Pub Date : 2024-07-01DOI: 10.1053/j.semnuclmed.2024.02.002
Peptide receptor radionuclide therapy (PRRT) today is a well-established treatment strategy for patients with neuroendocrine tumors (NET). First performed already more than 30 years ago, PRRT was incorporated only in recent years into the major oncology guidelines, based on its proven efficacy and safety in clinical trials. Following the phase 3 NETTER-1 trial, which led to the final registration of the radiopharmaceutical Luthatera® for G1/G2 NET patients in 2017, the long-term results of the phase 3 NETTER-2 trial may pave the way for a new treatment option also for advanced G2/G3 patients as first-line therapy. The growing knowledge about the synergistic effect of combined therapies could also allow alternative (re)treatment options for NET patients, in order to create a tailored treatment strategy. The evolving thera(g)nostic concept could be applied for the identification of patients who might benefit from different image-guided treatment strategies. In this scenario, the use of dual tracer PET/CT in NET patients, using both [18F]F-FDG/[68Ga]Ga-DOTA-somatostatin analog (SSA) for diagnosis and follow-up, is under discussion and could also result in a powerful prognostic tool. In addition, alternative strategies based on different metabolic pathways, radioisotopes, or combinations of different medical approaches could be applied. A number of different promising “doors” could thus open in the near future for the treatment of NET patients - and the “key” will be thera(g)nostic!
{"title":"Peptide Receptor Radionuclide Therapy of Neuroendocrine Tumors: Agonist, Antagonist and Alternatives","authors":"","doi":"10.1053/j.semnuclmed.2024.02.002","DOIUrl":"10.1053/j.semnuclmed.2024.02.002","url":null,"abstract":"<div><p>Peptide receptor radionuclide therapy (PRRT) today is a well-established treatment strategy for patients with neuroendocrine tumors (NET). First performed already more than 30 years ago, PRRT was incorporated only in recent years into the major oncology guidelines, based on its proven efficacy and safety in clinical trials. Following the phase 3 NETTER-1 trial, which led to the final registration of the radiopharmaceutical Luthatera® for G1/G2 NET patients in 2017, the long-term results of the phase 3 NETTER-2 trial may pave the way for a new treatment option also for advanced G2/G3 patients as first-line therapy. The growing knowledge about the synergistic effect of combined therapies could also allow alternative (re)treatment options for NET patients, in order to create a tailored treatment strategy. The evolving thera(g)nostic concept could be applied for the identification of patients who might benefit from different image-guided treatment strategies. In this scenario, the use of dual tracer PET/CT in NET patients, using both [<sup>18</sup>F]F-FDG/[<sup>68</sup>Ga]Ga-DOTA-somatostatin analog (SSA) for diagnosis and follow-up, is under discussion and could also result in a powerful prognostic tool. In addition, alternative strategies based on different metabolic pathways, radioisotopes, or combinations of different medical approaches could be applied. A number of different promising “doors” could thus open in the near future for the treatment of NET patients - and the “key” will be thera(g)nostic!</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/S0001299824000138/pdfft?md5=cbcf6b2a09edd61f40e40eec9199f61a&pid=1-s2.0-S0001299824000138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137269","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 : 2024-06-28DOI: 10.1053/j.semnuclmed.2024.05.009
Sanaz Katal, Parth Patel, Jonathan Lee, Kim Taubman, Ali Gholamrezanezhad
Recent advancements in PET technology have culminated in the development of total-body PET (TB-PET) systems, which overcome many limitations of traditional scanners. These TB-PET scanners, while still becoming widely available, represent the forefront of clinical imaging across numerous medical institutions worldwide. Early clinical applications have demonstrated their enhanced image quality, precise lesion quantification, and overall superior performance relative to conventional scanners. The capabilities of TB-PET technology, including extended scan range, ultrahigh sensitivity, exceptional temporal resolution, and dynamic imaging, offer significant potential to tackle unresolved clinical challenges in medical imaging. In this discussion, we aim to explore the emerging applications, opportunities, and future perspectives of TB-PET/CT in musculoskeletal disorders (MSDs). Clinical applications for both oncologic and non-oncologic musculoskeletal diseases are discussed, including inflammatory arthritis, infections, osteoarthritis, osteoporosis, and skeletal muscle disorders. From the ability to visualize small musculoskeletal structures and the entire axial and appendicular skeleton, TB-PET shows significant potential in the diagnosis and management of MSD conditions as it becomes more widely available.
