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PET Imaging in Psychiatric Disorders 精神疾病的PET成像。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.06.004
Rodolfo Ferrando , Daniel Hernandes , Bruno Galafassi Ghini , Artur Martins Coutinho
<div><div>Positron emission tomography (PET) has emerged as a pivotal imaging modality in the investigation of psychiatric disorders, enabling in vivo assessment of regional cerebral metabolism, neurotransmitter dynamics, receptor binding, synaptic density, and neuroinflammation. This comprehensive review synthesizes current evidence on the utility of PET imaging in elucidating the pathophysiology of major psychiatric conditions—including schizophrenia, mood disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, and addiction and its potential in clinical decision-making. <sup>18</sup>F-FDG-PET has consistently demonstrated regional metabolic abnormalities, most notably prefrontal hypometabolism in schizophrenia and major depressive disorder, with implications for negative symptomatology, cognitive dysfunction, and treatment resistance. Functional FDG-PET (fPET) has recently enabled dynamic metabolic mapping with high temporal resolution, allowing the evaluation of stimulus-induced changes in neuronal activity. Receptor-specific PET tracers have provided further insights into dopaminergic, serotonergic, glutamatergic, and GABAergic dysregulation across psychiatric spectra. Notably, schizophrenia is associated with a increased striatal dopamine (DA) synthesis capacity and DA release, and disrupted frontolimbic connectivity, while depression shows reduced serotonergic transporter binding and lower mGluR5 availability, supporting neurotransmitter system-based subtyping. PET imaging has also revealed neuroinflammatory signatures, such as altered TSPO binding, as well as synaptic density reductions via SV2A tracers in early psychosis, emphasizing shared neurobiological underpinnings and disease progression markers. In pediatric and neurodevelopmental disorders, including ASD, PET and multimodal approaches have contributed to identifying heterogeneous neurochemical phenotypes, linking abnormal glucose metabolism and receptor availability to specific behavioral domains. Clinically, PET imaging aids in the differential diagnosis of primary psychiatric disorders from neurodegenerative conditions, including behavioral variant frontotemporal dementia (bvFTD), by detecting disease-specific metabolic patterns and supporting biomarker-informed diagnostics. Furthermore, PET has been employed to predict and monitor treatment response across pharmacological and neuromodulatory interventions, including antidepressants, electroconvulsive therapy (ECT), and cognitive behavioral therapy (CBT), enabling strides toward personalized psychiatric care. Despite its promise, widespread clinical integration of PET in psychiatry remains limited by high cost, accessibility barriers, and the need for standardized acquisition and interpretation protocols. Ongoing advancements in radiopharmaceutical development, artificial intelligence, and normative imaging databases are expected to facilitate the incorporation of PET into routine psychiatric assessment a
