PURPOSETo compare the performance of a multidisciplinary team (MDT) with the proposed standardized PROMISE classification system for indeterminate bone uptake on staging PSMA PET.METHODS744 staging PSMA PET/CT scans (140 18F-PSMA-1007 and 604 68Ga-PSMA-11 PET/CT) were retrospectively reviewed for the presence of indeterminate bone metastatic staging. 95 scans which were discussed at an MDT meeting were further analysed for the comparison with the PROMISE classification system. MDT interpretation of the bone staging was recorded as positive or negative, based on risk stratification, imaging review, and clinically suitable management options. Additional resources were occasionally used, such as bone biopsy, musculoskeletal MRI, or re-evaluation after initial androgen deprivation therapy. MDT and PROMISE classification were compared for agreement. Statistical assessment was made on any differences in age, PSA, T-stage, Gleason score, risk, SUVmax and tracer used between negative and positive patients in both methods. Discordant cases were correlated with follow up data.RESULTSThe overall incidence of indeterminate bone uptake in staging PSMA PET scans was 16.9%, reaching 40% for 18F-PSMA-1007. There was substantial agreement between MDT and PROMISE interpretation (87.3%). The MDT was more likely to interpret an indeterminate bone uptake as negative in patients with lower Gleason score and in scans where 18F-PSMA-1007 was used. The data from long-term follow up favoured the MDT interpretation in all the cases of disagreement. Examples of pitfalls in rib or thoracic spine foci of uptake are presented and recommendations for PET reporters and MDTs have been generated based on the results.CONCLUSIONPROMISE may interpret indeterminate bone PSMA uptake with high accuracy. Therefore, PET reporters are recommended to use the PROMISE algorithm, while being mindful of common pitfalls related to the Gleason score, tracer used and anatomical localisation of indeterminate bone findings. Additional discussion in an MDT meeting is recommended with a view to resolve all equivocal findings.
{"title":"Multidisciplinary team interpretation performance for indeterminate bone uptake on PSMA PET during prostate cancer staging: Comparison with PROMISE criteria.","authors":"Dimitrios Priftakis,Fadilah Aziz,Noora Bin Essa,Reena Davda,Maria Lyasheva,Sudeshna Maitra,Francesco Fraioli,Simon Wan,Jamshed Bomanji,Asim Afaq","doi":"10.1007/s00259-026-07763-z","DOIUrl":"https://doi.org/10.1007/s00259-026-07763-z","url":null,"abstract":"PURPOSETo compare the performance of a multidisciplinary team (MDT) with the proposed standardized PROMISE classification system for indeterminate bone uptake on staging PSMA PET.METHODS744 staging PSMA PET/CT scans (140 18F-PSMA-1007 and 604 68Ga-PSMA-11 PET/CT) were retrospectively reviewed for the presence of indeterminate bone metastatic staging. 95 scans which were discussed at an MDT meeting were further analysed for the comparison with the PROMISE classification system. MDT interpretation of the bone staging was recorded as positive or negative, based on risk stratification, imaging review, and clinically suitable management options. Additional resources were occasionally used, such as bone biopsy, musculoskeletal MRI, or re-evaluation after initial androgen deprivation therapy. MDT and PROMISE classification were compared for agreement. Statistical assessment was made on any differences in age, PSA, T-stage, Gleason score, risk, SUVmax and tracer used between negative and positive patients in both methods. Discordant cases were correlated with follow up data.RESULTSThe overall incidence of indeterminate bone uptake in staging PSMA PET scans was 16.9%, reaching 40% for 18F-PSMA-1007. There was substantial agreement between MDT and PROMISE interpretation (87.3%). The MDT was more likely to interpret an indeterminate bone uptake as negative in patients with lower Gleason score and in scans where 18F-PSMA-1007 was used. The data from long-term follow up favoured the MDT interpretation in all the cases of disagreement. Examples of pitfalls in rib or thoracic spine foci of uptake are presented and recommendations for PET reporters and MDTs have been generated based on the results.CONCLUSIONPROMISE may interpret indeterminate bone PSMA uptake with high accuracy. Therefore, PET reporters are recommended to use the PROMISE algorithm, while being mindful of common pitfalls related to the Gleason score, tracer used and anatomical localisation of indeterminate bone findings. Additional discussion in an MDT meeting is recommended with a view to resolve all equivocal findings.