects amine-precursor handling. We systematically reviewed incremental diagnostic yield-defined as additional imaging-detected disease rather than demonstrated clinical benefit-and directional discordance between paired [18 F]FDOPA and [68Ga]Ga-DOTA-peptide PET in well-differentiated intestinal neuroendocrine tumors. PubMed, Scopus, and Web of Science were searched to 26 July 2026. Seven reports representing six diagnostic cohorts and one probable overlapping PRRT companion report were included. Compatible patient-level 2 × 2 tables were reconstructable in four reports; one historical two-patient subgroup was fully concordant. In the three informative cohorts (80 patients), only eight patients were discordant (three [18 F]FDOPA-only and five DOTA-peptide-only), with different directions across clinically heterogeneous studies; no pooled matched effect was estimated. At lesion level, [18 F]FDOPA often depicted additional hepatic, peritoneal, nodal, and pulmonary sites, but counts were clustered within patients. Serotonin/5-hydroxyindoleacetic acid associations were exploratory and did not define a selection threshold. No study established management or survival benefit. PRRT evidence was limited to eight patients. Current evidence supports task-specific interpretation of complementary imaging phenotypes, not routine dual-tracer imaging. [18 F]FDOPA cannot replace validated SSTR PET for receptor characterization or PRRT eligibility.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029574","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":"Elevated baseline C-reactive protein is associated with treatment failure and shorter survival after Yttrium-90 radioembolization in hepatocellular carcinoma.","authors":"Enes Mustafa Kaya, Burcu Esen Akkaş, Tevfik Güzelbey, Çağrı Erdim, Mustafa Fatih Arslan, Cihan Şin, Halil Burak Kapucu, Ayşe Betül Dere, Meryem Kaya","doi":"10.1007/s12149-026-02287-w","DOIUrl":"10.1007/s12149-026-02287-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of baseline C-reactive protein (CRP) on outcomes after yttrium-90 (Y-90) radioembolization (RE) for hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>This retrospective study included patients with HCC treated with Y-90 RE at a tertiary center (June 2022-June 2025). Dosimetry was based on 99mTc-MAA SPECT/CT with refined post hoc high-dose definitions. High-dose therapy was defined as tumor-absorbed dose > 250 Gy for lobar treatments (glass or resin). For segmentectomy, high dose was defined as perfused-liver absorbed dose > 400 Gy for glass and > 250 Gy for resin microspheres. Patients were stratified by baseline CRP: low (≤ 1 mg/dL) vs. high (> 1 mg/dL). Tumor response was assessed on gadoxetate-enhanced MRI using mRECIST. Local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were estimated by Kaplan-Meier and compared with log-rank tests. Cox regression identified independent prognostic factors.</p><p><strong>Results: </strong>The cohort comprised 103 patients (mean age 65.8 ± 9 years; 76.7% male). BCLC stages were A (n = 27), B (n = 35), and C (n = 41); median largest tumor diameter was 6.0 cm (IQR 4.1-8.8), and median follow-up was 26 months. On multivariable analysis, CRP > 1 mg/dL independently predicted inferior LPFS (HR 3.6, p < 0.001), PFS (HR 2.7, p = 0.002), and OS (HR 4.8, p < 0.001). High-dose treatment was independently associated with improved LPFS (HR 0.55, p = 0.043) and OS (HR 0.47, p = 0.021). In subgroup analyses, high-dose treatment was associated with longer survival in the low-CRP group but not in the high-CRP group.</p><p><strong>Conclusion: </strong>Baseline CRP > 1 mg/dL is a strong adverse prognostic factor after Y-90 RE. High-dose RE was associated with longer survival in patients with low CRP but not in those with elevated CRP; this hypothesis-generating observation requires prospective confirmation.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023556","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":"Radium-223 therapy in metastatic castration-resistant prostate cancer: baseline predictors of treatment completion and survival in a reimbursement-regulated Taiwanese cohort.","authors":"Hsi-Chen Tsai, Jing-Ren Tseng, Feng-Yuan Liu, Chun-Te Wu, Kai-Jie Yu, Po-Jung Su, Kung-Chu Ho","doi":"10.1007/s12149-026-02284-z","DOIUrl":"https://doi.org/10.1007/s12149-026-02284-z","url":null,"abstract":"<p><strong>Objective: </strong>Real-world outcomes of Ra-223 in Asian populations vary and are influenced by reimbursement policies that restrict use to symptomatic patients. We aimed to identify baseline predictors of treatment completion and overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) within a reimbursement-regulated Taiwanese cohort and to derive an exploratory composite prognostic classification.