{"title":"Total Body PET/CT: A Role in Musculoskeletal Diseases.","authors":"Sanaz Katal, Parth Patel, Jonathan Lee, Kim Taubman, Ali Gholamrezanezhad","doi":"10.1053/j.semnuclmed.2024.05.009","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.05.009","url":null,"abstract":"<p><p>Recent advancements in PET technology have culminated in the development of total-body PET (TB-PET) systems, which overcome many limitations of traditional scanners. These TB-PET scanners, while still becoming widely available, represent the forefront of clinical imaging across numerous medical institutions worldwide. Early clinical applications have demonstrated their enhanced image quality, precise lesion quantification, and overall superior performance relative to conventional scanners. The capabilities of TB-PET technology, including extended scan range, ultrahigh sensitivity, exceptional temporal resolution, and dynamic imaging, offer significant potential to tackle unresolved clinical challenges in medical imaging. In this discussion, we aim to explore the emerging applications, opportunities, and future perspectives of TB-PET/CT in musculoskeletal disorders (MSDs). Clinical applications for both oncologic and non-oncologic musculoskeletal diseases are discussed, including inflammatory arthritis, infections, osteoarthritis, osteoporosis, and skeletal muscle disorders. From the ability to visualize small musculoskeletal structures and the entire axial and appendicular skeleton, TB-PET shows significant potential in the diagnosis and management of MSD conditions as it becomes more widely available.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470547","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 : 2024-06-20DOI: 10.1053/j.semnuclmed.2024.05.003
Andrew Dullea, Lydia O'Sullivan, Kirsty K O'Brien, Marie Carrigan, Susan Ahern, Maeve McGarry, Patricia Harrington, Kieran A Walsh, Susan M Smith, Máirín Ryan
The aim of this overview was to consolidate existing evidence syntheses and provide a comprehensive overview of the evidence for 18F-prostate specific membrane antigen (PSMA) PET/CT in the staging of high-risk prostate cancer and restaging after biochemical recurrence. An overview of reviews was performed and reported in line with the preferred reporting items for overview of reviews (PRIOR) statement and synthesis without meta-analysis (SWiM) reporting guidelines. A comprehensive database and grey literature search were conducted up to July 18, 2023. Systematic reviews were assessed using the risk of bias in systematic reviews (ROBIS) tool. The certainty of the evidence was assessed using grading of recommendations, assessment, development and evaluations (GRADE). 11 systematic reviews were identified; 10 were at high or unclear risk of bias. Evidence reported on a per-patient, per-lymph node, and per-lesion basis for sensitivity, specificity and overall accuracy was identified. There was a lack of data on dose, adverse events and evidence directly comparing 18F-PSMA PET/CT to other imaging modalities. Evidence with moderate to very low certainty indicated high sensitivity, specificity and accuracy of 18F-PSMA PET/CT in patients with high-risk prostate cancer and biochemical recurrence. There was considerably lower certainty evidence and greater variability in effect estimates for outcomes for the combined intermediate/high-risk cohort. While evidence gaps remain for some outcomes, and most systematic reviews were at high or unclear risk of bias, the current evidence base is broadly supportive of 18F-PSMA PET/CT imaging in the staging and restaging of patients with high-risk prostate cancer and biochemical recurrence.
