Annals of Nuclear Medicine最新文献

{"title":"Comparison of radiolabeled somatostatin analogs (DOTATATE, DOTANOC, and DOTATOC) in somatostatin receptor (SSTR) imaging for gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs): a narrative literature review.","authors":"Ryan Reinardi Wijaya, Hendra Budiawan, Basuki Hidayat, Budi Darmawan, Trias Nugrahadi, Achmad Hussein Sundawa Kartamihardja","doi":"10.1007/s12149-025-02072-1","DOIUrl":"10.1007/s12149-025-02072-1","url":null,"abstract":"<p><p>Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) present a diagnostic challenge due to their heterogeneous nature and varying somatostatin receptor (SSTR) expressions. Although rare, their incidence has increased with earlier detection, which can improve overall survival. Functional SSTR imaging, especially with radiolabeled somatostatin analogs like DOTATATE, DOTANOC, and DOTATOC, offers greater sensitivity and specificity than anatomic imaging. However, differences in pharmacokinetics and binding affinities among these radiotracers lead to variability in diagnostic performance and clinical utility. As theranostics becomes central to GEP-NEN management, standardizing radiotracer selection is essential for diagnostic consistency and personalized therapy. This review summarizes current literature on the comparative performance of the three most commonly used radiotracers in GEP-NEN imaging, covering their SSTR subtype affinities, diagnostic accuracy, biodistribution, dosimetry, and clinical impact. Among the radiotracers, DOTATOC is considered the most superior for functional imaging due to its broad affinity for SSTR2 and SSTR5, yielding the highest tumor-to-background ratio (TBR). In comparison, DOTANOC is less effective because its lower tumor uptake and slower clearance result in a reduced TBR. Although it binds to SSTR2, SSTR3, and SSTR5, the low expression of SSTR3 in GEP-NENs limits the advantage of DOTANOC broader receptor affinity. DOTATATE exhibits the highest tumor uptake but also shows higher normal tissue uptake, potentially reducing diagnostic performance. However, its better tumor-to-bone uptake ratio makes it effective for detecting bone lesions, and it is also suitable for peptide receptor radionuclide therapy (PRRT) due to its prolonged intracellular retention. The sensitivity and specificity of these radiotracers vary across studies, with comparable clinical impact and dosimetry, suggesting they may be used interchangeably. However, DOTATATE combines high SSTR2 affinity, strong cellular retention, and rapid clearance, making it effective for both imaging and therapy. Its widespread use simplifies tracer inventory and supports harmonization in radiotheranostics, particularly in light of recent FDA approvals and the evolving landscape of theranostic practices. PET/CT scans are recommended over SPECT/CT for GEP-NEN diagnosis due to their higher accuracy. Enhancements in diagnostic performance may be achieved by combining SSTR tracers with radionuclides like ⁶⁴Cu and ¹⁸F, using somatostatin antagonists as tracers, or employing dual-tracer protocols with ¹⁸F-FDG.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":"755-773"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526202","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 and cutoff values of two amyloid PET scaling methods: centiloid scale and amyloid-β load.","authors":"Ryo Yamakuni, Mitsunari Abe, Naoyuki Ukon, Hiroshi Matsuda, Harumasa Takano, Nobukatsu Sawamoto, Atsushi Shima, Yuhei Mori, Hirofumi Sekino, Shiro Ishii, Kenji Fukushima, Toshiki Mizuno, Jin Narumoto, Takashi Hanakawa, Hiroshi Ito","doi":"10.1007/s12149-025-02051-6","DOIUrl":"10.1007/s12149-025-02051-6","url":null,"abstract":"<p><strong>Objective: </strong>To enhance amyloid-β (Aβ) positron emission tomography (PET) diagnostic accuracy and adjust for tracer differences, the amyloid-β load (Aβ_L) and centiloid (CL) scale were developed. However, the correlation and superiority of these indicators remain unclear. This study aimed to elucidate the correlation and determine cutoff values.