Seminars in nuclear medicine最新文献_第7页

Diagnostic Accuracy of 18F-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 18F-前列腺特异性膜抗原（PSMA）PET/CT 放射性标记物在高危前列腺癌或生化复发患者的分期和再分期中的诊断准确性：综述。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2024-06-21 DOI: 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.

本综述旨在整合现有的证据综述，全面概述18F-前列腺特异性膜抗原（PSMA）PET/CT用于高危前列腺癌分期和生化复发后重新分期的证据。根据综述首选报告项目（PRIOR）声明和无荟萃分析综合（SWiM）报告指南进行了综述报告。截至 2023 年 7 月 18 日，我们进行了全面的数据库和灰色文献检索。系统性综述采用系统性综述偏倚风险（ROBIS）工具进行评估。使用建议、评估、发展和评价分级（GRADE）对证据的确定性进行评估。共确定了 11 篇系统性综述，其中 10 篇存在较高或不明确的偏倚风险。根据每位患者、每个淋巴结和每个病灶的敏感性、特异性和总体准确性，确定了报告的证据。缺乏有关剂量、不良事件的数据，也缺乏直接比较18F-PSMA PET/CT与其他成像方式的证据。中度至极度不确定的证据表明，18F-PSMA PET/CT 对高危前列腺癌和生化复发患者具有较高的灵敏度、特异性和准确性。对于中/高风险合并队列的结果，证据的确定性要低得多，效应估计值的变异性也更大。虽然某些结果仍存在证据缺口，而且大多数系统性综述的偏倚风险较高或不明确，但目前的证据基础广泛支持18F-PSMA PET/CT成像对高危前列腺癌和生化复发患者进行分期和重新分期。

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引用次数: 0

Letter from the Editors 编辑的信

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-29 DOI: 10.1053/j.semnuclmed.2025.07.004

Kirsten Bouchelouche, M. Michael Sathekge

引用次数: 0

New Promising Targets for Imaging in Infection 新的有希望的感染成像靶点。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-22 DOI: 10.1053/j.semnuclmed.2025.06.013

Honest Ndlovu , Ismaheel O. Lawal , Kgomotso M.G. Mokoala , Sipho Mdanda , Mike M. Sathekge

The diagnosis of infection is crucial in-patient survival, prevention of prolonged hospitalization and undue morbidity and mortality. This can be achieved using various tools target at the specific microbes or the host immune response components. The most useful tool will be one that diagnoses the specific causative microbe by being able to distinguish sterile inflammation from infection which by itself causes inflammation. This allows timeous institution of the appropriate and effective antimicrobial therapy, effectively reducing the incidence of antimicrobial resistance. Current standard of care diagnostic tools such as inflammatory markers, culture, morphological imaging and molecular imaging tools has specific shortcomings which necessities enlist other tools to complement them. Various targets for infection imaging have been explored and demonstrated variable utilities in the preclinical or clinical settings. This review will discuss the relevant targets in bacteria, fungi and viruses and delve into the promising or novel molecular imaging tools.

感染的诊断是至关重要的住院病人生存，预防长期住院和不当的发病率和死亡率。这可以使用针对特定微生物或宿主免疫反应成分的各种工具来实现。最有用的工具将是通过能够区分无菌炎症和本身引起炎症的感染来诊断特定致病微生物的工具。这使得适当和有效的抗菌素治疗得以及时建立，有效地减少了抗菌素耐药性的发生率。目前的标准护理诊断工具，如炎症标志物、培养、形态成像和分子成像工具有特定的缺点，需要其他工具来补充。感染成像的各种目标已经被探索，并在临床前或临床设置中展示了不同的效用。本文将讨论细菌、真菌和病毒中的相关靶点，并探讨有前途的或新的分子成像工具。

引用次数: 0

Targets for Molecular Imaging of Neuroendocrine Tumors (NETs): An Overview and Update 神经内分泌肿瘤（NETs）分子成像靶点：综述与最新进展。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-05-28 DOI: 10.1053/j.semnuclmed.2025.04.003