{"title":"Diagnostic Accuracy of <sup>18</sup>F-Prostate Specific Membrane Antigen (PSMA) PET/CT Radiotracers in Staging and Restaging of Patients With High-Risk Prostate Cancer or Biochemical Recurrence: An Overview of Reviews.","authors":"Andrew Dullea, Lydia O'Sullivan, Kirsty K O'Brien, Marie Carrigan, Susan Ahern, Maeve McGarry, Patricia Harrington, Kieran A Walsh, Susan M Smith, Máirín Ryan","doi":"10.1053/j.semnuclmed.2024.05.003","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.05.003","url":null,"abstract":"<p><p>The aim of this overview was to consolidate existing evidence syntheses and provide a comprehensive overview of the evidence for <sup>18</sup>F-prostate specific membrane antigen (PSMA) PET/CT in the staging of high-risk prostate cancer and restaging after biochemical recurrence. An overview of reviews was performed and reported in line with the preferred reporting items for overview of reviews (PRIOR) statement and synthesis without meta-analysis (SWiM) reporting guidelines. A comprehensive database and grey literature search were conducted up to July 18, 2023. Systematic reviews were assessed using the risk of bias in systematic reviews (ROBIS) tool. The certainty of the evidence was assessed using grading of recommendations, assessment, development and evaluations (GRADE). 11 systematic reviews were identified; 10 were at high or unclear risk of bias. Evidence reported on a per-patient, per-lymph node, and per-lesion basis for sensitivity, specificity and overall accuracy was identified. There was a lack of data on dose, adverse events and evidence directly comparing <sup>18</sup>F-PSMA PET/CT to other imaging modalities. Evidence with moderate to very low certainty indicated high sensitivity, specificity and accuracy of <sup>18</sup>F-PSMA PET/CT in patients with high-risk prostate cancer and biochemical recurrence. There was considerably lower certainty evidence and greater variability in effect estimates for outcomes for the combined intermediate/high-risk cohort. While evidence gaps remain for some outcomes, and most systematic reviews were at high or unclear risk of bias, the current evidence base is broadly supportive of <sup>18</sup>F-PSMA PET/CT imaging in the staging and restaging of patients with high-risk prostate cancer and biochemical recurrence.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437431","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 : 2024-06-08DOI: 10.1053/j.semnuclmed.2024.05.007
Positron emission tomography/magnetic resonance (PET/MRI) hybrid imaging is now available for over a decade and although the quantity of installed systems is rather low, the number of emerging applications for cardiovascular diseases is still growing. PET/MRI provides integrated images of high quality anatomical and functional assessment obtained by MRI with the possibilities of PET for quantification of molecular parameters such as metabolism, inflammation, and perfusion. In recent years, sequential co-registration of myocardial tissue characterization with its molecular data had become an increasingly helpful tool in clinical practice and an integrated device simplifies this task. This review summarizes recent developments and future possibilities in the use of the PET/MRI in the diagnosis and treatment of cardiovascular disorders.
