Pub Date : 2024-08-23DOI: 10.1053/j.semnuclmed.2024.07.002
Pierre Courault, Luc Zimmer, Sophie Lancelot
At present, spinal cord imaging primarily uses magnetic resonance imaging (MRI) or computed tomography (CT), but the greater sensitivity of positron emission tomography (PET) techniques and the development of new radiotracers are paving the way for a new approach. The substantial rise in publications on PET radiotracers for spinal cord exploration indicates a growing interest in the functional and molecular imaging of this organ. The present review aimed to provide an overview of the various radiotracers used in this indication, in preclinical and clinical settings. Firstly, we outline spinal cord anatomy and associated target pathologies. Secondly, we present the state-of-the-art of spinal cord imaging techniques used in clinical practice, with their respective strengths and limitations. Thirdly, we summarize the literature on radiotracers employed in functional PET imaging of the spinal cord. In conclusion, we propose criteria for an ideal radiotracer for molecular spinal cord imaging, emphasizing the relevance of multimodal hybrid cameras, and particularly the benefits of PET-MRI integration.
目前,脊髓成像主要使用磁共振成像(MRI)或计算机断层扫描(CT),但正电子发射断层扫描(PET)技术更高的灵敏度和新型放射性racer的开发正在为新方法铺平道路。有关正电子发射计算机断层成像(PET)放射性核素用于脊髓探查的论文大量增加,表明人们对这一器官的功能和分子成像越来越感兴趣。本综述旨在概述临床前和临床环境中用于该适应症的各种放射性核素。首先,我们概述了脊髓解剖结构和相关靶点病理。其次,我们介绍了临床实践中使用的最先进的脊髓成像技术,以及它们各自的优势和局限性。第三,我们总结了脊髓功能 PET 成像中使用的放射性racer 的文献。最后,我们提出了用于脊髓分子成像的理想放射性示踪剂的标准,强调了多模态混合相机的相关性,尤其是 PET-MRI 集成的优势。
{"title":"Toward Functional PET Imaging of the Spinal Cord.","authors":"Pierre Courault, Luc Zimmer, Sophie Lancelot","doi":"10.1053/j.semnuclmed.2024.07.002","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.07.002","url":null,"abstract":"<p><p>At present, spinal cord imaging primarily uses magnetic resonance imaging (MRI) or computed tomography (CT), but the greater sensitivity of positron emission tomography (PET) techniques and the development of new radiotracers are paving the way for a new approach. The substantial rise in publications on PET radiotracers for spinal cord exploration indicates a growing interest in the functional and molecular imaging of this organ. The present review aimed to provide an overview of the various radiotracers used in this indication, in preclinical and clinical settings. Firstly, we outline spinal cord anatomy and associated target pathologies. Secondly, we present the state-of-the-art of spinal cord imaging techniques used in clinical practice, with their respective strengths and limitations. Thirdly, we summarize the literature on radiotracers employed in functional PET imaging of the spinal cord. In conclusion, we propose criteria for an ideal radiotracer for molecular spinal cord imaging, emphasizing the relevance of multimodal hybrid cameras, and particularly the benefits of PET-MRI integration.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1053/j.semnuclmed.2024.08.001
{"title":"Letter from the Editors","authors":"","doi":"10.1053/j.semnuclmed.2024.08.001","DOIUrl":"10.1053/j.semnuclmed.2024.08.001","url":null,"abstract":"","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1053/j.semnuclmed.2024.07.001
Aamir K Nazar, Sandip Basu
Somatostatin receptors (SSTR) are expressed by many tumours especially those related to neuro-endocrine origin and molecular functional imaging of SSTR expression using radiolabelled somatostatin analogs have revolutionized imaging of patients with these group of malignancies. Coming a long way from the first radiolabelled somatostatin analog 123I-Tyr-3-octreotide, there has been significant developments in terms of radionuclides used, the ligands and somatostatin derivatives. 111In-Pentetreotide extensively employed for imaging NETs at the beginning has now been replaced by 68Ga-SSA based PET-CT. SSA-PET/CT performs superior to conventional imaging modalities and has evolved in the mainframe for NET imaging. The advantages were multiple: (i) superior spatial resolution of PET versus SPECT, (ii) quantitative capabilities of PET aiding in disease activity and treatment response monitoring with better precision, (iii) shorter scan time and (iv) less patient exposure to radiation. The modality is indicated for staging, detecting the primary in CUP-NETs, restaging, treatment planning (along with FDG: the concept of dual-tracer PET-CT) as well as treatment response evaluation and follow-up of NETs. SSA PET/CT has also been incorporated in the guidelines for imaging of Pheochromocytoma-Paraganglioma, Medullary carcinoma thyroid, Meningioma and Tumor induced osteomalacia. At present, there is rising interest on (a) 18F-labelled SSA, (b) 64Cu-labelled SSA, and (c) somatostatin antagonists. 