Esmail Jafari , Majid Assadi , Meysam Nasiri , Hojjat Ahmadzadehfar

Neuroendocrine neoplasms (NENs) represent a diverse group of tumors originating from neuroendocrine cells, characterized by their unique biological behavior and clinical manifestations. The incidence of neuroendocrine tumors (NETs) has been rising, necessitating effective diagnostic and therapeutic strategies. Molecular imaging, particularly through techniques such as PET and SPECT, plays a pivotal role in the management of NETs. This review highlights the significance of somatostatin receptor imaging in the initial diagnostic work-up, staging, and treatment planning for NETs, emphasizing the utility of radiopharmaceuticals like [⁶⁸Ga]Ga-DOTATATE and [⁶⁸Ga]Ga-DOTA-LM3. These agents demonstrate high sensitivity and specificity, allowing for accurate delineation of disease extent and identification of occult primary tumors. Furthermore, the review discusses the emerging role of nonsomatostatin receptor targets, such as glucose metabolism and fibroblast activation protein, in enhancing the diagnostic capabilities of molecular imaging. The integration of advanced imaging modalities, including dual-tracer approaches, is explored for their potential to refine therapeutic strategies and improve patient outcomes. As the field of molecular imaging continues to evolve, ongoing research and clinical trials are essential to validate the efficacy and safety of novel imaging agents and techniques, ultimately enhancing the management of patients with neuroendocrine tumors.

神经内分泌肿瘤（NENs）是一类起源于神经内分泌细胞的肿瘤，具有独特的生物学行为和临床表现。神经内分泌肿瘤（NETs）的发病率一直在上升，需要有效的诊断和治疗策略。分子成像，特别是通过PET和SPECT等技术，在NETs的管理中起着关键作用。本综述强调了生长抑素受体成像在NETs的初始诊断、分期和治疗计划中的重要性，并强调了放射性药物如[68Ga]Ga-DOTATATE和[68Ga]Ga-DOTA-LM3的应用。这些药物具有很高的敏感性和特异性，可以准确地描述疾病的范围和识别隐匿的原发肿瘤。此外，本文还讨论了非生长抑素受体靶点（如葡萄糖代谢和成纤维细胞激活蛋白）在提高分子成像诊断能力方面的新作用。整合先进的成像方式，包括双示踪方法，探索其潜力，以完善治疗策略和改善患者的结果。随着分子成像领域的不断发展，正在进行的研究和临床试验对于验证新型成像剂和技术的有效性和安全性至关重要，最终增强神经内分泌肿瘤患者的管理。

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引用次数: 0

FAPI PET Versus FDG PET/CT in Gastrointestinal Cancers: An Overview FAPI PET与FDG PET/CT在胃肠道癌症中的对比：综述。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-05-21 DOI: 10.1053/j.semnuclmed.2025.04.006

Zhaoguo Lin , Pawel Rasinski , Ted Nilsson , Maria Holstensson , Yangmeihui Song , August Blomgren , Warissara Jutidamrongphan , Kalyani Pandya , Jimin Hong , Axel Rominger , Kuangyu Shi , Rimma Axelsson , Xiaoli Lan , Robert Seifert

Fibroblast activation protein (FAP) is a type II transmembrane serine protease that is highly expressed in cancer-associated fibroblasts (CAFs) but absent in quiescent fibroblasts. Its overexpression is associated with poor prognosis in various cancers and contributes to treatment resistance. In recent years, radiolabeled FAP inhibitors (FAPI) for PET imaging have shown promising clinical value across a range of cancers. Gastrointestinal (GI) malignancies, which often exhibit a desmoplastic reaction with a high density of FAP-expressing CAFs, are particularly well-suited for FAPI PET. Given the limitations of [¹⁸F]FDG PET in GI cancers, such as low sensitivity in certain histological subtypes and high physiological background uptake, FAPI PET is expected to serve as a complementary method, potentially enhancing both diagnostic accuracy and treatment guidance. This review provides a comprehensive comparison of the clinical applications of FAPI PET and [¹⁸F]FDG PET in various GI cancers, including their value in diagnosis, staging, and treatment guidance. Additionally, this review summarizes studies on the expanding role of FAPI PET, including its use in assessing treatment response and predicting prognosis, aiming to provide insights into its potential contribution to the improved management of GI malignancies.