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"2 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1007/s00259-025-07735-9
Sajjad Sadeghpour, Atena Aghaee, Saba Sadeghpour, Alessio Rizzo, Daniele Antonio Pizzuto, Salvatore Annunziata, Giorgio Treglia, Ramin Sadeghi
{"title":"Predicting the unpredictable: prognostic and predictive power of FAPI-PET imaging in oncology: a systematic review and meta-analysis","authors":"Sajjad Sadeghpour, Atena Aghaee, Saba Sadeghpour, Alessio Rizzo, Daniele Antonio Pizzuto, Salvatore Annunziata, Giorgio Treglia, Ramin Sadeghi","doi":"10.1007/s00259-025-07735-9","DOIUrl":"https://doi.org/10.1007/s00259-025-07735-9","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"2 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to: 68Ga-FAPI and 18F-FDG PET/CT for predicting pathologic response and progression-free survival in locally advanced esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy","authors":"Jiaon Dai, Yuheng Zou, Hui Wang, Hexiao Huang, Lixiang Yang, Bingwen Zou, Rong Tian","doi":"10.1007/s00259-026-07767-9","DOIUrl":"https://doi.org/10.1007/s00259-026-07767-9","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"102 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1007/s00259-025-07749-3
Dilara Denizmen Zorba, Duygu Has Simsek, Yasemin Sanli, Muhammet Ibrahim Karacam, Omer Naci Ergin, Arif Atahan Cagatay, Fikret Buyukkaya, Serkan Kuyumcu
Purpose Chronic bone and soft tissue infections pose a diagnostic challenge, as conventional imaging techniques often show limited sensitivity and specificity. Given that CXCR4 chemokine receptors are expressed on lymphocytes, key mediators of chronic inflammatory response, we hypothesized that CXCR4-targeted imaging may offer enhanced diagnostic accuracy. Accordingly, this study aimed to evaluate the diagnostic performance of [ 68 Ga]Ga-Pentixafor PET/CT in comparison with conventional 3-phase bone scintigraphy and [ 99m Tc]Tc-HMPAO-labelled leucocyte scintigraphy in patients with suspected chronic bone and soft tissue infections. Methods In this retrospective single-centre study, we included patients who underwent both conventional scintigraphic imaging and [ 68 Ga]Ga-Pentixafor PET/CT. Asymptomatic prostheses, orthopaedic implants, and diabetic foot regions within the same cohort served as controls. Two nuclear medicine specialists, blinded to patient data, evaluated imaging findings in consensus visually and quantitatively. Final diagnoses were confirmed by microbiological culture and/or histopathology for infected sites, and by clinical and radiological follow-up for non-infected control sites. Results A total of 20 patients with 25 suspected infectious foci and 14 control sites were evaluated. Of the 25 sites, 21 were confirmed to be infected; no infections were observed in the control sites. Scintigraphy correctly identified 19 infection sites (sensitivity: 90%, specificity: 83%), while [ 68 Ga]Ga-Pentixafor PET/CT was positive in all 21 infection sites, but demonstrated two false-positives (sensitivity: 100%, specificity: 89%). PET/CT showed higher overall accuracy (95% vs. 87%), although this difference did not reach statistical significance ( p = 0.07). Conclusion [ 68 Ga]Ga-Pentixafor PET/CT was accurate in detecting BSTIs, suggesting potential utility as a single-scan imaging approach. These results align with findings from limited prior studies and underscore the need for validation in larger cohorts.