</p><p><strong>Methods: </strong>Data from 281 consecutive participants (144 males; mean age, 69.6 years) in the Parkinson's and Alzheimer's Disease Dimensional Neuroimaging Initiative study were analyzed. Initial data, including Aβ PET, structural MRI, and Global Clinical Dementia Rating (G-CDR) scores, were reviewed. CL was calculated using the cerebral cortical and striatum Volume of Interest templates (VOI) and whole cerebellum VOI. Aβ_L was calculated using voxel-wise regression with two canonical images representing non-displaceable and specific binding. Visual estimation was performed by five radiologists, with two independently classify as visual-only Aβ-negative or Aβ-positive. The discrepancies were resolved through majority consensus involving a third observer. Additional visual estimation was performed for cases with CL value under 10 but visual-only Aβ-positive, and those over 30 but Aβ-negative, by two nuclear medicine radiologists. The discrepancies were resolved through discussion and classify as final Aβ diagnosis negative or positive.</p><p><strong>Results: </strong>CL and Aβ_L correlated linearly (CL = Aβ_L × 2.10-9.40, R² = 0.923). In predicting final Aβ diagnosis negative versus positive, both CL (AUC = 0.996) and Aβ_L (AUC = 0.997) were significant, with no significant differences (P = 0.882). The Youden Index was 23.3 for CL and 15.6 for Aβ_L. In predicting cognitively normal participants (G-CDR = 0) from others, both CL (AUC = 0.687) and Aβ_L (AUC = 0.667) were significant, with no significant differences (P = 0.379). The Youden Index was 11.9 for CL and 11.6 for Aβ_L. Using a non-biased Gaussian mixture model, the normal group's mean and SD were -2.5 (SD = 6.5) for CL and 3.7 (SD = 3.0) for Aβ_L, resulting in 95% limits (mean + 2SD) of 10.4 for CL and 9.7 for Aβ_L.</p><p><strong>Conclusions: </strong>This study demonstrated a high correlation and non-inferiority between CL and Aβ_L.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":"799-812"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958021","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 value of FDG PET/CT in determining the etiology of pericardial effusion.","authors":"Jinchuan Chen, Qian Wang, Yuan Li, Junxian Song","doi":"10.1007/s12149-025-02091-y","DOIUrl":"https://doi.org/10.1007/s12149-025-02091-y","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the imaging characteristics of FDG PET/CT in pericardial effusions from various etiologies and evaluate its diagnostic utility for differentiating these etiologies.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 71 patients who underwent FDG PET/CT imaging for etiological diagnosis of pericardial effusion from 2014 to 2024 in our hospital. Clinical, laboratory, and imaging data from FDG PET/CT were evaluated to characterize pericardial effusions attributable to malignant conditions, bacterial infections, other benign etiologies, and idiopathic causes, thus assessing the diagnostic efficacy of FDG PET/CT.</p><p><strong>Results: </strong>Pericardial lesions exhibited significant thickening and markedly increased FDG uptake in 89.5% of malignant cases and 77.8% of bacterial infection cases. When integrated with extrapericardial imaging findings, FDG PET/CT directly identified the underlying etiology in 68.4% of malignant and 44.4% of bacterial infection cases. Employing an integrated \"clinical-laboratory-imaging\" diagnostic approach, the positive diagnostic rate of FDG PET/CT increased to 56.3%, and FDG PET/CT was able to achieve etiologically suggestive imaging diagnoses in 100% of malignant cases, 77.8% of bacterial cases, and 47.8% overall. Ultimately, FDG PET/CT contributed to clinical management in 88.7% of patients.</p><p><strong>Conclusion: </strong>FDG PET/CT is valuable for the etiological diagnosis of pericardial effusions. Developing a comprehensive \"clinical-laboratory-imaging\" diagnostic model can substantially enhance the effectiveness of FDG PET/CT in determining the underlying causes of pericardial effusion.