成纤维细胞活化蛋白（FAP）是一种II型跨膜丝氨酸蛋白酶，在癌症相关成纤维细胞（CAFs）中高表达，但在静止成纤维细胞中不表达。它的过表达与各种癌症的不良预后有关，并有助于治疗耐药。近年来，放射性标记FAP抑制剂（FAPI）用于PET成像已显示出在一系列癌症中有希望的临床价值。胃肠道（GI）恶性肿瘤通常表现为高密度表达FAPI的caf的结缔组织增生反应，特别适合FAPI PET。考虑到[18F]FDG PET在胃肠道肿瘤中的局限性，如某些组织学亚型的低敏感性和高生理背景摄取，FAPI PET有望作为一种补充方法，潜在地提高诊断准确性和治疗指导。本文综述了FAPI PET和[18F]FDG PET在各种胃肠道肿瘤中的临床应用，包括其在诊断、分期和治疗指导方面的价值。此外，本综述总结了FAPI PET扩大作用的研究，包括其在评估治疗反应和预测预后方面的应用，旨在深入了解其对改善胃肠道恶性肿瘤管理的潜在贡献。

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引用次数: 0

Potential of Technetium and Rhenium Theranostics 锝和铼的治疗潜力。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-02-24 DOI: 10.1053/j.semnuclmed.2025.01.005

Geoffrey M. Currie , Eric M. Rohren

While theranostics has transformed the precision medicine landscape over the last decade, there is scope for the development of true theranostic pairs, e.g. diagnostic and therapeutic partners in which any physical, chemical, and biological differences are negligible to in vivo application. Although simple to state in theory, there are, in fact, limited options exhibiting optimal physical characteristics and wholly shared elements.

Further compounding real-world application of the traditional theranostic method are additional barriers. The use of PET/CT as the cornerstone of the diagnostic pair in theranostics creates inequity of access and opportunity based on socioeconomic and geographic factors, and the growing demand for both ⁶⁸Ga and ¹⁷⁷Lu is straining production capabilities globally. Improving access to theranostics globally will require novel thinking and infrastructure investment to ensure that patients of all economic and social backgrounds have access to this transformative technology.

An approach which is underdeveloped, but which may address gaps in health inequities and improve outcomes, is the application of the widely available generator-produced ^99mTc for imaging and ¹⁸⁸Re for therapy. Despite favourable and near identical radiochemistry, the search for the next generation of theranostic radionuclide pairs seldom references technetium or rhenium radionuclides. Advances in SPECT/CT instrumentation and radiochemistry provide an opportunity to deliver theranostics to communities not serviced by PET-based theranostics. The ¹⁸⁸Re and ^99mTc supply by daily elution of a generator affords significant convenience, flexibility and delayed biomolecule imaging. Low abundance gamma emissions of ¹⁸⁸Re allow serial imaging and dosimetry calculations. ^99mTc / ¹⁸⁸Re theranostics could address inequity in access and opportunity to cutting edge theranostics.

虽然治疗学在过去十年中已经改变了精准医疗领域，但真正的治疗配对仍有发展空间，例如诊断和治疗伴侣，其中任何物理，化学和生物学差异对于体内应用都可以忽略不计。虽然理论上说起来很简单，但实际上，有一些有限的选择表现出最佳的物理特性和完全共享的元素。传统治疗方法在实际应用中的进一步复杂化是另外的障碍。使用PET/CT作为治疗学诊断对的基础，基于社会经济和地理因素造成了获取和机会的不平等，对68Ga和177Lu的需求不断增长，使全球生产能力紧张。改善全球治疗学的可及性需要创新思维和基础设施投资，以确保所有经济和社会背景的患者都能获得这一变革性技术。有一种方法尚不发达，但可能解决卫生不平等方面的差距并改善结果，那就是应用广泛可得的发电机生产的99mTc用于成像和188Re用于治疗。尽管有利的和几乎相同的放射化学，寻找下一代治疗放射性核素对很少涉及锝或铼放射性核素。SPECT/CT仪器和放射化学的进步为没有pet治疗服务的社区提供了提供治疗的机会。每日洗脱的188Re和99mTc提供了显著的便利性、灵活性和延迟的生物分子成像。188Re的低丰度伽马辐射允许连续成像和剂量学计算。re治疗学可以解决在获取和机会上的不平等问题。