18F offers excellent imaging properties, 64Cu makes delayed imaging feasible which has implications in dosimetry and SSTR antagonists bind with the SST receptors with high affinity and specificity, providing high contrast images with less background, which can be translated to theranostics effectively. SSTR have been demonstrated in non-neuroendocrine tumours as well in the peer-reviewed literature, with studies demonstrating the potential of SSA PET/CT in Neuroblastoma, Nasopharyngeal carcinoma, carcinoma prostate (neuroendocrine differentiation) and lymphoma. This review will focus on the currently available SSAs and their history, different SPECT/PET agents, SSTR antagonists, comparison between the various imaging tracers, and their utility in both neuroendocrine and non-neuroendocrine tumors.
{"title":"Radiolabeled Somatostatin Analogs for Cancer Imaging.","authors":"Aamir K Nazar, Sandip Basu","doi":"10.1053/j.semnuclmed.2024.07.001","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.07.001","url":null,"abstract":"<p><p>Somatostatin receptors (SSTR) are expressed by many tumours especially those related to neuro-endocrine origin and molecular functional imaging of SSTR expression using radiolabelled somatostatin analogs have revolutionized imaging of patients with these group of malignancies. Coming a long way from the first radiolabelled somatostatin analog <sup>123</sup>I-Tyr-3-octreotide, there has been significant developments in terms of radionuclides used, the ligands and somatostatin derivatives. <sup>111</sup>In-Pentetreotide extensively employed for imaging NETs at the beginning has now been replaced by <sup>68</sup>Ga-SSA based PET-CT. SSA-PET/CT performs superior to conventional imaging modalities and has evolved in the mainframe for NET imaging. The advantages were multiple: (i) superior spatial resolution of PET versus SPECT, (ii) quantitative capabilities of PET aiding in disease activity and treatment response monitoring with better precision, (iii) shorter scan time and (iv) less patient exposure to radiation. The modality is indicated for staging, detecting the primary in CUP-NETs, restaging, treatment planning (along with FDG: the concept of dual-tracer PET-CT) as well as treatment response evaluation and follow-up of NETs. SSA PET/CT has also been incorporated in the guidelines for imaging of Pheochromocytoma-Paraganglioma, Medullary carcinoma thyroid, Meningioma and Tumor induced osteomalacia. At present, there is rising interest on (a) <sup>18</sup>F-labelled SSA, (b) <sup>64</sup>Cu-labelled SSA, and (c) somatostatin antagonists. <sup>18</sup>F offers excellent imaging properties, <sup>64</sup>Cu makes delayed imaging feasible which has implications in dosimetry and SSTR antagonists bind with the SST receptors with high affinity and specificity, providing high contrast images with less background, which can be translated to theranostics effectively. SSTR have been demonstrated in non-neuroendocrine tumours as well in the peer-reviewed literature, with studies demonstrating the potential of SSA PET/CT in Neuroblastoma, Nasopharyngeal carcinoma, carcinoma prostate (neuroendocrine differentiation) and lymphoma. This review will focus on the currently available SSAs and their history, different SPECT/PET agents, SSTR antagonists, comparison between the various imaging tracers, and their utility in both neuroendocrine and non-neuroendocrine tumors.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1053/j.semnuclmed.2024.04.003
Coronary heart disease (CHD) remains the top cause of death due to cardiovascular conditions worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out atherosclerosis, leading to the adoption of hybrid imaging techniques. Hybrid imaging combines computed tomography (CT) with MPI techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of radiotracer uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.