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726929","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":"Recent advances in theranostics and oncology PET: emerging radionuclides and targets","authors":"Tadashi Watabe,&nbsp;Kenji Hirata,&nbsp;Mami Iima,&nbsp;Masahiro Yanagawa,&nbsp;Tsukasa Saida,&nbsp;Akihiko Sakata,&nbsp;Satoru Ide,&nbsp;Maya Honda,&nbsp;Ryo Kurokawa,&nbsp;Kentaro Nishioka,&nbsp;Mariko Kawamura,&nbsp;Rintaro Ito,&nbsp;Koji Takumi,&nbsp;Seitaro Oda,&nbsp;Shunsuke Sugawara,&nbsp;Keitaro Sofue,&nbsp;Daiju Ueda,&nbsp;Shinji Naganawa","doi":"10.1007/s12149-025-02090-z","DOIUrl":"10.1007/s12149-025-02090-z","url":null,"abstract":"<div><p>Theranostics, a novel integrated approach that combines cancer diagnosis and therapy by switching the radionuclide, has attracted growing attention. Various oncology PET probes other than FDG have been developed for the highly sensitive and precise detection of many types of cancer with the advancements in PET scanners, supporting the innovative development in theranostics. In therapeutic applications, radioligand therapy targeting somatostatin receptors (SSTR) and prostate-specific membrane antigen (PSMA) has already demonstrated significant clinical benefits. Terbium-161 (¹⁶¹Tb) has emerged as a new beta and Auger electron emitter, showing greater therapeutic efficacy compared to ¹⁷⁷Lu. Alpha emitters, such as astatine (²¹¹At), are currently being evaluated in investigator-initiated clinical trials, with preliminary efficacy data reported for [²¹¹At]NaAt in patients with radioiodine-refractory thyroid cancer. Novel pan-tumor targeting agents, such as TROP-2, Nectin-4, LAT1, GPC-1, and EphA2, are also under development, and clinical translation of radioligand therapy is anticipated. These innovations in theranostics are expected to further broaden the scope of precision medicine in oncology.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 9","pages":"909 - 921"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02090-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guidelines for 18F-Fluciclovine 2024 in the Japanese Society of Nuclear Medicine","authors":"Kimiteru Ito,&nbsp;Seishi Jinnouchi,&nbsp;Kaoru Kikukawa,&nbsp;Chio Okuyama,&nbsp;Yoshifumi Sugawara,&nbsp;Masami Kawamoto,&nbsp;Koichi Koyama,&nbsp;Kanae Kawai Miyake,&nbsp;Koji Murakami","doi":"10.1007/s12149-025-02089-6","DOIUrl":"10.1007/s12149-025-02089-6","url":null,"abstract":"<div><p>¹⁸F-Fluciclovine was the first ¹⁸F-labeled amino acid PET tracer to be approved for clinical use in Japan, receiving regulatory approval in March 2021 and being listed for reimbursement in June 2024. In response to this development, the Japanese Society of Nuclear Medicine initiated the formulation of clinical guidelines to ensure the appropriate use of this radiopharmaceutical in clinical practice. This guideline provides a comprehensive overview of the clinical characteristics of ¹⁸F-Fluciclovine in malignant glioma, including indications for use, imaging protocols, interpretation of PET images, and considerations for radiation safety. The Japanese version of this guideline was compiled by a voluntary editorial committee and officially approved by the Japanese Society of Nuclear Medicine on August 16, 2024. The primary objective of this guideline is to consolidate the current scientific evidence on ¹⁸F-Fluciclovine and to clarify its clinical utility, appropriate usage, and imaging methodologies. By doing so, it aims to promote the proper implementation of ¹⁸F-Fluciclovine in clinical settings and to serve as a reference for future applications related to the expansion of insurance coverage and reimbursement decisions.</p><p>It is recommended that PET examinations using ¹⁸F-Fluciclovine in Japan be conducted in accordance with this guideline. Although the content is tailored to the Japanese medical system and regulatory framework, the imaging protocols, radiation safety management, and interpretation methods described herein are also expected to be internationally applicable and relevant.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 9","pages":"899 - 908"},"PeriodicalIF":2.