European Journal of Nuclear Medicine and Molecular Imaging最新文献

Purpose: This study aimed to investigate the association between achieved lipid levels, as an indicator of lipid residual risk, and longitudinal changes in myocardial perfusion and function in patients with acute anterior myocardial infarction (AMI) after percutaneous coronary intervention (PCI), using serial rest-stress CZT-SPECT imaging.

Methods: In this retrospective cohort study, 462 anterior AMI patients post-PCI were categorized by their mean follow-up lipid levels into three groups: double-target achievement (LDL-C ≤ 1.4 mmol/L and reduction ≥ 50%; non-HDL-C < 2.2 mmol/L), single-target achievement (met LDL-C target only), and non-achievement. Myocardial perfusion was assessed by regadenoson stress/rest CZT-SPECT (D-SPECT camera) at 7 days and 12 months. Parameters included myocardial perfusion score (MPS), ischemic segment count, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume (LVEDV). Major adverse cardiovascular events (MACE) were recorded.

Results: The double-target group had significantly higher PCSK9 inhibitor use (66.0%) than the single-target (48.1%) and non-achievement groups (23.0%, P < 0.001). At 12 months, this group exhibited a lower MACE incidence (8.1% vs. 13.3% and 22.4%, P = 0.001), driven by reduced angina. Multivariable Cox regression confirmed that double-target achievement was independently associated with lower MACE risk (HR 0.38, P = 0.014) after adjusting for PCSK9 inhibitor use. Longitudinally, the double-target group showed the greatest improvement in MPS (ΔMPS - 5.0 ± 2.1) and LVEF compared to other groups (P < 0.001).

Conclusion: Achieving stringent dual lipid targets post-PCI is associated with improved long-term myocardial perfusion, attenuated adverse remodeling, and lower MACE incidence. While these benefits are linked to intensive lipid-lowering therapy including PCSK9 inhibitors, achieving lipid targets remains an independent predictor of improved outcomes.

Purpose: This systematic review provides a comprehensive overview of flexible intraoperative detector technologies for robotic and laparoscopic image-guided surgery, with a focus on their clinical applications and impact. Additionally, it offers a perspective on future directions in the field.

Methods: The review was conducted according to PRISMA guidelines. A systematic search of PubMed and Google Scholar was performed up to June 2024 and updated through May 2025. Of 539 records initially identified, 90 studies met the inclusion criteria after screening and full-text assessment.

Results: Of the included studies, 61 involved human applications. Flexible detectors were classified into ultrasound (n = 29), radioactivity (gamma and beta, n = 38), optical (n = 19: fluorescence, endomicroscopy, Raman), and miscellaneous technologies (n = 4). Flexible ultrasound and radioactivity probes were the most employed in clinical settings, they were shown to enhance intraoperative dexterity with equivalent performance to conventional rigid probes. They enabled previously unfeasible procedures, such as robotic PSMA-targeted radioguided surgery. In contrast, optical and miscellaneous probes, though applied in human studies, remain largely at an early or conceptual stage, with limited demonstration of direct clinical impact.

Conclusion: Flexible sensing technologies offer advantages in size, flexibility, ergonomics, and integration with robotic platforms, enabling and/or improving image-guided surgery within the field of minimally-invasive interventions. The ultrasound and radioactivity ones showed the strongest utility, while optical and miscellaneous require further clinical evaluation. Overall, broader clinical adoption requires more rigorous, prospective trials to establish their efficacy and impact on surgical performance and outcomes.

Purpose: The prostate-specific membrane antigen (PSMA) inhibitor [²¹¹At]YF2 was investigated in a Phase 0 microdose study in patients with metastatic castration resistant prostate cancer (mCRPC). The x-rays from ²¹¹At decay were used to assess biodistribution and dosimetry.

Methods: The biodistribution of [²¹¹At]YF2 initially was evaluated in CD-1 mice and human-equivalent estimated radiation doses were calculated using Rapid 3D-RD software. Three patients with PSMA-positive metastases confirmed by [⁶⁸Ga]Ga-PSMA-11 PET/CT received [²¹¹At]YF2 (29.6-44.4 MBq) intravenously. Whole-body planar imaging was performed at 1, 4, and 24 h while SPECT/CT was conducted at 4 and 24 h. Safety assessment was performed for 7 d. Volumes of interest were manually delineated to generate time-activity curves for radiation dosimetry calculation with Rapid 3D-RD software.

Results: Preliminary human dosimetry estimates based on murine data indicated that the kidneys received the highest dose (35.14 mGy/MBq). [²¹¹At]YF2 was well tolerated with all adverse events being ≤ Grade 2. High uptake of [²¹¹At]YF2 was observed initially in kidneys, bladder, salivary glands, and thyroid, followed by rapid clearance. Even at 24 h, pronounced uptake of [²¹¹At]YF2 in metastases identified by PSMA-PET was observed in all patients with the most prominent metastasis receiving an average dose of 31.4 mGy/MBq. A kidney dose of 15.3 mGy/MBq was calculated from patient images, considerably lower than predicted from murine biodistribution-derived human dosimetry.

Conclusions: [²¹¹At]YF2 was safely administered to mCRPC patients and metastatic lesions were clearly delineated by ²¹¹At imaging. Normal organ accumulation resulted in favorable dosimetry. Based on these results, [²¹¹At]YF2 warrants further clinical development.