{"title":"Cardiac PET/MRI: Recent Developments and Future Aspects","authors":"","doi":"10.1053/j.semnuclmed.2024.05.007","DOIUrl":"10.1053/j.semnuclmed.2024.05.007","url":null,"abstract":"<div><p>Positron emission tomography/magnetic resonance (PET/MRI) hybrid imaging is now available for over a decade and although the quantity of installed systems is rather low, the number of emerging applications for cardiovascular diseases is still growing. PET/MRI provides integrated images of high quality anatomical and functional assessment obtained by MRI with the possibilities of PET for quantification of molecular parameters such as metabolism, inflammation, and perfusion. In recent years, sequential co-registration of myocardial tissue characterization with its molecular data had become an increasingly helpful tool in clinical practice and an integrated device simplifies this task. This review summarizes recent developments and future possibilities in the use of the PET/MRI in the diagnosis and treatment of cardiovascular disorders.</p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0001299824000485/pdfft?md5=79d15b14d56bad653566c550449cf8bc&pid=1-s2.0-S0001299824000485-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296645","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}
Recently developed long axial field of view (LAFOV) PET-CT scanners, including total body scanners, are already in use in a few centers worldwide. These systems have some major advantages over standard axial field of view (SAFOV) PET-CT scanners, mainly due to up to 20 times higher sensitivity and therefore improved lesion detectability. Other advantages are the reduction of the PET acquisition time for a static whole-body measurement, the reduction of the administered radiotracer dose, and the ability to perform delayed scans with good image quality, which is important for imaging radionuclides with long half-lives and pharmaceuticals with long biodistribution times, such as 89Zr-labeled antibodies. The reduction of the applied tracer dose leads to less radiation exposure and may facilitate longitudinal studies, especially in oncological patients, for the evaluation of therapy. The reduction in acquisition time for a static whole body (WB) study allows a markedly higher patient throughput. Furthermore, LAFOV PET-CT scanners enable for the first-time WB dynamic PET scanning and WB parametric imaging with an improved image quality due to increased sensitivity and time resolution. WB tracer kinetics is of particular interest for the characterization of novel radiopharmaceuticals and for a better biological characterization of cancer diseases, as well as for a more accurate assessment of the response to new targeted therapies. Further technological developments based on artificial intelligence (AI) approaches are underway and may in the future allow CT-less attenuation correction or ultralow dose CT for attenuation correction as well as segmentation algorithms for the evaluation of total metabolic tumor volume. The aim of this review is to present dedicated PET acquisition protocols for oncological studies with LAFOV scanners, including static and dynamic acquisition as well as parametric scans, and to present literature data to date on this topic.
{"title":"Total Body PET-CT Protocols in Oncology.","authors":"Antonia Dimitrakopoulou-Strauss, Leyun Pan, Christos Sachpekidis","doi":"10.1053/j.semnuclmed.2024.05.008","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.05.008","url":null,"abstract":"<p><p>Recently developed long axial field of view (LAFOV) PET-CT scanners, including total body scanners, are already in use in a few centers worldwide. These systems have some major advantages over standard axial field of view (SAFOV) PET-CT scanners, mainly due to up to 20 times higher sensitivity and therefore improved lesion detectability. Other advantages are the reduction of the PET acquisition time for a static whole-body measurement, the reduction of the administered radiotracer dose, and the ability to perform delayed scans with good image quality, which is important for imaging radionuclides with long half-lives and pharmaceuticals with long biodistribution times, such as <sup>89</sup>Zr-labeled antibodies. The reduction of the applied tracer dose leads to less radiation exposure and may facilitate longitudinal studies, especially in oncological patients, for the evaluation of therapy. The reduction in acquisition time for a static whole body (WB) study allows a markedly higher patient throughput. Furthermore, LAFOV PET-CT scanners enable for the first-time WB dynamic PET scanning and WB parametric imaging with an improved image quality due to increased sensitivity and time resolution. WB tracer kinetics is of particular interest for the characterization of novel radiopharmaceuticals and for a better biological characterization of cancer diseases, as well as for a more accurate assessment of the response to new targeted therapies. Further technological developments based on artificial intelligence (AI) approaches are underway and may in the future allow CT-less attenuation correction or ultralow dose CT for attenuation correction as well as segmentation algorithms for the evaluation of total metabolic tumor volume. The aim of this review is to present dedicated PET acquisition protocols for oncological studies with LAFOV scanners, including static and dynamic acquisition as well as parametric scans, and to present literature data to date on this topic.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293684","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 : 2024-06-07DOI: 10.1053/j.semnuclmed.2024.05.005
Geoffrey M Currie, K Elizabeth Hawk, Eric M Rohren
Generative artificial intelligence (AI) algorithms for both text-to-text and text-to-image applications have seen rapid and widespread adoption in the general and medical communities. While limitations of generative AI have been widely reported, there remain valuable applications in patient and professional communities. Here, the limitations and biases of both text-to-text and text-to-image generative AI are explored using purported applications in medical imaging as case examples. A direct comparison of the capabilities of four common text-to-image generative AI algorithms is reported and recommendations for the most appropriate use, DALL-E 3, justified. The risks use and biases are outlined, and appropriate use guidelines framed for use of generative AI in nuclear medicine. Generative AI text-to-text and text-to-image generation includes inherent biases, particularly gender and ethnicity, that could misrepresent nuclear medicine. The assimilation of generative AI tools into medical education, image interpretation, patient education, health promotion and marketing in nuclear medicine risks propagating errors and amplification of biases. Mitigation strategies should reside inside appropriate use criteria and minimum standards for quality and professionalism for the application of generative AI in nuclear medicine.