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02089-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of FDG-PET/CT findings in mucosal melanoma of the head and neck treated with carbon ion radiotherapy.","authors":"Ayako Hino, Nobutaka Mizoguchi, Hiroaki Koge, Ryohei Yaguchi, Manatsu Yoshida, Takashi Matsuki, Madoka Furukawa, Tomoaki Nagase, Harumi Mochizuki, Akira Kakiuchi, Shihyao Cheng, Yayoi Yamamoto, Tsunehiro Doiuchi, Hiroaki Kurihara","doi":"10.1007/s12149-025-02069-w","DOIUrl":"https://doi.org/10.1007/s12149-025-02069-w","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in patients with mucosal melanoma of the head and neck (MMHN) treated with carbon ion radiotherapy (CIRT).</p><p><strong>Methods: </strong>This single-center retrospective study included patients with MMHN who underwent CIRT and FDG-PET/CT. Correlations between pre-treatment FDG-PET/CT-derived parameters, including the maximum standardized uptake variable (SUVmax), metabolic tumor volume (MTV) with a 50% threshold, total lesion glycolysis (TLG), bone marrow/liver SUVmax and mean standardized uptake variable (SUVmean) ratios, and spleen/liver SUVmax and SUVmean ratios (SLRmax, SLRmean), with clinical parameters and prognosis were statistically analyzed.</p><p><strong>Results: </strong>A total of 32 patients with MMHN were enrolled (median age, 72.5 years). The tumor stages were distributed as follows: T3, 17 patients; T4a, 14 patients; T4b, one patient. The median total observation period was 22.6 months, the median overall survival (OS) was 21.6 months, and the median progression-free survival (PFS) was 11.5 months. Thirteen patients (40.6%) died, 10 (31.3%) experienced local recurrence, and 19 (59.4%) had distant metastases during the observation period. The 1 and 3-year survival rates were 78.1% and 62.5%, respectively. FDG-PET/CT showed pronounced positive uptake for all tumors (median SUVmax: 13.8, range 2.7-33.0). SLRmax was high in patients with negative programmed death-ligand 1 expression in the tumor (p = 0.05). PFS was shorter in patients with a high MTV (p = 0.018). In the multivariate analysis, MTV was an independent prognostic factor for PFS (hazard ratio, 2.60; 95% confidence interval, 1.065-6.345; p = 0.036). MTV and TLG were not predictive of OS in the univariate analysis.</p><p><strong>Conclusions: </strong>FDG-PET/CT showed a strong positive uptake for MMHN. FDG-PET/CT-derived imaging parameters may be significant prognostic biomarkers for predicting tumor progression in patients with MMHN.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706067","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":"Distribution patterns of brown adipose tissue on FDG-PET/CT has age characteristics.","authors":"Yasuchiyo Toyama, Tomoya Kotani, Nagara Tamaki, Sachimi Yamada, Shimpei Akiyama, Yoshitomo Nakai, Taisei Kanayama, Chio Okuyama, Kei Yamada","doi":"10.1007/s12149-025-02087-8","DOIUrl":"https://doi.org/10.1007/s12149-025-02087-8","url":null,"abstract":"<p><strong>Purpose: </strong>Brown adipose tissue (BAT) contributes to thermoregulation and energy expenditure. Although BAT is abundant in early childhood and declines with age, its distribution across age groups remains unclear. This study examined age-related BAT distribution using fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).</p><p><strong>Materials and methods: </strong>A total of 8695 FDG-PET/CT scans performed for clinical purposes were retrospectively reviewed. FDG accumulation with a standardized uptake value (SUV) max > 1.5 in known BAT regions was considered positive. BAT distribution patterns were classified into T-type (positive accumulation in the supraclavicular or axillary region), I-type (positive accumulation in the cervical or paravertebral region without supraclavicular or axillary involvement), lipomatous hypertrophy of the interatrial septum (LHIS)-type (positive accumulation localized only to the LHIS), and others (cases not fitting any type).