Annals of Nuclear Medicine最新文献

Objectives: This study aimed to assess the performance of state-of-the-art multimodal large language models (LLMs), specifically GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro, on Japanese Nuclear Medicine Board Examination (JNMBE) questions and to evaluate the influence of visual information on the decision-making process.

Methods: This study utilized 92 questions with images from the JNMBE (2019-2023). The LLMs' responses were assessed under two conditions: providing both text and images and providing only text. Each model answered all questions thrice, and the most frequent answer choice was considered the final answer. The accuracy and agreement rates among the model answers were evaluated using statistical tests.

Results: GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro exhibited no significant differences in terms of accuracy between the text-and-image and text-only conditions. GPT-4o and Claude 3 Opus demonstrated accuracies of 54.3% (95% CI: 44.2%-64.1%) each when provided with both text and images; however, they selected the same options as in the text-only condition for 71.7% of the questions. Gemini 1.5 Pro performed significantly worse than GPT-4o under text and image conditions. The agreement rates among the model answers ranged from weak to moderate.

Conclusion: The influence of images on decision-making in nuclear medicine is limited to the latest multimodal LLMs, and their diagnostic ability in this highly specialized field remains insufficient. Improving the utilization of image information and enhancing the answer reproducibility are crucial for the effective application of LLMs in nuclear medicine education and practice. Further advancements in these areas are necessary to harness the potential of LLMs as assistants in nuclear medicine diagnosis.

Objective: To evaluate the diagnostic performance of dual-time-point ¹⁸F-PSMA-11 PET/CT imaging at 30 and 60 min post-injection (p.i.) in treatment-naïve patients with prostate cancer (PCa).

Methods: Twenty treatment-naïve patients with histology-proven PCa who underwent ¹⁸F-PSMA-11 PET/CT scans at both 30 and 60-min p.i. were retrospectively analyzed. Lesion detection, semi-quantitative analysis of lesion and background, and unspecific bone uptake (UBU) between two time points were evaluated and compared. Besides, interrater reliability was also evaluated.

Results: Lesion detection was consistent at both 30 and 60-min p.i. imaging of 20 patients (mean age 72 ± 9), identifying 27 primary prostate lesions, 84 lymph node metastases, bone metastases in 8 patients, and other metastases in 2 patients. Primary prostate lesions showed no significant difference in SUVmax and target-to-blood pool (T/B) ratios between the two imaging times, while these parameters significantly increased over time in bone metastases. Lymph node metastases showed no significant difference in SUVmax but higher T/B ratios at 60 min compared to 30 min. A higher frequency of UBU was observed at 60 min (37.3%) compared to 30 min (32.3%), with significantly higher SUVmax and T/B ratios at 60 min. 85.6% UBU was categorized as PSMA-RADS 2 at 60 min, and the others were PSMA-RADS 3 or 4. The most frequent localization was vertebrae, followed by ribs. Interrater reliability was almost perfect for lesion detection at both time points.

Conclusion: Early 30-min ¹⁸F-PSMA-11 PET/CT imaging provided comparable PCa lesion detection and semi-quantitative analysis with reduced UBU to the standard 60-min imaging.

Objecive: To investigate temporal trends in the individual workload of nuclear medicine physicians at a large tertiary care academic center between 2008 and 2023.

Methods: This study analyzed the reporting workload of nuclear medicine physicians in a large tertiary care academic center in The Netherlands on 36 unique (randomly sampled) calendar days, for each year between 2008 and 2023. The average daily departmental workload (measured with relative value units) was calculated for each year between 2008 and 2023. The individual workload was calculated by dividing the average daily departmental workload in each year by the available full-time equivalent nuclear medicine physicians in each year. Mann-Kendall tests were used to assess for any temporal monotonic trends in individual workload and types of nuclear medicine procedures performed.

Results: Individual workload increased significantly between 2008 and 2023 (Mann-Kendall tau of 0.611, P = 0.001). Individual workload in 2023 was 86% higher than in 2008. The use of positron emission tomography (PET) increased significantly (Mann-Kendall tau of 0.912, P < 0.001) between 2008 and 2023. The use of diagnostic scintigraphy decreased significantly in the same period (Mann-Kendall tau of -0.817, P < 0.001). The use of DEXA also showed a significant decrease (Mann-Kendall tau of -0.467, P = 0.013), but this decrease was negligible on a relative scale. The number of therapeutic procedures (Mann-Kendall tau of -0.100, P = 0.626) remained statistically stable in this period.

Conclusions: Our single-center study showed that the individual workload of nuclear medicine physicians has increased significantly between 2008 and 2023, driven by the rise in PET scans. The demand for both diagnostic and therapeutic nuclear medicine procedures and associated workload is expected to keep on increasing in the foreseeable future. This workload trend should be taken into account by policymakers involved in nuclear medicine staffing planning. A healthy balance between the nuclear medicine workforce and workload is necessary to maintain the quality of care, to be able to perform other important (academic) tasks such as research, educating and training medical students and residents, and management, and to prevent physician burnout and dropout.

The treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) has made significant advancements in the twenty-first century. This study aimed to assess the current state of research and identify potential new directions by conducting a bibliometric analysis of scientific publications on RAIR-DTC treatment. Publications relevant to RAIR-DTC, published from January 1, 2000, to December 31, 2023, were retrieved from the Web of Science Core Collection. Bibliometric analyses of major keywords, authors, countries, institutions, publications, and journals were conducted using CiteSpace and VOSviewer. A total of 859 papers were included in the analysis. The results demonstrated a rising trend in the number of publications over time. The United States was identified as the leading contributor in terms of publication output, citations, and international collaborations. Gustave Roussy emerged as the top organization in publication productivity, while the journal Thyroid had the highest number of related publications. The research on RAIR treatment was categorized into three key hotspots: clinical trials of targeted therapies, novel therapeutic strategies, and debates surrounding the RAIR-DTC management. RAIR-DTC research is expanding from the clinical trial phase of tyrosine kinase inhibitor monotherapy to a more complex combination therapy strategy, in particular, the synergistic effect of immune checkpoint inhibitors and other therapeutic agents, requiring more high-quality prospective studies to validate the clinical benefits. Moreover, the timely identification of RAIR-DTC patients holds the potential to enable early disease intervention, constituting a pivotal novel research direction in the future.

Objective: The study aimed to assess the impact of postoperative radioactive iodine (RAI) therapy on parathyroid function in patients who underwent total or subtotal thyroidectomy for differentiated thyroid cancer (DTC).

Methods: Data from 150 patients treated with RAI for DTC and 76 patients with low-risk DTC not receiving RAI were retrospectively analyzed. Clinical characteristics, preoperative and 1-month postoperative biochemical parameters, and adjusted calcium, phosphorus, parathyroid hormone (PTH), and 25-hydroxyvitamin D3 (25-OH-D) levels at 3 months, 1 year, 3 years, and 5 years post-RAI (or in the low-risk group) were recorded.

Results: A total of 226 DTC patients were included in the study (80.5% female, mean age 42.7 ± 13.2 years). Total thyroidectomy was performed in 97.3% (n = 220) of patients, with central lymph node dissection (CLND) in 41.6% (n = 94). No significant preoperative differences in PTH, aCa, P, Mg, or 25-hydroxyvitamin D3 levels were observed. However, patients receiving ≥ 3.7 GBq (or 100 mCi) RAI (n = 70) had lower calcium and PTH levels at the end of the first year following RAI treatment (p = 0.048, p = 0.032). The non-RAI group showed significantly higher calcium levels at one month postoperatively (p = 0.031) and lower rates of CLND and neck dissection. No significant differences in biochemical parameters were found at the five-year follow-up, except for one patient who developed normocalcemic hyperparathyroidism after RAI.

Conclusion: High-dose RAI therapy may lead to transient decreases in calcium and PTH levels in the early post-treatment period. However, long-term parathyroid function appears to remain unaffected in DTC patients, regardless of the RAI dose administered. Nonetheless, close monitoring of calcium and PTH levels is recommended, particularly in the early post-treatment period, to promptly manage any potential transient hypoparathyroidism.

Objective: Diuretic renal scintigraphy is important in diagnosing pelvi-ureteric junction obstruction (PUJO) in antenatally detected hydronephrotic (ANH) kidneys. Early-phase dynamic renal scintigraphy has several pitfalls contributing to the false interpretation of obstructed drainage, especially after pyeloplasty. This study explores the utility of delayed imaging in ^99mTc-L,L-Ethylenedicysteine (EC) diuretic renal scintigraphy to assess post-pyeloplasty renal drainage in ANH.

Methods: Data from May 2019 to January 2024 was retrospectively studied to identify infants with ANH who underwent surgery for PUJO and pre-and post-surgical assessment of renal drainage using ^99mTc-L,L-EC diuretic renal scintigraphy. Dynamic and post-void static images were analyzed to calculate percentage drainage till 3 h. Pre- and post-operative quantitative parameters were compared. Receiver operator curve analysis was done to calculate the threshold drainage to detect renal obstruction on postvoid images.

Results: In a cohort of 104 patients with a mean age of 10.1 ± 6.5 months (range 2-36 months) at surgery, 106 renal units (bilateral involvement in two patients) were analyzed. There was no significant difference in the sum of obstructive and equivocal curve patterns (105 vs 79, p = 0.06) and T_1/2 values (105 vs 82, p = 0.093) before and after surgery. However, there was a significant difference between the pre-and post-surgery median 3-h percentage drainage (26 vs 80%, p < 0.001). A drainage threshold of less than 59% at 3 h had 93.4% sensitivity and 92.5% specificity to detect obstructive drainage.

Conclusion: Delayed images in diuretic renal scintigraphy are crucial in accurately interpreting post-pyeloplasty drainage patterns and help overcome pitfalls of the dynamic study.