{"title":"Generative Artificial Intelligence Biases, Limitations and Risks in Nuclear Medicine: An Argument for Appropriate Use Framework and Recommendations.","authors":"Geoffrey M Currie, K Elizabeth Hawk, Eric M Rohren","doi":"10.1053/j.semnuclmed.2024.05.005","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.05.005","url":null,"abstract":"<p><p>Generative artificial intelligence (AI) algorithms for both text-to-text and text-to-image applications have seen rapid and widespread adoption in the general and medical communities. While limitations of generative AI have been widely reported, there remain valuable applications in patient and professional communities. Here, the limitations and biases of both text-to-text and text-to-image generative AI are explored using purported applications in medical imaging as case examples. A direct comparison of the capabilities of four common text-to-image generative AI algorithms is reported and recommendations for the most appropriate use, DALL-E 3, justified. The risks use and biases are outlined, and appropriate use guidelines framed for use of generative AI in nuclear medicine. Generative AI text-to-text and text-to-image generation includes inherent biases, particularly gender and ethnicity, that could misrepresent nuclear medicine. The assimilation of generative AI tools into medical education, image interpretation, patient education, health promotion and marketing in nuclear medicine risks propagating errors and amplification of biases. Mitigation strategies should reside inside appropriate use criteria and minimum standards for quality and professionalism for the application of generative AI in nuclear medicine.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293683","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}
PSMA-targeted PET/CT is currently considered the most effective non-invasive diagnostic technique for imaging PSMA-positive lesions in prostate cancer (PC), and its introduction has significantly enhanced the role of nuclear medicine in both the diagnosis and therapy (theranostics) of this oncological entity. In line with developments in radiopharmaceuticals, significant progress has been made in the development of PET/CT systems. In particular, the advent of long axial field-of-view (LAFOV) PET/CT scanners has represented a major leap forward in molecular imaging, with early results from clinical applications of these systems showing significant improvements over previous standard axial field-of-view systems in terms of sensitivity, image quality and lesion quantification, while enabling whole-body dynamic PET imaging. In this context, the introduction of the new LAFOV scanners may further enhance the use and potential of PSMA-ligand PET/CT in the diagnosis and management of PC. The initial but steadily growing literature on the application of the new technology in the field of PSMA-ligand PET/CT has already yielded encouraging results regarding the detection of PC lesions with high sensitivity while providing the possibility of ultra-fast or ultra-low dose examinations. Moreover, whole-body dynamic PET has rendered for the first time feasible to capture the pharmacokinetics PSMA-ligands in all major organs and most tumor lesions with high temporal resolution. The main results of these studies are presented in this review.