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引用次数: 0

New Targets for Positron Emission Tomography Imaging in Parkinson´s Disease 帕金森病正电子发射断层成像的新靶点。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-06-07 DOI: 10.1053/j.semnuclmed.2025.05.004

Yu-Jie Yang , Yi-Xin Zhao , Xin-Yi Li , Chuantao Zuo

In recent years, the neuroimaging biomarkers for Parkinson’s disease (PD) has advanced rapidly, targeting to the key pathological mechanisms such as α-synuclein (α-syn) aggregation, neuroinflammation, mitochondrial dysfunction and brain clearance. This review summarized the novel imaging targets and their clinical practice in human studies. The presynaptic dopamine transporters and ¹⁸F-Fluorodeoxyglucose positron emission tomography (PET) have been characterized as established biomarkers in PD. Furthermore, as the key pathogenic protein in PD, α-syn aggregation forming Lewy bodies could drive the neuronal degeneration, making the α-syn-targeted PET imaging a critical focus in PD research. Other co-pathologies, including amyloid-β and tau protein, were also concluded for their clinical implications in PD. Additionally, the PET imaging targets for neuroinflammatory mechanisms, including mitochondrial dysfunction, microglial and astrocyte activation, hold promise for further investigation. Finally, the radiotracers detecting disruptions of blood-brain barrier and glymphatic system would also represent as therapeutic opportunities. In conclusion, the vigorous development of novel imaging biomarkers in PD will refine the diagnostic frameworks, promoting for the future disease-modifying therapies.

近年来，帕金森病（PD）的神经影像学生物标志物研究进展迅速，主要针对α-突触核蛋白（α-syn）聚集、神经炎症、线粒体功能障碍和脑清除等关键病理机制。本文综述了新型成像靶点及其在人体研究中的临床应用。突触前多巴胺转运蛋白和18f -氟脱氧葡萄糖正电子发射断层扫描（PET）已被表征为帕金森病的既定生物标志物。此外，α-syn聚集形成的路易小体是PD的关键致病蛋白，可驱动神经元变性，因此α-syn靶向PET成像成为PD研究的关键焦点。其他共同病理，包括淀粉样蛋白-β和tau蛋白，也总结了它们在PD中的临床意义。此外，PET成像目标的神经炎症机制，包括线粒体功能障碍，小胶质细胞和星形胶质细胞活化，有希望进一步研究。最后，放射性示踪剂检测血脑屏障和淋巴系统的破坏也将代表治疗的机会。总之，PD中新型成像生物标志物的蓬勃发展将完善诊断框架，促进未来的疾病改善治疗。

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引用次数: 0

Diagnostic Value of Gastrin-Releasing Peptide Receptor-Targeted PET Imaging in Oncology: A Systematic Review 胃泌素释放肽受体靶向PET成像在肿瘤诊断中的价值：系统综述。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-01-24 DOI: 10.1053/j.semnuclmed.2025.01.001

Nasibeh Mohseninia , Roya Eisazadeh , Seyed Ali Mirshahvalad , Nazanin Zamani-Siahkali , Anton Amadeus Hörmann , Christian Pirich , Andrei Iagaru , Mohsen Beheshti