{"title":"Evaluating chronic bone and soft tissue infections with [68Ga]Ga-Pentixafor PET/CT: a head-to-head comparison with scintigraphy","authors":"Dilara Denizmen Zorba, Duygu Has Simsek, Yasemin Sanli, Muhammet Ibrahim Karacam, Omer Naci Ergin, Arif Atahan Cagatay, Fikret Buyukkaya, Serkan Kuyumcu","doi":"10.1007/s00259-025-07749-3","DOIUrl":"https://doi.org/10.1007/s00259-025-07749-3","url":null,"abstract":"Purpose Chronic bone and soft tissue infections pose a diagnostic challenge, as conventional imaging techniques often show limited sensitivity and specificity. Given that CXCR4 chemokine receptors are expressed on lymphocytes, key mediators of chronic inflammatory response, we hypothesized that CXCR4-targeted imaging may offer enhanced diagnostic accuracy. Accordingly, this study aimed to evaluate the diagnostic performance of [ <jats:sup>68</jats:sup> Ga]Ga-Pentixafor PET/CT in comparison with conventional 3-phase bone scintigraphy and [ <jats:sup>99m</jats:sup> Tc]Tc-HMPAO-labelled leucocyte scintigraphy in patients with suspected chronic bone and soft tissue infections. Methods In this retrospective single-centre study, we included patients who underwent both conventional scintigraphic imaging and [ <jats:sup>68</jats:sup> Ga]Ga-Pentixafor PET/CT. Asymptomatic prostheses, orthopaedic implants, and diabetic foot regions within the same cohort served as controls. Two nuclear medicine specialists, blinded to patient data, evaluated imaging findings in consensus visually and quantitatively. Final diagnoses were confirmed by microbiological culture and/or histopathology for infected sites, and by clinical and radiological follow-up for non-infected control sites. Results A total of 20 patients with 25 suspected infectious foci and 14 control sites were evaluated. Of the 25 sites, 21 were confirmed to be infected; no infections were observed in the control sites. Scintigraphy correctly identified 19 infection sites (sensitivity: 90%, specificity: 83%), while [ <jats:sup>68</jats:sup> Ga]Ga-Pentixafor PET/CT was positive in all 21 infection sites, but demonstrated two false-positives (sensitivity: 100%, specificity: 89%). PET/CT showed higher overall accuracy (95% vs. 87%), although this difference did not reach statistical significance ( <jats:italic>p</jats:italic> = 0.07). Conclusion [ <jats:sup>68</jats:sup> Ga]Ga-Pentixafor PET/CT was accurate in detecting BSTIs, suggesting potential utility as a single-scan imaging approach. These results align with findings from limited prior studies and underscore the need for validation in larger cohorts.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"397 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSEImpaired glymphatic function is considered an important characteristic of cognitive decline, but the role of tau pathology as a mediator remains unclear. This study investigated whether tau burden mediates the association between diffusion tensor image analysis along the perivascular space (DTI-ALPS) and cognitive impairment or brain atrophy. Also, we explored whether DTI-ALPS index predicts longitudinal cognitive deterioration over time.METHODSWe included 144 individuals with mild cognitive impairment (MCI), Alzheimer's disease dementia (ADD), and other dementia, or normal cognition. All participants underwent 3.0-Tesla MRI, 18F-MK6240 and 18F-Flutemetamol PET scans, APOE genotyping, and comprehensive neuropsychological assessments. Among these, 101 were followed longitudinally for two years. Mediation analyses within a causal framework were used to investigate whether tau burden mediated the association between DTI-ALPS index and cognition function and structural MRI measures. Longitudinal associations were tested using linear mixed-effects models.RESULTSDTI-ALPS index was significantly lower in cognitively impaired individuals compared to cognitively normal (CN) participants. Lower DTI-ALPS index was associated with higher tau burden and worse cognitive function. Tau burden was also inversely associated with cognition. Mediation analysis indicated that tau burden accounted for approximately 21-27% of the association between DTI-ALPS and cognition. Longitudinal analysis showed baseline lower DTI-ALPS index also predicted faster longitudinal cognitive decline.CONCLUSIONOur findings suggest that the DTI-ALPS index is an indirect marker of glymphatic dysfunction associated with tau accumulation and cognitive decline. Tau pathology may partially link compromised glymphatic clearance to cognitive impairment.