目前,PSMA 靶向 PET/CT 被认为是对前列腺癌(PC)中 PSMA 阳性病灶进行成像的最有效的非侵入性诊断技术,它的问世大大加强了核医学在这种肿瘤的诊断和治疗(治疗学)中的作用。随着放射性药物的发展,PET/CT 系统的开发也取得了重大进展。特别是长轴视场 PET/CT 扫描仪的出现代表了分子成像技术的重大飞跃,这些系统的早期临床应用结果表明,与以前的标准轴视场系统相比,在灵敏度、图像质量和病变定量方面都有显著改善,同时实现了全身动态 PET 成像。在这种情况下,新型 LAFOV 扫描仪的推出可能会进一步提高 PSMA 配体 PET/CT 在 PC 诊断和治疗中的应用和潜力。在 PSMA 配体 PET/CT 领域应用新技术的初期文献虽然不多,但却在稳步增加,在高灵敏度检测 PC 病灶方面取得了令人鼓舞的成果,同时还提供了超快速或超低剂量检查的可能性。此外,全身动态 PET 首次实现了以高时间分辨率捕捉所有主要器官和大多数肿瘤病灶中 PSMA 配体的药代动力学。本综述介绍了这些研究的主要结果。
{"title":"Long Axial Field-of-View (LAFOV) PET/CT in Prostate Cancer.","authors":"Christos Sachpekidis, Antonia Dimitrakopoulou-Strauss","doi":"10.1053/j.semnuclmed.2024.05.004","DOIUrl":"https://doi.org/10.1053/j.semnuclmed.2024.05.004","url":null,"abstract":"<p><p>PSMA-targeted PET/CT is currently considered the most effective non-invasive diagnostic technique for imaging PSMA-positive lesions in prostate cancer (PC), and its introduction has significantly enhanced the role of nuclear medicine in both the diagnosis and therapy (theranostics) of this oncological entity. In line with developments in radiopharmaceuticals, significant progress has been made in the development of PET/CT systems. In particular, the advent of long axial field-of-view (LAFOV) PET/CT scanners has represented a major leap forward in molecular imaging, with early results from clinical applications of these systems showing significant improvements over previous standard axial field-of-view systems in terms of sensitivity, image quality and lesion quantification, while enabling whole-body dynamic PET imaging. In this context, the introduction of the new LAFOV scanners may further enhance the use and potential of PSMA-ligand PET/CT in the diagnosis and management of PC. The initial but steadily growing literature on the application of the new technology in the field of PSMA-ligand PET/CT has already yielded encouraging results regarding the detection of PC lesions with high sensitivity while providing the possibility of ultra-fast or ultra-low dose examinations. Moreover, whole-body dynamic PET has rendered for the first time feasible to capture the pharmacokinetics PSMA-ligands in all major organs and most tumor lesions with high temporal resolution. The main results of these studies are presented in this review.</p>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200149","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}
Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and 18F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. 18F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as 111In-Biotin, 99mTc-Ubiquicidin, 18F-Na-Fluoride, 18F-labeled white blood cells and 124I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.
骨骼和关节的感染,如果误诊,可能会导致严重的发病率甚至死亡。及时诊断和适当处理可以减少骨和关节感染的社会经济影响。形态学成像如超声和x线平片是一线检查,然而,早期感染的发现可能是阴性或非特异性的。核医学成像技术在骨和关节感染的诊断中与形态学成像具有互补作用。混合系统(SPECT/CT, SPECT/MRI, PET/CT或PET/MRI)的可用性提高了评估感染程度的特异性。骨扫描作为一个看门人是有用的,其中阴性扫描以良好的准确性排除败血症,然而阳性扫描是非诊断性的,应该考虑更具体的示踪剂。这些包括使用标记白细胞和抗粒细胞抗体。已经提出了各种定性和定量解释标准,以提高扫描的特异性。PET具有更好的图像分辨率,18F-FDG是PET成像的主要示踪剂,在肿瘤学和炎症/感染性疾病中有应用。与基于SPECT的示踪剂相比,它已经证明了更高的灵敏度,然而,它仍然缺乏特异性。18F-FDG PET已被用于监测骨和关节感染的治疗。其他研究较少、未商业化的SPECT和PET示踪剂,如111in -生物素、99mtc -泛素、18f - na -氟化物、18f标记的白细胞和124I-Fialuridine等,已显示出很大的前景,然而,它们在各种骨骼和关节感染中的作用尚未确定。PET或PET/MRI混合成像为改善关节和骨骼感染的诊断提供了巨大的潜力。
{"title":"PET/CT and SPECT/CT for Infection in Joints and Bones: An Overview and Future Directions","authors":"Kgomotso M.G. Mokoala MD, PhD , Honest Ndlovu MD , Ismaheel Lawal MD, PhD , Mike Machaba Sathekge MD, PhD","doi":"10.1053/j.semnuclmed.2023.10.007","DOIUrl":"10.1053/j.semnuclmed.2023.10.007","url":null,"abstract":"<div><p>Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and <sup>18</sup>F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. <sup>18</sup>F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as <sup>111</sup>In-Biotin, <sup>99m</sup>Tc-Ubiquicidin, <sup>18</sup>F-Na-Fluoride, <sup>18</sup>F-labeled white blood cells and <sup>124</sup>I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.</p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0001299823000879/pdfft?md5=000269a7f09b331b3498085f8cb0657e&pid=1-s2.0-S0001299823000879-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452392","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 : 2024-05-01DOI: 10.1053/j.semnuclmed.2023.10.003