{"title":"Hybrid Imaging: Calcium Score and Myocardial Perfusion Imaging","authors":"","doi":"10.1053/j.semnuclmed.2024.04.003","DOIUrl":"10.1053/j.semnuclmed.2024.04.003","url":null,"abstract":"<div><p><span><span><span>Coronary heart disease (CHD) remains the top cause of death due to </span>cardiovascular conditions<span> worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting </span></span>coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out </span>atherosclerosis<span><span><span>, leading to the adoption of hybrid imaging techniques<span>. Hybrid imaging combines computed tomography (CT) with MPI techniques such as </span></span>positron emission tomography<span> (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of </span></span>radiotracer<span> uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.</span></span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1053/j.semnuclmed.2024.05.012
Cardiac amyloidosis (CA) is caused by the misfolding, accumulation and aggregation of proteins into large fibrils in the extracellular compartment of the myocardium, leading to restrictive cardiomyopathy, heart failure and death. The major forms are transthyretin (ATTR) CA and light-chain (AL) CA, based on the respective precursor protein. Each of them requires early diagnosis for a timely treatment initiation that will improve patient outcomes. For this, radionuclide imaging is essentially used as single-photon emission computed tomography (SPECT) with bone-avid radiotracers or as positron emission tomography (PET) with amyloid-binding radiotracers. Both offer unprecedented specificity for the diagnostic of CA. SPECT has even revolutionized the diagnosis of ATTR-CA by making it non-invasive. Indeed, SPECT has now entered the standard diagnostic pathway to CA and has led to earlier diagnosis of the disease. SPECT also modified the epidemiology of ATTR-CA, highlighting that the disease is much more frequent than previously believed, and showing that ATTR-CA plays a substantial role in HFpEF and aortic stenosis, particularly among elderly patients. In parallel, amyloid-binding radiotracers for PET have accumulated a substantial amount of evidence, but are not approved for clinical use in CA yet. Further studies are needed to refine acquisition protocols and validate results in broader populations. Unlike bone-avid SPECT radiotracers, PET radiotracers have been specifically created to bind to amyloid fibrils. Thus, PET is the only imaging method that is truly specific for amyloid deposits and very sensitive to any amyloid type. Indeed, PET can not only detect ATTR-CA, but also AL-CA and rare hereditary forms. For both SPECT and PET, advances in quantitation of myocardial uptake have generated more granular and reproducible findings, paving the way for progress in earlier diagnosis, risk stratification and therapeutic response monitoring. Encouraging findings have shown that SPECT and PET are sensitive to early CA when other diagnostic methods are negative. Both radionuclide imaging techniques can predict adverse outcomes, but more evidence is needed to determine how to use them in conjunction with usual prognostic staging scores. Studies on follow-up imaging after therapy suggested that SPECT and PET can capture myocardial changes in CA, but again, more data are needed to meaningfully interpret such changes. Based on all these promising results, radionuclide imaging has the potential to further impact the landscape of CA in diagnosis, prognosis and follow-up, but also to substantially contribute to the assessment of novel therapies that will improve the lives of patients with CA.