{"title":"Tau PET imaging as a mediator between glymphatic dysfunction and cognitive decline: a cross-sectional and longitudinal study.","authors":"Juyeon Ko,Gayeong Son,Ha Eun Seo,Jaelim Cho,Jae-Yoon Kim,Sang-Yoon Lee,Daegyeom Kim,ShinEui Park,Kee Hyung Park,Samuel N Lockhart,Dong-Hyun Kim,Young Noh","doi":"10.1007/s00259-025-07756-4","DOIUrl":"https://doi.org/10.1007/s00259-025-07756-4","url":null,"abstract":"PURPOSEImpaired glymphatic function is considered an important characteristic of cognitive decline, but the role of tau pathology as a mediator remains unclear. This study investigated whether tau burden mediates the association between diffusion tensor image analysis along the perivascular space (DTI-ALPS) and cognitive impairment or brain atrophy. Also, we explored whether DTI-ALPS index predicts longitudinal cognitive deterioration over time.METHODSWe included 144 individuals with mild cognitive impairment (MCI), Alzheimer's disease dementia (ADD), and other dementia, or normal cognition. All participants underwent 3.0-Tesla MRI, 18F-MK6240 and 18F-Flutemetamol PET scans, APOE genotyping, and comprehensive neuropsychological assessments. Among these, 101 were followed longitudinally for two years. Mediation analyses within a causal framework were used to investigate whether tau burden mediated the association between DTI-ALPS index and cognition function and structural MRI measures. Longitudinal associations were tested using linear mixed-effects models.RESULTSDTI-ALPS index was significantly lower in cognitively impaired individuals compared to cognitively normal (CN) participants. Lower DTI-ALPS index was associated with higher tau burden and worse cognitive function. Tau burden was also inversely associated with cognition. Mediation analysis indicated that tau burden accounted for approximately 21-27% of the association between DTI-ALPS and cognition. Longitudinal analysis showed baseline lower DTI-ALPS index also predicted faster longitudinal cognitive decline.CONCLUSIONOur findings suggest that the DTI-ALPS index is an indirect marker of glymphatic dysfunction associated with tau accumulation and cognitive decline. Tau pathology may partially link compromised glymphatic clearance to cognitive impairment.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"41 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1007/s00259-026-07764-y
Tan Hui, Zhiqun Mao
{"title":"\"Tiger man sign\" in sarcoid myopathy.","authors":"Tan Hui, Zhiqun Mao","doi":"10.1007/s00259-026-07764-y","DOIUrl":"https://doi.org/10.1007/s00259-026-07764-y","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1007/s00259-026-07772-y
Wolfram A Bosbach,Radi Saiyed Alsheikh,Nasir Gözlügöl,Federico Caobelli,Robert Seifert,Clemens Mingels,Mohamed Shelan,Dilara Akhoundova,Berna C Özdemir,Jörg Beyer,Paul Cumming,Axel Rominger,Ali Afshar-Oromieh
INTRODUCTIONWe investigated whether prompt changes in prostate-specific-antigen (PSA) levels within two days after the first cycle of prostate-specific-membrane-antigen radioligand therapy (PSMA-RLT) with [177Lu]Lu-PSMA-617 predicted treatment response and mean survival.METHODSIn a retrospective study of 76 metastatic castration resistant prostate cancer (mCRPC) patients, we evaluated pretreatment PSA-values and their relative changes in PSA (dPSA) two days later. We tested for correlations between dPSA with long-term biochemical response (BCR) to treatment, using a priori criteria for relevant PSA decrease (dPSA < -10%), stable PSA (-10% ≤ dPSA ≤ + 10%) and relevant PSA increase (dPSA > 10%), along with evaluation of biochemical therapy outcome according to the Prostate-Cancer-Working-Group (PCWG3).RESULTSTwo days after the first [177Lu]Lu-PSMA-617 cycle, 32 (42%) of the patientsshowed PSA decrease, of whom 19 (59%) had experienced a partial response according toPCWG3 criteria. Of the 37 patients with stable PSA, 17 (46%) showed partial response totreatment according to PCWG3 criteria. Among the seven patients with PSA increase, three(43%) showed partial response. Pearson correlation analysis showed statistically significantcorrelations between dPSA on day 2 and relative Nadir for the first two treatment cycles.Patients with PSA decrease or stable PSA compared to those with an increase of PSA two daysafter cycle 1 lived longer on average (399, 405 and 225 days, respectively).CONCLUSIONCompared to those with increased PSA levels, patients with decreased or stable PSA levels two days after the first [177Lu]Lu-PSMA-617 RLT cycle were more likely to have favorable biochemical response according to PCWG3 criteria and presented with a longer overall survival.