Gastrin-releasing peptide receptor (GRPR), overexpressed in various cancers, is a promising target for positron emission tomography (PET). This systematic review investigated the diagnostic value of GRPR-targeted PET imaging in oncology. A systematic search was conducted on major medical databases until May 23, 2024. Keywords were modified to include clinical original studies on GRPR-targeted PET in cancer patients. Out of 1624 searched studies initially, 107 were eligible for the full-text review. Overall, data from 38 studies met inclusion criteria, investigating GRPR-targeting radiotracers in breast cancer, prostate cancer, gastrointestinal stromal tumours (GIST) and gliomas (including optic pathway glioma and glioblastoma multiforme). In breast cancer, GRPR-targeted PET effectively detected primary tumours and metastases, particularly in estrogen receptor (ER)-positive patients, and predicted treatment response. In prostate cancer, high sensitivity (up to 88%) and specificity (up to 90%) for detecting primary tumours were observed, providing added value when combined with magnetic resonance imaging (MRI). In biochemical recurrence, sites of prostate cancer were identified even at PSA levels below 0.5ng/dL. Compared with PSMA PET, GRPR-targeted PET showed comparable or superior detection rates. Considering GIST, GRPR-targeted PET imaging proved to be a valuable diagnostic tool, particularly when [¹⁸F] FDG PET results were inconclusive. Regarding gliomas, GRPR-targeted PET achieved a 100% detection rate (MRI reference), aiding localization, preoperative planning, and differentiation between recurrence and malignant transformation. GRPR-targeted PET shows promise in improving cancer diagnostics, particularly in ER-positive breast cancer, prostate cancer, and gliomas, and may enhance clinical decision-making.

胃泌素释放肽受体（GRPR）在多种癌症中过表达，是正电子发射断层扫描（PET）的一个有希望的靶点。本系统综述探讨了grpr靶向PET成像在肿瘤学中的诊断价值。到2024年5月23日，对主要医学数据库进行了系统搜索。修改关键词，纳入肿瘤患者grpr靶向PET的临床原始研究。在最初检索的1624项研究中，有107项符合全文综述的条件。总体而言，38项研究的数据符合纳入标准，研究了grpr靶向放射性示踪剂在乳腺癌、前列腺癌、胃肠道间质瘤（GIST）和胶质瘤（包括视神经通路胶质瘤和多形性胶质母细胞瘤）中的应用。在乳腺癌中，grpr靶向PET可有效检测原发肿瘤和转移灶，尤其是雌激素受体（ER）阳性患者，并预测治疗反应。在前列腺癌中，观察到检测原发性肿瘤的高灵敏度（高达88%）和特异性（高达90%），当与磁共振成像（MRI）结合使用时提供了附加价值。在生化复发中，即使PSA水平低于0.5ng/dL，也能确定前列腺癌的部位。与PSMA PET相比，grpr靶向PET的检出率相当或更高。考虑到GIST， grpr靶向PET成像被证明是一种有价值的诊断工具，特别是当[18F] FDG PET结果不确定时。对于胶质瘤，grpr靶向PET的检出率达到100% （MRI参考），有助于定位、术前规划和区分复发与恶性转化。grpr靶向PET有望改善癌症诊断，特别是er阳性乳腺癌、前列腺癌和胶质瘤，并可能增强临床决策。

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引用次数: 0

Molecular Imaging for Response Assessment of Neuroendocrine Tumors (NET) 神经内分泌肿瘤反应评估的分子影像学研究。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-05-09 DOI: 10.1053/j.semnuclmed.2025.04.005

Martina Di Franco , Giuseppe Lamberti , Davide Campana , Valentina Ambrosini

Assessing treatment response in neuroendocrine tumors (NET) remains a significant challenge due to their typically indolent growth and heterogenity, the frequent occurrence of disease stabilization rather than tumor shrinkage after therapy, and the inherent limitations of conventional imaging criteria. While molecular imaging—primarily somatostatin receptor (SST) PET/CT—has improved lesion detection, the absence of standardized response criteria limits its clinical utility and prevents its use as full replacement of conventional imaging. Emerging strategies, including revised thresholds for dimensional changes, criteria evaluating different features, such as lesions’ density and functional tumor volumes, offer potential improvements in response evaluation but require further validation for routine clinical implementation. This review examines the current challenges in assessing NET treatment response, evaluates the strengths and limitations of available imaging modalities, and discusses emerging approaches and future directions for optimizing therapeutic monitoring in the heterogeneous panorama of NET.