正电子发射断层扫描(PET)已成为研究精神疾病的关键成像方式,能够在体内评估区域脑代谢、神经递质动力学、受体结合、突触密度和神经炎症。这篇全面的综述综合了PET成像在阐明主要精神疾病的病理生理学方面的现有证据,包括精神分裂症、情绪障碍、自闭症谱系障碍、注意力缺陷/多动障碍、成瘾及其在临床决策中的潜力。18F-FDG-PET一直显示出区域代谢异常,最明显的是精神分裂症和重度抑郁症的前额叶代谢低下,与阴性症状、认知功能障碍和治疗抵抗有关。功能性FDG-PET (fPET)最近实现了高时间分辨率的动态代谢映射,可以评估刺激诱导的神经元活动变化。受体特异性PET示踪剂提供了进一步了解多巴胺能、血清素能、谷氨酸能和gaba能在精神光谱中的失调。值得注意的是,精神分裂症与纹状体多巴胺(DA)合成能力和释放能力增加以及额叶连通性中断有关,而抑郁症则表现出血清素能转运体结合减少和mGluR5可用性降低,支持基于神经递质系统的亚型。PET成像也揭示了神经炎症特征,如TSPO结合改变,以及通过SV2A示踪剂在早期精神病中突触密度降低,强调了共同的神经生物学基础和疾病进展标志物。在儿童和神经发育障碍中,包括ASD, PET和多模式方法有助于识别异质神经化学表型,将异常的糖代谢和受体可用性与特定的行为领域联系起来。临床上,PET成像通过检测疾病特异性代谢模式和支持生物标志物诊断,有助于神经退行性疾病(包括行为变异性额颞叶痴呆(bvFTD))的原发性精神疾病的鉴别诊断。此外,PET已被用于预测和监测药理学和神经调节干预的治疗反应,包括抗抑郁药、电痉挛疗法(ECT)和认知行为疗法(CBT),使个性化精神病学护理取得了长足的进步。尽管PET很有前景,但由于高昂的成本、可获得性障碍以及对标准化获取和解释协议的需求,它在精神病学中的广泛临床整合仍然受到限制。放射药物开发、人工智能和规范成像数据库的持续进步有望促进PET纳入常规精神病学评估和治疗计划。这篇综述强调了PET在精确精神病学中的变革性作用,并倡导其扩大研究和临床应用。
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引用次数: 0
PET/CT in the Imaging of CNS Tumors PET/CT在中枢神经系统肿瘤成像中的应用。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.04.002
Katarzyna Barańska , Katarzyna Niemas , Kacper Pełka , Jolanta Kunikowska
Central nervous system (CNS) tumors are quite rare but cause significant morbidity and mortality. Positron Emission Tomography (PET) is a widely utilized imaging modality within the field of nuclear medicine. CNS tumor diagnostics are an essential tool in the diagnosis and treatment of patients with glioma, offering valuable insights into tumor characteristics, treatment response and outcomes. A variety of different tracers are used in PET imaging of brain tumors including 18F-labeled fluorodeoxyglucose ([18F]FDG), markers showing amino acid metabolism, angiogenesis or inflammatory processes. In this article we describe possibility of use different tracers in different clinical scenario of CNS tumors.
中枢神经系统(CNS)肿瘤非常罕见,但发病率和死亡率很高。正电子发射断层扫描(PET)是核医学领域中广泛应用的成像方式。中枢神经系统肿瘤诊断是胶质瘤患者诊断和治疗的重要工具,为肿瘤特征、治疗反应和结果提供了有价值的见解。多种不同的示踪剂用于脑肿瘤的PET成像,包括18F标记的氟脱氧葡萄糖([18F]FDG),显示氨基酸代谢,血管生成或炎症过程的标记物。在本文中,我们描述了在中枢神经系统肿瘤的不同临床情况下使用不同示踪剂的可能性。
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引用次数: 0
Current Developments on [18F]FDG PET/CT in Inflammatory Disorders of the Central Nervous System [18F]FDG PET/CT在中枢神经系统炎症性疾病中的研究进展
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.06.001
Gilles N. Stormezand , Janine Doorduin , Andor W.J.M. Glaudemans , Anouk van der Hoorn , Bauke M. De Jong
2-Deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) is widely used to study cerebral glucose metabolism and may be useful in several inflammatory disorders of the central nervous system. Emerging literature suggests that [18F]FDG may be more sensitive to detect abnormalities in auto-immune encephalitis (AIE) in comparison to MRI, especially in NDMA receptor encephalitis. Distinct patterns of regional abnormalities in AIE have been reported, depending on the auto-antibody involved. Predominant findings are hypermetabolism of the mediotemporal lobe and hypometabolism in parietal and occipital lobes. The possibility for whole body imaging in the setting of malignancy screening further strengthens the importance of [18F]FDG PET in AIE when associated with paraneoplastic syndromes. Other inflammatory conditions of the central nervous system where [18]FDG PET may facilitate diagnosis include neurosarcoidosis and potential neuropsychiatric manifestations of systemic lupus erythematodes. More recently, [18F]FDG PET has been used in patients to evaluate postacute sequelae of COVID-19, allowing assessment of specific neuronal impairments at the individual level and determination of time-dependent metabolic alterations.