</p><p><strong>Results: </strong>BAT accumulation was observed in 78 patients (0.9% prevalence): T-type (18), I-type (39), LHIS-type (18), and others (3). The mean ages for T-type, I-type, LHIS-type, and others were 29.8 ± 17.3, 73.6 ± 18.1, 72.9 ± 12.5, and 67.0 ± 11.5 years, respectively. Patients in the T-type group were significantly younger than those in the I-type- and LHIS-type groups (p < 0.01).</p><p><strong>Conclusions: </strong>This study identified three BAT distribution types, with T-type occurring in mostly younger compared with the I-type and LHIS type. Recognizing these patterns may improve FDG-PET/CT diagnostic accuracy.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706066","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":"Innovations in clinical PET image reconstruction: advances in Bayesian penalized likelihood algorithm and deep learning","authors":"Kenta Miwa,&nbsp;Tensho Yamao,&nbsp;Fumio Hashimoto,&nbsp;Noriaki Miyaji,&nbsp;Yuto Kamitaka,&nbsp;Masaki Masubuchi,&nbsp;Taisuke Murata,&nbsp;Tokiya Yoshii,&nbsp;Rinya Kobayashi,&nbsp;Shohei Fukuda,&nbsp;Naochika Akiya,&nbsp;Kaito Wachi,&nbsp;Kei Wagatsuma","doi":"10.1007/s12149-025-02088-7","DOIUrl":"10.1007/s12149-025-02088-7","url":null,"abstract":"<div><p>Recent advances in PET image reconstruction have focused on achieving high image quality and quantitative accuracy. Bayesian penalized likelihood (BPL) algorithms, such as Q.Clear and HYPER Iterative that have been integrated into commercial PET systems offer robust image noise suppression and edge preservation through regularization. In parallel, methods based on deep learning such as SubtlePET, AiCE, uAI^® HYPER DLR, and Precision DL have emerged primarily as post-processing techniques. They use trained convolutional neural networks to reduce image noise while preserving lesion contrast. These methods have reduced image acquisition times or reduced radiotracer doses while maintaining diagnostic confidence. uAI^® HYPER DPR represents a hybrid approach by embedding deep learning in iterative reconstruction. This review summarizes the technical principles and the clinical performance of BPL and deep learning-based PET reconstruction algorithms, and discusses key considerations such as image quality and quantitative accuracy of PET images. This review should deepen understanding of advanced PET image reconstruction techniques and accelerate their clinical implementation across diverse PET imaging applications.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 9","pages":"875 - 898"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02088-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision-language model performance on the Japanese Nuclear Medicine Board Examination: high accuracy in text but challenges with image interpretation.","authors":"Rintaro Ito, Keita Kato, Marina Higashi, Yumi Abe, Ryogo Minamimoto, Katsuhiko Kato, Toshiaki Taoka, Shinji Naganawa","doi":"10.1007/s12149-025-02084-x","DOIUrl":"https://doi.org/10.1007/s12149-025-02084-x","url":null,"abstract":"<p><strong>Objective: </strong>Vision language models (VLMs) allow visual input to Large Language Models. VLMs have been developing rapidly, and their accuracy is improving rapidly. Their performance in nuclear medicine compared to state-of-the-art models, including reasoning models, is not yet clear. We evaluated state-of-the-art VLMs using problems from the past Japan Nuclear Medicine Board Examination (JNMBE) and assessed their strengths and limitations.</p><p><strong>Methods: </strong>We collected 180 multiple-choice questions from JNMBE (2022-2024). About one-third included diagnostic images. We used eight latest VLMs. ChatGPT o1 pro, ChatGPT o1, ChatGPT o3-mini, ChatGPT-4.5, Claude 3.7, Gemini 2.0 Flash thinking, Llama 3.2, and Gemma 3 were tested. Each model answered every question three times in a deterministic setting, and the final answer was set by majority vote. Two board-certified nuclear medicine physicians independently provided reference answers, with a third expert resolving disagreements. We calculated overall accuracy with 95% confidence intervals and performed subgroup analyses by question type, content, and exam year.