Olivier Gheysens MD, PhD , Marie Péan de Ponfilly MD, PhD , Gaetane Nocturne MD, PhD , Raphaële Seror MD, PhD , Florent L. Besson MD, PhD , François Jamar MD, PhD
Polymyalgia rheumatica (PMR) is an inflammatory disorder usually diagnosed in patients older than 50 years of age. It is characterized by sudden onset pain and prolonged morning stiffness in the scapular and/or pelvic girdle, sometimes debilitating and accompanied by constitutional symptoms such as weight loss. In approximately 20% of the cases, it is linked to giant cell arteritis (GCAV) representing a disease continuum. The diagnosis is mainly clinical and noninvasive imaging such as ultrasound of joints may be helpful. In atypical PMR cases, whole body imaging using [18F]FDG-PET/CT may be useful. First, to confirm or rule out the diagnosis of PMR, secondly, to assess the coexistence of a GCA, and thirdly to establish the differential diagnosis with other types of arthritides encountered in this age group, such as elderly-onset rheumatoid arthritis, spondyloarthropathies, crystal-induced arthropathies or the rare remittent seronegative symmetrical synovitis with pitting edema. Relatively typical patterns of [18F]FDG-PET/CT are well known, based on the clinical distribution of the disease (eg, scapular and pelvic girdle, interspinous bursae, sterno-costoclavicular joints, entheses), especially the hypermetabolism at the interspinous lumbar bursae that has shown the best post-test likelihood ratio in a meta-analysis. This article focuses on the differential diagnosis and on the visual and semi-quantitative tools that can be used to guide to the correct diagnosis of PMR as an add-on to the clinical picture. Further, we briefly discuss the options that can improve molecular imaging in the future for inflammatory rheumatisms in elderly.
{"title":"[18F]FDG-PET/CT in Polymyalgia Rheumatica: An Update and Future Aspects","authors":"Olivier Gheysens MD, PhD , Marie Péan de Ponfilly MD, PhD , Gaetane Nocturne MD, PhD , Raphaële Seror MD, PhD , Florent L. Besson MD, PhD , François Jamar MD, PhD","doi":"10.1053/j.semnuclmed.2023.10.003","DOIUrl":"10.1053/j.semnuclmed.2023.10.003","url":null,"abstract":"<div><p><span><span><span><span>Polymyalgia rheumatica<span> (PMR) is an inflammatory disorder usually diagnosed </span></span>in patients older than 50 years of age. It is characterized by sudden onset pain and prolonged </span>morning stiffness in the scapular and/or </span>pelvic girdle<span>, sometimes debilitating and accompanied by constitutional symptoms<span> such as weight loss. In approximately 20% of the cases, it is linked to giant cell arteritis<span> (GCAV) representing a disease continuum. The diagnosis is mainly clinical and noninvasive imaging such as ultrasound of joints may be helpful. In atypical PMR cases, whole body imaging using [</span></span></span></span><sup>18</sup><span><span>F]FDG-PET/CT may be useful. First, to confirm or rule out the diagnosis of PMR, secondly, to assess the coexistence of a GCA, and thirdly to establish the differential diagnosis with other types of arthritides encountered in this age group, such as elderly-onset rheumatoid arthritis<span>, spondyloarthropathies, crystal-induced </span></span>arthropathies<span> or the rare remittent seronegative symmetrical synovitis with pitting edema. Relatively typical patterns of [</span></span><sup>18</sup><span><span>F]FDG-PET/CT are well known, based on the clinical distribution of the disease (eg, scapular and pelvic girdle, interspinous bursae, sterno-costoclavicular joints, entheses), especially the hypermetabolism at the interspinous lumbar bursae that has shown the best post-test likelihood ratio in a meta-analysis. This article focuses on the differential diagnosis and on the visual and semi-quantitative tools that can be used to guide to the correct diagnosis of PMR as an add-on to the clinical picture. Further, we briefly discuss the options that can improve </span>molecular imaging<span> in the future for inflammatory rheumatisms in elderly.</span></span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462514","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}
Spondylodiscitis, characterized by inflammation of the intervertebral disc and adjacent vertebral bodies, presents a diagnostic challenge due to its nonspecific clinical manifestations and variable imaging findings.
