Nuclear Medicine and Molecular Imaging最新文献

Objective: Epilepsy is one of the most serious brain disorders which can be treated with antiepileptic drugs. However, for those with refractory focal epilepsy, surgical resection of the epileptogenic zones (EZ) is the gold standard for achieving long-term seizure-free status. The aim of this study was to construct a predictive model to localize EZs from SPECT images using radiomics.

Methods: Twenty sets of ictal and interictal SPECT images were collected retrospectively. Image preprocessing, including normalization and registration of the SPECT data and the calculation of z-score images, was performed using statistical parametric mapping software (SPM12). In this study, we extracted radiomic features from ictal images and z-score images using two methods: the voxel-based and the map-based methods. Subsequently, six radiomic models (two extraction methods for each of the ictal, the z-score, and the combined ictal/z-score models) were constructed, and their performances were compared to nuclear medicine physician readings.

Results: The voxel-based combined model achieved the highest sensitivity (0.954 ± 0.044) and AUC value (0.918 ± 0.044), followed by the map-based combined model (AUC = 0.895 ± 0.065). The voxel-based ictal model achieved the third-highest AUC value (0.848 ± 0.052) and the highest specificity (0.848 ± 0.052). In comparison, physician readings had a sensitivity of 0.679 ± 0.277 and a specificity of 0.980 ± 0.007.

Conclusion: Radiomic analysis of SPECT images showed a promising ability to improve the prediction of EZ locations in epilepsy patients. These findings suggested that radiomic models can effectively support physicians in clinical decision making.

Supplementary information: The online version contains supplementary material available at 10.1007/s13139-025-00921-5.

[This corrects the article DOI: 10.1007/s13139-025-00928-y.].

Abstract: Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is transforming the treatment landscape for prostate cancer. However, clinical data and outcomes for Asian patients remain limited and they are underrepresented in pivotal clinical trials. Although emerging retrospective series from Asia demonstrate comparable efficacy and safety profiles to Western cohorts, several points warrant attention. Asian men frequently present with aggressive, advanced-stage disease and distinct genomic profiles, characterized by lower rates of ERG fusions and TP53/PTEN mutations, and higher frequencies of FOXA1 and SPOP alterations. These genomic differences could influence PSMA expression and responsiveness to therapy. Additionally, Asian populations exhibit higher susceptibility to myelosuppression, necessitating careful patient selection and dose management. The development of region-specific radiopharmaceuticals and clinical trials, alongside systematic real-world data collection, will be essential for optimizing PSMA-targeted RLT in Asian contexts. Incorporating PSMA-based therapies earlier in disease management strategies also presents promising avenues for improving outcomes. Personalized approaches informed by ethnic-specific disease biology and clinical experience will be crucial for effectively bridging the current knowledge gaps in PSMA-targeted RLT for Asian prostate cancer patients.

Clinical trial number: Not applicable.

Radiohalogens, including fluorine-18 (F-18) and radioiodine (I-123, I-124, and I-131), have been utilized widely for both diagnostic imaging and targeted radionuclide therapy owing to their favorable nuclear properties, well-established radiochemistry, and broad applicability to biomolecules. Among the diverse radionuclides utilized in this field, the production of astatine-211, a promising alpha-emitting radiohalogen, has expanded globally, stimulating a growing interest in theranostic applications that leverage the unique properties of radiohalogens. This review article provides an overview of radiohalogens in nuclear medicine, discussing their current status and future prospects in theranostic radiopharmaceuticals.

This systematic review evaluates the diagnostic and theranostic utilities of fibroblast activation protein inhibitor (FAPI PET) in patients with soft tissue sarcomas (STS). PubMed, Scopus, and Web of Science were researched for clinical studies employing FAPI PET in STS, covering literature up to October 15, 2024. This review synthesized 36 studies, involving 316 patients and about 30 STS subtypes. Twenty-one case reports highlighted FAPI's diagnostic utility. Comparative analyses often favored FAPI PET/CT over FDG PET/CT for tumor delineation, showing higher SUVmax and tumor-to-background ratios, especially in vascular tumors. Seven original studies consistently reported reliable FAPI uptake metrics across STS subtypes in 253 patients, strongly correlating with FAP immunohistochemistry. FAPI PET/CT generally demonstrated higher uptake, improved accuracy, and better lesion detection than FDG PET/CT, supporting its use in staging and restaging of recurrent and metastatic STS. Eight studies assessed FAPI PET/CT for FAPI-based radioligand therapy (RLT) eligibility, with posttherapeutic outcome predominantly resulted in disease stabilization (16 out of 36 patients), and a favorable safety profile. FAPI PET/CT outperforms FDG in detecting recurrent/metastatic STS, offering higher accuracy in most STS types. FAPI-based radioligand therapy is a promising, safe treatment for challenging STS, with encouraging efficacy.

Supplementary information: The online version contains supplementary material available at 10.1007/s13139-025-00936-y.

Theranostics, a combination of therapeutic and diagnostic approaches using molecular imaging and targeted radionuclide therapy, represents a significant advancement in personalized medicine. The Indian subcontinent, with its vast and diverse population, presents a unique landscape for the development and implementation of theranostics. This review critically examines the opportunities, challenges, and future directions of theranostics in the region. The large patient burden provides a fertile ground for research and clinical applications. Additionally, the presence of skilled manpower and established infrastructure offers a solid foundation for its advancement. However, financial constraints, uneven geographical distribution of expertise, and manpower shortages pose significant hurdles. This paper discusses strategies to address these challenges, emphasizing policy interventions, capacity building, and research initiatives to ensure equitable and sustainable growth of theranostics in the Indian subcontinent.

Theranostics, the combined use of radiopharmaceuticals for diagnosis and therapy, has seen a significant evolution, accelerated by its application in prostate cancer. While this field has grown exponentially over the past decade, its implementation remains fraught with challenges, especially in developing countries. These challenges span three stages: pre-establishment, establishment, and post-establishment of theranostics centers. This article explores these obstacles and offers insights into overcoming them. In the pre-establishment phase, key barriers include limited government funding, lack of administrative support, and personal risks. During establishment, multitasking, the absence of trained personnel, and resource shortages are prominent hurdles. Post-establishment trials include overcoming colonial mentality, limited patient access due to financial constraints, logistical difficulties, and a lack of research capacity, among others. Despite these tests, successful establishment of theranostics centers is possible through strong leadership, rigorous training, international collaboration, and a patient-centered approach. The experience of the Philippines illustrates that, while the road is challenging, it is ultimately achievable with clear vision, unrelenting dedication, and the stakeholders' cooperation.