评估神经内分泌肿瘤（NET）的治疗反应仍然是一个重大挑战，因为它们通常生长缓慢和异质性，治疗后经常出现疾病稳定而不是肿瘤缩小，以及传统影像学标准的固有局限性。虽然分子成像（主要是生长抑素受体（SST） PET/ ct）改善了病变检测，但缺乏标准化的反应标准限制了其临床应用，并阻碍了其作为传统成像的完全替代。新兴策略，包括修订尺寸变化的阈值，评估不同特征的标准，如病变密度和功能性肿瘤体积，为反应评估提供了潜在的改进，但需要进一步验证常规临床实施。本综述探讨了评估NET治疗反应的当前挑战，评估了可用成像方式的优势和局限性，并讨论了优化NET异质性全景治疗监测的新兴方法和未来方向。

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引用次数: 0

New Promising Targets for Imaging in Cardiovascular Diseases 心血管疾病成像的新靶点。

IF 5.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in nuclear medicine

Pub Date : 2025-09-01 Epub Date: 2025-06-23 DOI: 10.1053/j.semnuclmed.2025.05.006

Mia Ståhle , Cristina Popescu , Christoph Rischpler , Han Zhang , Samia Massalha , Leonor Lopes , Axel Rominger , Federico Caobelli

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, driven by complex and dynamic molecular processes such as inflammation, fibrosis, metabolic dysregulation, thrombosis, and vascular remodeling. While conventional imaging techniques provide valuable anatomical and functional information, they fail to capture these underlying pathophysiological mechanisms at the molecular level. Molecular imaging, particularly with PET and SPECT, offers the potential to noninvasively visualize and quantify these processes, enabling earlier diagnosis, better risk stratification, and more precise treatment guidance. Despite substantial progress in clinical cardiology, there is a growing need for novel radiotracers that can target key disease-driving mechanisms beyond traditional perfusion or viability imaging. Emerging radiopharmaceuticals now enable the assessment of myocardial fibrosis (e.g., collagen-targeted and MMP-targeted tracers), cardiomyocyte stress responses (e.g., oxidative stress, unfolded protein response, endothelin signaling), and metabolic alterations (e.g., fatty acid, ketone, and glucose metabolism). Additionally, new tracers are being developed for thrombosis, vascular inflammation, plaque instability, and even for innovative targets such as cellular senescence and gut-derived inflammatory pathways. These developments reflect a paradigm shift towards imaging-driven phenotyping of cardiovascular disease. This review provides a comprehensive overview of the latest advances in molecular imaging tracers for cardiovascular applications, with a focus on their biological rationale, preclinical and clinical evidence, and translational challenges. We categorize tracers by their mechanistic targets and highlight their potential for integration into precision cardiology.

心血管疾病（cvd）仍然是世界范围内发病率和死亡率的主要原因，由复杂和动态的分子过程驱动，如炎症、纤维化、代谢失调、血栓形成和血管重塑。虽然传统的成像技术提供了有价值的解剖和功能信息，但它们无法在分子水平上捕获这些潜在的病理生理机制。分子成像，特别是PET和SPECT，提供了无创可视化和量化这些过程的潜力，使早期诊断，更好的风险分层和更精确的治疗指导成为可能。尽管临床心脏病学取得了实质性进展，但对新型放射性示踪剂的需求日益增长，这种示踪剂可以针对传统灌注或生存能力成像之外的关键疾病驱动机制。新兴的放射性药物现在能够评估心肌纤维化（例如，胶原靶向和mmp靶向示踪剂），心肌细胞应激反应（例如，氧化应激，未折叠蛋白反应，内皮素信号传导）和代谢改变（例如，脂肪酸，酮和葡萄糖代谢）。此外，新的示踪剂正在开发用于血栓形成、血管炎症、斑块不稳定，甚至用于创新靶点，如细胞衰老和肠道来源的炎症途径。这些发展反映了向成像驱动的心血管疾病表型的范式转变。本文综述了分子成像示踪剂在心血管应用方面的最新进展，重点介绍了分子成像示踪剂的生物学原理、临床前和临床证据以及转化挑战。我们将示踪剂按其机制靶点进行分类，并强调其整合到精确心脏病学中的潜力。

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引用次数: 0