2-脱氧-2-[18F]氟- d -葡萄糖正电子发射断层扫描(FDG-PET)被广泛用于研究脑葡萄糖代谢,并可能在中枢神经系统的几种炎症性疾病中有用。新出现的文献表明[18F]FDG可能比MRI更敏感地发现自身免疫性脑炎(AIE)的异常,特别是NDMA受体脑炎。据报道,AIE的不同区域异常模式取决于所涉及的自身抗体。主要表现为中颞叶代谢高,顶叶和枕叶代谢低。在恶性肿瘤筛查的背景下,全身显像的可能性进一步加强了[18F]FDG PET在与副肿瘤综合征相关的AIE中的重要性。[18]FDG PET可能有助于诊断中枢神经系统的其他炎症包括神经结节病和系统性红斑狼疮的潜在神经精神表现。最近,[18F]FDG PET已用于患者评估COVID-19急性后后遗症,可在个体水平上评估特异性神经元损伤并确定时间依赖性代谢改变。
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引用次数: 0
Artificial Intelligence Augmented Cerebral Nuclear Imaging 人工智能增强脑核成像。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.05.005
Geoffrey M. Currie , K. Elizabeth Hawk
Artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), has significant potential to advance the capabilities of nuclear neuroimaging. The current and emerging applications of ML and DL in the processing, analysis, enhancement and interpretation of SPECT and PET imaging are explored for brain imaging. Key developments include automated image segmentation, disease classification, and radiomic feature extraction, including lower dimensionality first and second order radiomics, higher dimensionality third order radiomics and more abstract fourth order deep radiomics. DL-based reconstruction, attenuation correction using pseudo-CT generation, and denoising of low-count studies have a role in enhancing image quality. AI has a role in sustainability through applications in radioligand design and preclinical imaging while federated learning addresses data security challenges to improve research and development in nuclear cerebral imaging. There is also potential for generative AI to transform the nuclear cerebral imaging space through solutions to data limitations, image enhancement, patient-centered care, workflow efficiencies and trainee education. Innovations in ML and DL are re-engineering the nuclear neuroimaging ecosystem and reimagining tomorrow’s precision medicine landscape.
人工智能(AI),特别是机器学习(ML)和深度学习(DL),在提高核神经成像能力方面具有巨大的潜力。探讨了当前和新兴的ML和DL在脑成像中SPECT和PET成像的处理、分析、增强和解释方面的应用。主要发展包括自动图像分割、疾病分类和放射学特征提取,包括低维一阶和二阶放射组学、高维三阶放射组学和更抽象的四阶深度放射组学。基于dl的重建、伪ct生成的衰减校正以及低计数研究的去噪都对提高图像质量有一定的作用。人工智能通过在放射配体设计和临床前成像中的应用在可持续性方面发挥作用,而联邦学习解决了数据安全挑战,以改善核脑成像的研究和开发。生成式人工智能也有潜力通过解决数据限制、图像增强、以患者为中心的护理、工作流程效率和培训生教育来改变核脑成像领域。机器学习和深度学习的创新正在重新设计核神经成像生态系统,并重新构想未来的精准医学前景。
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引用次数: 0
Update on Molecular Imaging in Epilepsy 癫痫分子影像学研究进展。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.05.007
Kowshik Vengadesan , Ankita Phulia , Rakesh Kumar
Epilepsy is one of the commonest neurological disorders worldwide. It is characterized by recurrent unprovoked seizures and has significant effects on one’s daily life. Though almost two thirds of patients with epilepsy respond well with one or more antiepileptic drugs, about 30% patients suffer with drug resistant epilepsy (DRE). Patients with focal variant of DRE, often have a focal pathology in brain and benefit vastly by removing or disconnecting the foci of origin of epileptiform waves from other parts of the cerebral cortex. While clinical examination, MRI and EEG are the first line investigations done in such patients before surgery, many a times they yield normal or discordant or multiple lesions of which only 1 or 2 are epileptogenic. It is in such cases; molecular imaging such as SPECT and PET helps in accurately demarcating the EZ for planning epilepsy surgery. The functional integrity of the rest of the brain can also be assessed by PET and SPECT, which may also offer valuable insights into the potential pathophysiology of the neurocognitive and behavioral impairments commonly seen in these patients. Epilepsy continues to be a common indication for perfusion SPECT as it is the only imaging method that can visualize the ictal onset zone in vivo. Interictal FDG PET/CT is a single investigation that can provide most information about EZ whereas SPECT has to be done twice—ictal and interictal. The evolution of advanced image analysis techniques like SISCOM, SISCOS, PISCOM and newer receptor-based PET tracers has further refined the localization of the seizure onset zone.