心脏淀粉样变性(CA)是由于蛋白质在心肌细胞外错误折叠、堆积和聚集成大纤维,从而导致限制性心肌病、心力衰竭和死亡。根据各自的前体蛋白,主要分为转甲状腺素(ATTR)CA 和轻链(AL)CA。每种类型都需要早期诊断,以便及时开始治疗,从而改善患者的预后。为此,放射性核素成像技术主要用于使用骨亲和性放射性核素的单光子发射计算机断层扫描(SPECT)或使用淀粉样蛋白结合型放射性核素的正电子发射计算机断层扫描(PET)。这两种方法都为 CA 诊断提供了前所未有的特异性。SPECT 甚至彻底改变了 ATTR-CA 的诊断方法,使其成为无创诊断。事实上,SPECT 现在已进入 CA 的标准诊断途径,并使疾病诊断更早。SPECT还改变了ATTR-CA的流行病学,突显出该病的发病率比以前认为的要高得多,并显示ATTR-CA在高频血流衰竭和主动脉瓣狭窄中起着重要作用,尤其是在老年患者中。与此同时,用于 PET 的淀粉样蛋白结合放射性同位素也积累了大量证据,但尚未被批准用于 CA 的临床治疗。还需要进一步的研究来完善采集方案,并在更广泛的人群中验证结果。与嗜骨 SPECT 放射性标记物不同,PET 放射性标记物是专门用来与淀粉样蛋白纤维结合的。因此,PET 是唯一真正针对淀粉样蛋白沉积的成像方法,对任何类型的淀粉样蛋白都非常敏感。事实上,PET 不仅能检测 ATTR-CA,还能检测 AL-CA 和罕见的遗传型淀粉样变性。对于 SPECT 和 PET 来说,心肌摄取定量方面的进步已经产生了更加精细和可重复的结果,为早期诊断、风险分层和治疗反应监测的进展铺平了道路。令人鼓舞的研究结果表明,当其他诊断方法呈阴性时,SPECT 和 PET 对早期 CA 很敏感。这两种放射性核素成像技术都能预测不良预后,但还需要更多证据来确定如何将它们与通常的预后分期评分结合使用。关于治疗后随访成像的研究表明,SPECT 和 PET 可以捕捉 CA 中心肌的变化,但同样需要更多的数据来有意义地解释这些变化。基于所有这些充满希望的结果,放射性核素成像有可能进一步影响CA的诊断、预后和随访,同时也能为新型疗法的评估做出重大贡献,从而改善CA患者的生活。
{"title":"Radionuclide Imaging of Cardiac Amyloidosis: An Update and Future Aspects","authors":"","doi":"10.1053/j.semnuclmed.2024.05.012","DOIUrl":"10.1053/j.semnuclmed.2024.05.012","url":null,"abstract":"<div><p><span><span><span><span>Cardiac amyloidosis<span><span> (CA) is caused by the misfolding, accumulation and aggregation of proteins into large fibrils in the extracellular compartment of the myocardium, leading to </span>restrictive cardiomyopathy, heart failure and death. The major forms are </span></span>transthyretin (ATTR) CA and light-chain (AL) CA, based on the respective </span>precursor protein<span>. Each of them requires early diagnosis for a timely treatment initiation that will improve patient outcomes. For this, radionuclide imaging is essentially used as single-photon emission computed tomography (SPECT) with bone-avid </span></span>radiotracers<span><span> or as positron emission tomography<span> (PET) with amyloid-binding radiotracers. Both offer unprecedented specificity for the diagnostic of CA. SPECT has even revolutionized the diagnosis of ATTR-CA by making it non-invasive. Indeed, SPECT has now entered the standard diagnostic pathway to CA and has led to earlier diagnosis of the disease. SPECT also modified the epidemiology of ATTR-CA, highlighting that the disease is much more frequent than previously believed, and showing that ATTR-CA plays a substantial role in </span></span>HFpEF<span> and aortic stenosis<span>, particularly among elderly patients. In parallel, amyloid-binding radiotracers for PET have accumulated a substantial amount of evidence, but are not approved for clinical use in CA yet. Further studies are needed to refine acquisition protocols and validate results in broader populations. Unlike bone-avid SPECT radiotracers, PET radiotracers have been specifically created to bind to amyloid fibrils. Thus, PET is the only imaging method that is truly specific for amyloid deposits and very sensitive to any amyloid type. Indeed, PET can not only detect ATTR-CA, but also AL-CA and rare hereditary forms. For both SPECT and PET, advances in quantitation of myocardial uptake have generated more granular and reproducible findings, paving the way for progress in earlier diagnosis, risk stratification<span> and therapeutic response monitoring. Encouraging findings have shown that SPECT and PET are sensitive to early CA when other diagnostic methods are negative. Both radionuclide imaging techniques can predict </span></span></span></span></span>adverse outcomes<span>, but more evidence is needed to determine how to use them in conjunction with usual prognostic staging scores. Studies on follow-up imaging after therapy suggested that SPECT and PET can capture myocardial changes in CA, but again, more data are needed to meaningfully interpret such changes. Based on all these promising results, radionuclide imaging has the potential to further impact the landscape of CA in diagnosis, prognosis and follow-up, but also to substantially contribute to the assessment of novel therapies that will improve the lives of patients with CA.</span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1053/j.semnuclmed.2024.06.001
Janke Kleynhans, Thomas Ebenhan, Mike Machaba Sathekge