{"title":"Prompt PSA changes as a prognostic marker for response to PSMA-radioligand therapy.","authors":"Wolfram A Bosbach,Radi Saiyed Alsheikh,Nasir Gözlügöl,Federico Caobelli,Robert Seifert,Clemens Mingels,Mohamed Shelan,Dilara Akhoundova,Berna C Özdemir,Jörg Beyer,Paul Cumming,Axel Rominger,Ali Afshar-Oromieh","doi":"10.1007/s00259-026-07772-y","DOIUrl":"https://doi.org/10.1007/s00259-026-07772-y","url":null,"abstract":"INTRODUCTIONWe investigated whether prompt changes in prostate-specific-antigen (PSA) levels within two days after the first cycle of prostate-specific-membrane-antigen radioligand therapy (PSMA-RLT) with [177Lu]Lu-PSMA-617 predicted treatment response and mean survival.METHODSIn a retrospective study of 76 metastatic castration resistant prostate cancer (mCRPC) patients, we evaluated pretreatment PSA-values and their relative changes in PSA (dPSA) two days later. We tested for correlations between dPSA with long-term biochemical response (BCR) to treatment, using a priori criteria for relevant PSA decrease (dPSA < -10%), stable PSA (-10% ≤ dPSA ≤ + 10%) and relevant PSA increase (dPSA > 10%), along with evaluation of biochemical therapy outcome according to the Prostate-Cancer-Working-Group (PCWG3).RESULTSTwo days after the first [177Lu]Lu-PSMA-617 cycle, 32 (42%) of the patientsshowed PSA decrease, of whom 19 (59%) had experienced a partial response according toPCWG3 criteria. Of the 37 patients with stable PSA, 17 (46%) showed partial response totreatment according to PCWG3 criteria. Among the seven patients with PSA increase, three(43%) showed partial response. Pearson correlation analysis showed statistically significantcorrelations between dPSA on day 2 and relative Nadir for the first two treatment cycles.Patients with PSA decrease or stable PSA compared to those with an increase of PSA two daysafter cycle 1 lived longer on average (399, 405 and 225 days, respectively).CONCLUSIONCompared to those with increased PSA levels, patients with decreased or stable PSA levels two days after the first [177Lu]Lu-PSMA-617 RLT cycle were more likely to have favorable biochemical response according to PCWG3 criteria and presented with a longer overall survival.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"6 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSEThis review examines Marine-Lenhart syndrome (MLS), an uncommon thyroid disorder that combines Graves' disease with autonomously functioning thyroid nodules (AFTNs) and demonstrates why nuclear medicine imaging is essential for accurate diagnosis and treatment planning.METHODSWe reviewed case reports and case series published over the past three decades and analyzed clinical presentation, diagnostic approaches, prevalence rates, disease mechanisms, and treatment outcomes of MLS.RESULTSThis relatively rare syndrome occurs in approximately 0.8-4.3% of patients with Graves' disease, though rates vary depending on the diagnostic criteria and imaging methods used. It presents a diagnostic challenge because AFTNs often remain suppressed and appear "cold" on initial scans, only becoming visible after treatment - the characteristic "unmasking effect". Thyroid scintigraphy with either 99mTc-pertechnetate or 123I provides functional information that structural imaging cannot show. Treatment differs from standard Graves' disease management as MLS requires higher radioiodine activities because nodules may escape radiation damage, and patients may need radioiodine re-ablation. Type 3 MLS, which includes cold nodules, requires careful cancer risk evaluation with ultrasound and fine-needle aspiration when appropriate.CONCLUSIONNuclear medicine imaging is crucial for MLS diagnosis and treatment planning. Functional imaging identifies AFTNs, guides appropriate radioiodine treatment, and prevents treatment failure. Routine thyroid scintigraphy is recommended in all patients with hyperthyroidism and thyroid nodules before starting therapy.