</p><p><strong>Methods: </strong>We retrospectively studied 170 men with symptomatic, bone-predominant mCRPC who received Ra-223 under Taiwan National Health Insurance criteria (April 2019-December 2024; follow-up through April 2026). Baseline variables were evaluated as predictors of treatment completion (all six cycles) by logistic regression and of OS by Kaplan-Meier and Cox proportional-hazards models. To avoid immortal time bias, treatment completion was excluded from the OS model. A 0-5 classification was constructed from the independent baseline risk factors and internally validated by bootstrap resampling.</p><p><strong>Results: </strong>The completion rate was 61% (104/170) and median OS was 15.2 months. Baseline alkaline phosphatase (ALP ≤ 102 U/L; OR 0.20) and hemoglobin (Hb ≥ 10 g/dL; OR 0.35) and absence of prior radiotherapy (OR 0.46) were independently associated with treatment completion (modeled as odds of early discontinuation). Five baseline factors were independently associated with OS: no prior chemotherapy (HR 0.63), no prior androgen-receptor-pathway-inhibitor (ARPI) therapy (HR 0.47), prostate-specific antigen (PSA) ≤ 19.4 ng/mL (HR 0.49), ALP ≤ 102 U/L (HR 0.36), and Hb ≥ 10 g/dL (HR 0.45); the ARPI association is exploratory (18 ARPI-naive patients). The 0-5 composite classification stratified three risk groups (log-rank p < 0.001): restricted mean survival 58.8 months for low-risk versus median OS of 15.6 and 6.7 months for intermediate- and high-risk groups; the optimism-corrected C-index was 0.69.</p><p><strong>Conclusions: </strong>In a symptomatic, reimbursement-regulated mCRPC cohort, baseline ALP and Hb are associated with Ra-223 completion, whereas survival is associated with tumor activity (ALP, PSA), marrow reserve (Hb), and prior systemic therapy. The classification provides prognostic stratification within a Ra-223-treated population but does not establish treatment-specific benefit and requires external validation.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975291","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":"From sensitivity gain to clinical decisions: total-body and long-axial-field-of-view PET/CT for diagnosis and image-based management in oncology and systemic disease.","authors":"Mallareddy Banala, Shabbir Ezuddin, Rikesh Makanji, Mark Foley","doi":"10.1007/s12149-026-02282-1","DOIUrl":"https://doi.org/10.1007/s12149-026-02282-1","url":null,"abstract":"<p><p>Total-body (TB) and long-axial-field-of-view (LAFOV) PET/CT systems provide extended axial coverage and substantially higher sensitivity than conventional PET/CT. This structured narrative review evaluates how that sensitivity is translated into dose reduction, shorter acquisition, dynamic or parametric imaging, delayed imaging, and image-based management in oncology and selected systemic diseases. PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Library were searched for January 2015-April 2026, with a separate ClinicalTrials.gov search; the manuscript was appraised using SANRA. Seventy-four full-text publications were assessed, and 55 principal TB/LAFOV publications informed the synthesis. Evidence is strongest for protocol optimisation, including reduced activity and abbreviated acquisition, but many studies rely on retrospective list-mode subsampling or image-quality endpoints. Recent comparative studies provide early diagnostic-accuracy and management-impact signals, although single-centre design, delayed-imaging confounding, incomplete reference standards, and absent outcome data limit inference. Dynamic imaging, immunoPET, paediatric applications, and post-radioembolisation ⁹⁰Y dosimetry remain promising but early. Multicentre validation, cross-platform harmonisation, patient-centred outcomes, workflow studies, and prospective health-economic evaluation are required.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966045","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}