Gallium-68 has gained substantial momentum since 2003 as a versatile radiometal that is extremely useful for application in the development of novel oncology targeting diagnostic radiopharmaceuticals. It is available through both generator produced radioactivity and via cyclotron production methods and can therefore be implemented in either small- or large-scale production facilities. It can also be implemented within different spectrum of infrastructure settings with relative ease. Whilst many of the radiopharmaceuticals are being development and investigated, which is summarized in this manuscript, [68Ga]Ga-SSTR2 and [68Ga]Ga-PSMA has prominence in current clinical guidelines. The novel tracer [68Ga]Ga-FAPi has also gained significant interest in the clinical context. A comparison of the labelling strategies followed to incorporate gallium-68 and fluorine-18 into the same molecular targeting constructs clearly demonstrate that gallium-68 complexation is the most convenient approach. Recently, cold kit based starting products are available to make the small-scale production of gallium-68 radiopharmaceuticals even more efficient when combined with generator produced gallium-68. The regulatory aspects is currently changing to support the implementation of gallium-68 and other diagnostic radiopharmaceuticals, simplifying the translation towards clinical use. Overall, the development of gallium-68 based radiopharmaceuticals is not only rapidly changing the landscape of diagnosis in oncology, but this growth also promotes innovation and progress in new applications of therapeutic radiometals such as lutetium-177 and actinium-225.
{"title":"Expanding Role for Gallium-68 PET Imaging in Oncology.","authors":"Janke Kleynhans, Thomas Ebenhan, Mike Machaba Sathekge","doi":"10.1053/j.semnuclmed.2024.06.001","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.06.001","url":null,"abstract":"<p><p>Gallium-68 has gained substantial momentum since 2003 as a versatile radiometal that is extremely useful for application in the development of novel oncology targeting diagnostic radiopharmaceuticals. It is available through both generator produced radioactivity and via cyclotron production methods and can therefore be implemented in either small- or large-scale production facilities. It can also be implemented within different spectrum of infrastructure settings with relative ease. Whilst many of the radiopharmaceuticals are being development and investigated, which is summarized in this manuscript, [<sup>68</sup>Ga]Ga-SSTR2 and [<sup>68</sup>Ga]Ga-PSMA has prominence in current clinical guidelines. The novel tracer [<sup>68</sup>Ga]Ga-FAPi has also gained significant interest in the clinical context. A comparison of the labelling strategies followed to incorporate gallium-68 and fluorine-18 into the same molecular targeting constructs clearly demonstrate that gallium-68 complexation is the most convenient approach. Recently, cold kit based starting products are available to make the small-scale production of gallium-68 radiopharmaceuticals even more efficient when combined with generator produced gallium-68. The regulatory aspects is currently changing to support the implementation of gallium-68 and other diagnostic radiopharmaceuticals, simplifying the translation towards clinical use. Overall, the development of gallium-68 based radiopharmaceuticals is not only rapidly changing the landscape of diagnosis in oncology, but this growth also promotes innovation and progress in new applications of therapeutic radiometals such as lutetium-177 and actinium-225.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.semnuclmed.2024.05.011
Combination models utilising treatments from two or more therapeutic classes are well established in cancer care. In the new era of theranostic (theragnostic) medicine there is an ongoing need to identify and refine novel combination strategies to optimise multidisciplinary care for conditions commonly encountered in nuclear medicine such as neuroendocrine neoplasms (NEN), prostate cancer (PCa), and thyroid cancer, along with seeking advancements in molecular imaging and therapy techniques for other tumour streams. This concise review explores the background of theranostic monotherapy, established approaches to combination strategies in theranostics, and emerging targeted radionuclide therapies in use or under active investigation, with a focus on Australian-led studies.