癫痫是世界上最常见的神经系统疾病之一。它的特点是反复发作的无端发作,对一个人的日常生活有重大影响。虽然近三分之二的癫痫患者对一种或多种抗癫痫药物反应良好,但约30%的患者患有耐药癫痫(DRE)。局灶性DRE变异型患者通常在大脑中有局灶性病理,通过从大脑皮层的其他部分切除或断开癫痫样波的起源灶,可以极大地获益。虽然临床检查,MRI和EEG是术前对这类患者进行的一线检查,但很多时候它们显示正常或不一致或多个病变,其中只有1或2个是癫痫性的。在这种情况下;分子成像如SPECT和PET有助于准确地划定EZ,以便计划癫痫手术。脑其他部分的功能完整性也可以通过PET和SPECT进行评估,这也可能为这些患者常见的神经认知和行为障碍的潜在病理生理学提供有价值的见解。癫痫仍然是灌注SPECT的一个常见适应症,因为它是唯一一种能够在体内可视化癫痫发作区的成像方法。间歇期FDG PET/CT是一次检查,可以提供关于EZ的大部分信息,而SPECT必须进行两次间歇期和间歇期。先进的图像分析技术,如SISCOM, SISCOS, PISCOM和新的基于受体的PET示踪剂的发展,进一步完善了癫痫发作区域的定位。
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引用次数: 0
18F-FDG PET for Dementia Evaluation: Co-pathologies, New Diseases, and Its Roles in the Era of Antiamyloid Treatment 18F-FDG PET用于痴呆评估:共病、新疾病及其在抗淀粉样蛋白治疗时代的作用。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.04.007
Tanyaluck Thientunyakit , Weerasak Muangpaisan , Satoshi Minoshima
Dementia, which impairs a person's cognition and ability in daily tasks and is often caused by neurodegenerative disorders, remains one of the most challenging neuropsychiatric conditions. The prevalence of dementia has been steadily increasing in aging societies. Recently, antiamyloid treatment has been developed and approved for the treatment of Alzheimer’s disease (AD), which is known as the major cause of dementia. Such therapeutic developments have accelerated the use of in vivo biomarkers in research, clinical trials, and clinical practice. Past and recent developments of several biomarkers, including 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), have played a pivotal role in understanding the underlying mechanisms of dementing disorders and accelerating progress in both research and clinical practice, leading to more accurate clinical diagnosis, recognition of co-pathologies, better understanding of new diseases, treatment planning, and response evaluation. This article reviews the roles of brain FDG PET, one of the well-established imaging biomarkers, as a valuable tool for studying brain metabolism and its applications in clinical and research settings, particularly for the treatment of dementia.