</p><p><strong>Results: </strong>Overall accuracies ranged from 36.1% (Gemma 3) to 83.3% (ChatGPT o1 pro). ChatGPT o1 pro achieved the highest score (150/180, 83.3% [95% CI: 77.1-88.5%]), followed by ChatGPT o3-mini (82.8%) and ChatGPTo1 (78.9%). All models performed better on text-only questions than on image-based ones; ChatGPT o1 pro correctly answered 89.5% of text questions versus 66.0% of image questions. VLMs demonstrated limitations in handling with questions on Japanese regulations. ChatGPT 4.5 excelled in neurology-related image-based questions (76.9%). Accuracy was slightly lower from 2022 to 2024 for most models.</p><p><strong>Conclusions: </strong>VLMs demonstrated high accuracy on the JNMBE, especially on text-based questions, but exhibited limitations with image recognition questions. These findings show that VLMs can be a good assistant for text-based questions in medical domains but have limitations when it comes to comprehensive questions that include images. Currently, VLMs cannot replace comprehensive training and expert interpretation. Because VLMs evolve rapidly and exam difficulty varies annually, these findings should be interpreted in that context.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636008","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":"Kinetic and quantitative analysis of [¹⁸F]SMBT-1 PET imaging for monoamine oxidase B.","authors":"Kotaro Hiraoka, Berihu Mesfin, Yingying Wu, Yuki Shimizu, Asuka Kikuchi, Ryuichi Harada, Aiko Ishiki, Yoshihito Funaki, Shozo Furumoto, Shunji Mugikura, Nobuyuki Okamura, Akio Kikuchi, Kazuhiko Yanai, Hiroyuki Arai, Hiroshi Watabe, Manabu Tashiro","doi":"10.1007/s12149-025-02083-y","DOIUrl":"https://doi.org/10.1007/s12149-025-02083-y","url":null,"abstract":"<p><strong>Background and objective: </strong>In neuroinflammation, activated astrocytes, called reactive astrocytes, highly express monoamine oxidase B (MAO-B). [¹⁸F]SMBT-1 is a novel PET tracer developed for imaging neuroinflammation, with highly selective binding to MAO-B. The quantification method for [¹⁸F]SMBT-1 PET imaging has not been established, although some human studies using [¹⁸F]SMBT-1 PET imaging have already been conducted. In this study, we explored the most appropriate method for quantifying [¹⁸F]SMBT-1 PET.</p><p><strong>Methods: </strong>Dynamic PET scanning of [¹⁸F]SMBT-1, accompanied by serial arterial blood sampling, was performed in healthy elderly subjects. With PET and blood data, the total distribution volumes (Vts) in the brain regions were calculated using a one-tissue compartment model (1TCM), a two-tissue compartment model (2TCM), and Logan graphical analysis. Standardized uptake values (SUVs) and SUV ratio-1 (SUVR-1) were determined for different time frames and reference regions.</p><p><strong>Results: </strong>The values of the χ² criterion and Akaike's Information Criterion (AIC) in the brain regions were lower in 2TCM than in 1TCM, suggesting that 2TCM was a better model in terms of curve fitting. However, the very high coefficient of variation (%COV) for parameters such as K1, k2, k3, and k4 in 2TCM suggests that these parameters may not have been properly estimated. SUVs, especially at 50-70 and 70-90 min post-injection, were strongly correlated with Vt (r = 0.9188-0.9445, p < 0.0001). SUVR-1 at these time points, referenced to various regions, showed significant correlations with MAO-B distribution in the brain shown in a previous postmortem study (r = 0.9362-0.9399, p < 0.0001).</p><p><strong>Conclusions: </strong>These findings suggest that SUVR-1, especially at 50-70 min and 70-90 min post-injection, reflects MAO-B distribution and is useful for quantifying [¹⁸F]SMBT-1 PET imaging, potentially enabling noninvasive assessment of neuroinflammation in the brain.</p><p><strong>Trial registration: </strong>Japan Registry of Clinical Trials (jRCT) (jRCTs021200019). It was registered on August 25, 2020. The jRCT was approved as a member of the Primary Registry Network of the WHO ICTRP.</p>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636006","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}