{"title":"Combination Strategies and Targeted Radionuclide Therapies","authors":"","doi":"10.1053/j.semnuclmed.2024.05.011","DOIUrl":"10.1053/j.semnuclmed.2024.05.011","url":null,"abstract":"<div><p>Combination models utilising treatments from two or more therapeutic classes are well established in cancer care. In the new era of theranostic (theragnostic) medicine there is an ongoing need to identify and refine novel combination strategies to optimise multidisciplinary care for conditions commonly encountered in nuclear medicine such as neuroendocrine neoplasms (NEN), prostate cancer (PCa), and thyroid cancer, along with seeking advancements in molecular imaging and therapy techniques for other tumour streams. This concise review explores the background of theranostic monotherapy, established approaches to combination strategies in theranostics, and emerging targeted radionuclide therapies in use or under active investigation, with a focus on Australian-led studies.</p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0001299824000527/pdfft?md5=415e590ae2db68a4d4a6983b796f0879&pid=1-s2.0-S0001299824000527-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.semnuclmed.2024.06.002
In Greek mythology, The Phoenix is an immortal bird that dies, but then achieves new life by rising from the ashes of its predecessor. Radioimmunotherapy (RIT) of B-cell Non-Hodgkin lymphoma (NHL) is a field which once began to fly high—with FDA approval of the anti-CD20 RITs Zevalin® and Bexxar® in 2002 and 2003 respectively, as safe and effective therapies of NHL. However, despite their therapeutic efficacy, Bexxar® was withdrawn from the market by the manufacturer in 2014 due to limited commercial demand and Zevalin® has had very limited to no availability of late. I-131 rituximab is used to a limited extent in Australia, India and other countries, as well.
But has RIT of NHL been (perhaps prematurely) left for dead by many? Given the current great clinical and commercial interest in radiopharmaceutical therapies of cancer, notably PSMA and SSTR targeting agents in prostate and neuroendocrine cancers, can radioimmunotherapy of NHL—like the mythical Phoenix—now rise from its ashes in an even better form to fly higher, faster, farther and longer than before?
在希腊神话中,凤凰是一种不死鸟,死后会从前身的灰烬中复活,获得新生。B 细胞非霍奇金淋巴瘤(NHL)的放射免疫疗法(RIT)曾一度高歌猛进,美国食品及药物管理局分别于 2002 年和 2003 年批准了抗 CD20 RIT Zevalin® 和 Bexxar®,作为 NHL 安全有效的疗法。然而,尽管疗效显著,但由于商业需求有限,Bexxar®已于2014年被制造商撤出市场,而Zevalin®近来的供应也非常有限,甚至没有供应。I-131 利妥昔单抗在澳大利亚、印度和其他国家也得到了有限的应用。但是,NHL 的 RIT 是否已被许多人(也许是过早地)抛弃?鉴于目前临床和商业界对放射性药物治疗癌症,特别是前列腺癌和神经内分泌癌的 PSMA 和 SSTR 靶向药物的极大兴趣,NHL 的放射免疫疗法能否像神话中的凤凰涅槃一样,以更好的姿态比以前飞得更高、更快、更远、更久?