痴呆症会损害一个人的认知能力和日常工作能力,通常由神经退行性疾病引起,仍然是最具挑战性的神经精神疾病之一。在老龄化社会中,痴呆症的患病率一直在稳步上升。最近,抗淀粉样蛋白治疗已被开发并批准用于治疗阿尔茨海默病(AD),这是众所周知的痴呆症的主要原因。这样的治疗发展加速了体内生物标志物在研究、临床试验和临床实践中的应用。包括18f -氟脱氧葡萄糖(FDG)正电子发射断层扫描(PET)在内的几种生物标志物的过去和最近的发展,在了解痴呆疾病的潜在机制和加速研究和临床实践的进展方面发挥了关键作用,从而导致更准确的临床诊断,识别共同病理,更好地了解新疾病,治疗计划和反应评估。本文综述了脑FDG PET作为一种成熟的成像生物标志物,作为研究脑代谢的有价值工具及其在临床和研究环境中的应用,特别是在治疗痴呆症方面的应用。
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引用次数: 0
The Current Role of Tau PET Imaging in Neurodegeneration 目前Tau PET成像在神经变性中的作用。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.03.002
Greet Vanderlinden , Rik Vandenberghe , Mathieu Vandenbulcke , Koen Van Laere
Neurodegenerative tauopathies are characterized by the pathological hyperphosphorylation of tau proteins that subsequently form aggregates. Tau PET tracers with affinity to bind these pathological tau aggregates have been developed to measure disease progression and to support therapeutic drug development. In this review, we summarize the pathophysiology of tau throughout the range of neurodegenerative tauopathies. We outline the available first- and second-generation tau PET tracers, with a focus on new tau PET tracer developments, and discuss the quantification of tau PET images. Next, we summarize how tau PET relates to cerebrospinal fluid and plasma tau biomarkers. Finally, we review the current recommendations on the clinical use of tau PET versus fluid tau biomarkers in diagnosis, prognosis and treatment development.
神经退行性tau病的特点是病理过度磷酸化的tau蛋白,随后形成聚集体。Tau PET示踪剂具有结合这些病理性Tau聚集体的亲和力,已被开发用于测量疾病进展并支持治疗药物开发。在这篇综述中,我们总结了神经退行性tau病变的病理生理学。我们概述了可用的第一代和第二代tau PET示踪剂,重点介绍了新的tau PET示踪剂的发展,并讨论了tau PET图像的量化。接下来,我们总结了tau PET与脑脊液和血浆tau生物标志物的关系。最后,我们回顾了目前关于tau PET与液体tau生物标志物在诊断、预后和治疗发展方面的临床应用的建议。
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引用次数: 0
Neuroimaging of Mild Traumatic Injury 轻度外伤性损伤的神经影像学。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.06.002
Gabriela Capriotti , Alessia Guarnera , Andrea Romano , Giulia Moltoni , Giorgia Granese , Alessando Bozzao , Alberto Signore
Traumatic brain injury (TBI) is a global public health problem and is a leading cause of disability, morbidity and death in children and adults in USA It is characterised by alteration of neurological, behavioral and cognitive function as consequence of biomechanical insulte and possible progression to chronic encephalopathy. According to the CDC, approximately 75% of all reported TBIs are considered mild in form. Mild TBI is defined as individuals who had head trauma with subsequent mild deficit on the GCS and thu are frequently observed in military combat, athletes and motor vehicle accidents. Clinical assessment of mTBI is difficult and therefore different neuroimaging techniques have been used to characterized different stages of the disease. This article reviews the utility of imaging while focusing on the emerging applications of advanced MRI studies and PET in TBI.
创伤性脑损伤(TBI)是一个全球性的公共卫生问题,是美国儿童和成人致残、发病和死亡的主要原因,其特点是生物力学损伤导致神经、行为和认知功能改变,并可能发展为慢性脑病。根据疾病预防控制中心的数据,大约75%的报告的创伤性脑损伤在形式上被认为是轻微的。轻度创伤性脑损伤被定义为个体有头部创伤,随后GCS出现轻度缺陷,这种情况经常在军事战斗、运动员和机动车事故中观察到。mTBI的临床评估是困难的,因此不同的神经影像学技术已被用于表征疾病的不同阶段。本文回顾了成像的应用,同时重点介绍了先进的MRI研究和PET在TBI中的新应用。
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引用次数: 0
Letter from the Editors 编辑的信
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 10.1053/j.semnuclmed.2025.06.009
M Michael Sathekge, Kirsten Bouchelouche
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引用次数: 0
Toward Functional PET Imaging of the Spinal Cord 实现脊髓功能性 PET 成像。
IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2025-07-01 DOI: 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。
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引用次数: 0
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Seminars in nuclear medicine
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