The 1st World Congress of Nuclear Medicine and Biology was held from September 30 to October 4 1974 in Japan. This was an epoch-making event in the history of Nuclear Medicine in Japan as well as in the World. The huge success of the meeting contributed a lot to the rapid and remarkable progress of nuclear medicine thereafter. The author served as a secretary of the local organizing committee for the Congress. The author would like to record the event summarizing the publications made by the local organization committee. The author would like to share with nuclear medicine professionals of younger generations the unforgettable experiences which he has kept in memory for the past half a century. The author believes this historical review will help to pave the future way of nuclear medicine by recalling how the World Federation and Congress was started with the great efforts of the excellent minds of predecessors.

Objective: FAPI-PET/CT exhibits high tumor uptake and low background accumulation, enabling high-sensitivity tumor detection. We compared the diagnostic performance of ⁶⁸ Ga-FAPI-46 PET/CT plus contrast-enhanced CT (CE-CT), ¹⁸F-FDG PET/CT plus CE-CT, and standalone CE-CT in patients with various malignancies.

Methods: 232 patients underwent ⁶⁸ Ga-FAPI-46 PET/CT,¹⁸F-FDG PET/CT, and CE-CT each within 4 weeks. Detection rates were assessed by a blinded reader, with ≥ 2 weeks between scans of the same patient to avoid recall bias. A sub-analysis of diagnostic performance was performed for 490 histopathologically validated lesions. Detection rates were compared using McNemar's test.

Results: Lesion-based detection rates in ⁶⁸ Ga-FAPI-46 PET/CT plus CE-CT, ¹⁸F-FDG PET/CT plus CE-CT, and CE-CT alone were 91.2% (1540/1688), 82.5% (1393/1688) and 60.2% (1016/1688). The detection rates were significantly higher for ⁶⁸ Ga-FAPI-46 PET/CT plus CE-CT than for ¹⁸F-FDG PET/CT plus CE-CT (p < 0.02 for primary lesions and p < 0.001 for total, abdominopelvic nodal, liver and other visceral lesions) and CE-CT (p < 0.0001 for total, primary, cervicothoracic nodal, abdominopelvic nodal, liver, other visceral, and bone lesions). In the sub-analysis, sensitivity, specificity, positive and negative predictive value, and accuracy were 61.3%, 96.7%, 81.4%, 91.4% and 90.0% for ⁶⁸ Ga-FAPI-46 PET/CT plus CE-CT, 57.0%, 95.7%, 75.7%, 90.5% and 88.4% for ¹⁸F-FDG PET/CT plus CE-CT, and 51.6%, 97.2%, 81.4%, 89.6% and 88.6% for CECT, respectively.

Conclusions: ⁶⁸ Ga-FAPI-46 PET/CT plus CE-CT demonstrates a higher tumor detection rate than ¹⁸F-FDG PET/CT plus CE-CT and CE-CT in a diverse spectrum of malignancies, especially for primary, abdominopelvic nodal, liver, and other visceral lesions. Further studies on which entities draw particular benefit from ⁶⁸ Ga-FAPI-46 PET/CT are warranted to aid appropriate diagnostic workup.

Trial registration: A total of N = 232 patients were analyzed. Of these, N = 50 patients were included in a prospective interventional trial (NCT05160051), and N = 175 in a prospective observational trial (NCT04571086) for correlation and clinical follow-up of PET findings; N = 7 patients were analyzed retrospectively.

Introduction: The aim of this work was to investigate homogeneity and stability of liver SUV in terms of different malignancies considering different body normalization schemes and blood glucose concentrations as well as PET/CT imaging systems.

Methods: The study included 207 patients with four different types of cancers namely breast, lymphoma, lung, and bone-metastasis. Data acquisition was performed with GE Discovery IQ, Biograph mCT, uMI 550, and Ingenuity TF64 after a single intravenous injection of 194 ± 67.5 MBq of 18F-FDG.

Results: In body weight normalization, SUVmax and SUVmean in bone-mets as well as SUVmean in lung patients were not statistically different among scanners especially for data corrected for glucose levels (p = 0.062, 0.121, and 0.150, respectively). In SUVlbm derived from lung patients, there was no significant differences in Philips in comparison to GE and Siemens (both, p > 0.05) for data corrected and not corrected for glucose levels. In SUVbsa, the only non-significant difference revealed among scanners was in the measurements of SUVmean obtained from lung and bone-mets (p = 0.107 and 0.114) both corrected for glucose levels. In SUVbmi, SUVmean of lung and bone-mets as well as SUVmax of bone-mets showed a non-significant differences among the four different scanning systems (p = 0.303, 0.091, and 0.222, respectively) for data corrected for glucose levels.

Conclusion: Liver glucose correction needs further investigations in individual tumors but could be potentially affected by whether measurements are made on SUVmean versus SUVmax, body weight normalization, as well as the imaging system. As such, selection of normalization to body weight method should be carefully selected before clinical adoption and clinically adopted and body surface area would provide the highest correlation. As such, normalization of body weight should be carefully made before clinical adoption. SUVmean proves to be useful and stable metric when liver is corrected for blood glucose levels.