{"title":"The Rebirth of Radioimmunotherapy of Non-Hodgkin Lymphoma: The Phoenix of Nuclear Medicine?","authors":"","doi":"10.1053/j.semnuclmed.2024.06.002","DOIUrl":"10.1053/j.semnuclmed.2024.06.002","url":null,"abstract":"<div><p>In Greek mythology, The Phoenix is an immortal bird that dies, but then achieves new life by rising from the ashes of its predecessor. Radioimmunotherapy (RIT) of B-cell Non-Hodgkin lymphoma (NHL) is a field which once began to fly high—with FDA approval of the anti-CD20 RITs Zevalin® and Bexxar® in 2002 and 2003 respectively, as safe and effective therapies of NHL. However, despite their therapeutic efficacy, Bexxar® was withdrawn from the market by the manufacturer in 2014 due to limited commercial demand and Zevalin® has had very limited to no availability of late. I-131 rituximab is used to a limited extent in Australia, India and other countries, as well.</p><p>But has RIT of NHL been (perhaps prematurely) left for dead by many? Given the current great clinical and commercial interest in radiopharmaceutical therapies of cancer, notably PSMA and SSTR targeting agents in prostate and neuroendocrine cancers, can radioimmunotherapy of NHL—like the mythical Phoenix—now rise from its ashes in an even better form to fly higher, faster, farther and longer than before?</p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0001299824000552/pdfft?md5=b833aefa8485793f3e088110aae5fbea&pid=1-s2.0-S0001299824000552-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.semnuclmed.2024.02.003
Radiotheranostics, a combination of diagnostic and therapeutic approaches, was first utilized in cancer management using radiopharmaceuticals to both image and selectively treat specific cancer subtypes nearly a century ago. Radiotheranostic strategies rooted in nuclear medicine have revolutionized the treatment landscape for individuals diagnosed with prostate cancer and neuroendocrine tumors in the past 10 years. In specific contexts, these approaches have emerged as the prevailing standard, yielding numerous positive results. The field of radiotheranostics shows great potential for future clinical applications. This article aims to examine the key factors that will contribute to the success of radiotheranostics in the future, as well as the current challenges and potential strategies to overcome them, with insight into the global radiotheranostic market.
{"title":"Radiotheranostics Global Market and Future Developments","authors":"","doi":"10.1053/j.semnuclmed.2024.02.003","DOIUrl":"10.1053/j.semnuclmed.2024.02.003","url":null,"abstract":"<div><p>Radiotheranostics, a combination of diagnostic and therapeutic approaches, was first utilized in cancer management using radiopharmaceuticals<span><span><span> to both image and selectively treat specific cancer subtypes nearly a century ago. Radiotheranostic strategies rooted in nuclear medicine have revolutionized the treatment landscape for individuals diagnosed with </span>prostate cancer and </span>neuroendocrine tumors in the past 10 years. In specific contexts, these approaches have emerged as the prevailing standard, yielding numerous positive results. The field of radiotheranostics shows great potential for future clinical applications. This article aims to examine the key factors that will contribute to the success of radiotheranostics in the future, as well as the current challenges and potential strategies to overcome them, with insight into the global radiotheranostic market.</span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1053/j.semnuclmed.2024.05.010
The advancement of theranostics, which combines therapeutic and diagnostic capabilities in oncology, has significantly impacted cancer management. This review explores fibroblast activation protein (FAP) expression in the tumor microenvironment (TME) and its association with various malignancies, highlighting its potential as a theranostic marker for PET/CT imaging using FAP-targeted tracers and for FAP-targeted radiopharmaceutical therapy. We examine the development and clinical applications of FAP inhibitors (FAPIs) and peptides, providing insights into their diagnostic accuracy, initial therapeutic efficacy, and clinical impact across diverse cancer types, as well as the synthesis of novel FAP-targeted ligands. This review aims to showcase the promising outcomes and challenges in integrating FAP-targeted approaches into cancer management.
{"title":"Radiomolecular Theranostics With Fibroblast-Activation-Protein Inhibitors and Peptides","authors":"","doi":"10.1053/j.semnuclmed.2024.05.010","DOIUrl":"10.1053/j.semnuclmed.2024.05.010","url":null,"abstract":"<div><p>The advancement of theranostics, which combines therapeutic and diagnostic capabilities in oncology<span><span>, has significantly impacted cancer management. This review explores fibroblast activation protein (FAP) expression in the tumor microenvironment<span> (TME) and its association with various malignancies, highlighting its potential as a theranostic marker for PET/CT imaging using FAP-targeted </span></span>tracers<span> and for FAP-targeted radiopharmaceutical<span> therapy. We examine the development and clinical applications of FAP inhibitors<span> (FAPIs) and peptides, providing insights into their diagnostic accuracy, initial therapeutic efficacy, and clinical impact across diverse cancer types, as well as the synthesis of novel FAP-targeted ligands. This review aims to showcase the promising outcomes and challenges in integrating FAP-targeted approaches into cancer management.</span></span></span></span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}