This review examines the role of PET-CT with FDG, in the evaluation of spondylodiscitis, focusing on its utility in diagnosis, assessment of disease extent, treatment response monitoring, and prognostication.
FDG PET-CT, by combining metabolic and anatomical imaging modalities, offers superior sensitivity and specificity compared to conventional imaging techniques in detecting infectious foci, distinguishing between infection and post-treatment changes, and identifying occult sources of infection. Additionally, FDG PET-CT facilitates the localization of infection, aiding in targeted biopsy and guiding surgical intervention. Moreover, quantitative PET parameters, such as standardized uptake values (SUVs), hold promise for predicting treatment response and prognosis. Despite its advantages, FDG PET-CT has limitations, including false-positive results in the setting of inflammation and limited availability in resource-constrained settings.
Collaborative efforts between radiologists, nuclear medicine specialists, infectious disease specialists, and spine surgeons are essential to optimize the role of FDG PET-CT in the multidisciplinary management of spondylodiscitis. Further research is warranted to elucidate the cost-effectiveness and clinical impact of FDG PET-CT in this challenging clinical entity.
{"title":"The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) in the Diagnosis and Evaluation of Spondylodiscitis","authors":"Diana Paez MD , Francesco Giammarile MD , Anita Brink MD , Osvaldo García-Pérez MD , Enrique Estrada-Lobato MD, MSc","doi":"10.1053/j.semnuclmed.2024.04.001","DOIUrl":"10.1053/j.semnuclmed.2024.04.001","url":null,"abstract":"<div><p>Spondylodiscitis, characterized by inflammation of the intervertebral disc and adjacent vertebral bodies, presents a diagnostic challenge due to its nonspecific clinical manifestations and variable imaging findings.</p><p>This review examines the role of PET-CT with FDG, in the evaluation of spondylodiscitis, focusing on its utility in diagnosis, assessment of disease extent, treatment response monitoring, and prognostication.</p><p>FDG PET-CT, by combining metabolic and anatomical imaging modalities, offers superior sensitivity and specificity compared to conventional imaging techniques in detecting infectious foci, distinguishing between infection and post-treatment changes, and identifying occult sources of infection. Additionally, FDG PET-CT facilitates the localization of infection, aiding in targeted biopsy and guiding surgical intervention. Moreover, quantitative PET parameters, such as standardized uptake values (SUVs), hold promise for predicting treatment response and prognosis. Despite its advantages, FDG PET-CT has limitations, including false-positive results in the setting of inflammation and limited availability in resource-constrained settings.</p><p>Collaborative efforts between radiologists, nuclear medicine specialists, infectious disease specialists, and spine surgeons are essential to optimize the role of FDG PET-CT in the multidisciplinary management of spondylodiscitis. Further research is warranted to elucidate the cost-effectiveness and clinical impact of FDG PET-CT in this challenging clinical entity.</p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857680","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}