{"title":"Marine-Lenhart syndrome: why nuclear medicine imaging remains essential for diagnosis and treatment.","authors":"Petra Petranović Ovčariček,Rosaria Maddalena Ruggeri,Alfredo Campennì,Isabella Corrêa Chaves Nunes,Daria Maccora,Murat Tuncel,Luca Giovanella","doi":"10.1007/s00259-025-07751-9","DOIUrl":"https://doi.org/10.1007/s00259-025-07751-9","url":null,"abstract":"PURPOSEThis review examines Marine-Lenhart syndrome (MLS), an uncommon thyroid disorder that combines Graves' disease with autonomously functioning thyroid nodules (AFTNs) and demonstrates why nuclear medicine imaging is essential for accurate diagnosis and treatment planning.METHODSWe reviewed case reports and case series published over the past three decades and analyzed clinical presentation, diagnostic approaches, prevalence rates, disease mechanisms, and treatment outcomes of MLS.RESULTSThis relatively rare syndrome occurs in approximately 0.8-4.3% of patients with Graves' disease, though rates vary depending on the diagnostic criteria and imaging methods used. It presents a diagnostic challenge because AFTNs often remain suppressed and appear \"cold\" on initial scans, only becoming visible after treatment - the characteristic \"unmasking effect\". Thyroid scintigraphy with either 99mTc-pertechnetate or 123I provides functional information that structural imaging cannot show. Treatment differs from standard Graves' disease management as MLS requires higher radioiodine activities because nodules may escape radiation damage, and patients may need radioiodine re-ablation. Type 3 MLS, which includes cold nodules, requires careful cancer risk evaluation with ultrasound and fine-needle aspiration when appropriate.CONCLUSIONNuclear medicine imaging is crucial for MLS diagnosis and treatment planning. Functional imaging identifies AFTNs, guides appropriate radioiodine treatment, and prevents treatment failure. Routine thyroid scintigraphy is recommended in all patients with hyperthyroidism and thyroid nodules before starting therapy.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"29 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1007/s00259-026-07760-2
Enio Barci,Maximilian J Mair,Jonas Reis,Katharina Müller,Jera Isakaj,Ergi Istrefi,Isabelle von Polenz,Sophie C Siegmund,Lena Kaiser,Matthias Preusser,Christian Schichor,Niklas Thon,Patrick Harter,Louisa von Baumgarten,Robert Forbrig,Nathalie L Albert
{"title":"Characteristics of [18F]FET PET and MRI in isocitrate dehydrogenase (IDH)-mutant gliomas diagnosed according to the WHO 2021 classification - a retrospective analysis.","authors":"Enio Barci,Maximilian J Mair,Jonas Reis,Katharina Müller,Jera Isakaj,Ergi Istrefi,Isabelle von Polenz,Sophie C Siegmund,Lena Kaiser,Matthias Preusser,Christian Schichor,Niklas Thon,Patrick Harter,Louisa von Baumgarten,Robert Forbrig,Nathalie L Albert","doi":"10.1007/s00259-026-07760-2","DOIUrl":"https://doi.org/10.1007/s00259-026-07760-2","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"42 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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