Annals of Nuclear Medicine最新文献

Objective: Pathological upgrading is common in men with ISUP Grade Group (GG) 1 prostate cancer due to sampling limitations. ⁶⁸Ga-PSMA-11 PET/CT is promising for characterizing tumor biology. The 5-point PRIMARY score, which considers uptake, focality, and location, has limited data on predicting occult high-grade cancer in GG1 biopsy patients. This study assessed the score's accuracy in predicting upgrading in GG1 prostate cancer patients with PSA < 20 ng/mL undergoing radical prostatectomy.

Materials and methods: This retrospective study included 71 patients with biopsy-proven GG1 prostate adenocarcinoma, PSA < 20 ng/mL, and ⁶⁸Ga-PSMA-11 PET/CT performed within 2 months before radical prostatectomy. PRIMARY scores [1-5] were assigned by two blinded nuclear medicine physicians; scores ≥ 4 were considered high-risk. Pathological upgrading was defined as ISUP GG ≥ 2 on prostatectomy specimens. Diagnostic performance was assessed using ROC analysis, and univariate and multivariate logistic regression models were constructed to determine independent predictors of upgrading.

Results: Pathological upgrading occurred in 45/71 patients (63.4%). Upgrading rates increased markedly across PRIMARY score categories: 25% for scores ≤ 3, 81.3% for score 4, and 100% for score 5 (p < 0.001). A PRIMARY score ≥ 4 demonstrated excellent diagnostic performance (AUC = 0.979), with 97.8% sensitivity, 88.5% specificity, 93.6% PPV, 95.6% NPV, and 94.3% accuracy. SUVmax (AUC = 0.944) and PI-RADS ≥ 4 (AUC = 0.721) were also associated with upgrading; however, in multivariate analysis, only the PRIMARY score remained an independent predictor (OR: 19.9; 95% CI: 2.92-135.28; p = 0.002).

Conclusion: "The ⁶⁸Ga-PSMA-11 PET/CT PRIMARY score was strongly associated with pathological upgrading in this surgically treated cohort of biopsy-confirmed ISUP GG1 patients with PSA < 20 ng/mL undergoing radical prostatectomy. Incorporating PSMA-based intraprostatic pattern analysis could improve the accuracy of preoperative grading, potentially supporting consideration of surgical management rather than definitive radiotherapy when determining the optimal treatment strategy. Prospective multicenter validation is warranted before broader clinical implementation.

Objective: The progression of tau pathology in Alzheimer's disease (AD) is closely linked to cognitive decline. Visual Braak staging of tau PET reflects neurofibrillary tangle distribution but requires expertise in interpretation. The present study aimed to evaluate agreement between Braak stages and semi-quantitative CenTauRz and Simplified Temporal-Occipital Classification (STOC).

Methods: We collected data from 112 persons with normal cognition (NC), as well as 103 patients with mild cognitive impairment (MCI), and 48 with AD who were assessed by ¹⁸F-flortaucipir PET and MRI in the ADNI3 study. A board-certified nuclear medicine physician visually assessed Braak stages on PET images. CenTauRz scores were derived by converting standardized uptake value ratios (SUVRs) from five predefined regions. STOC stages was based on SUVRs from four regions, and classified cognitive impairment into five stages of typical tau progression or atypical patterns. Tau positivity was defined as Braak stage ≥ IV, CenTauRz ≥ 2.0, or STOC stage ≥ 2/atypical. Concordance (Cohen's κ) and Spearman's correlations (rho, ρ) with Braak stages were calculated.

Results: The accuracy of CenTauRz compared to Braak stages was 0.84-0.90, κ = 0.61-0.77, and ρ = 0.67-0.83 and that of STOC was 0.87; κ = 0.71, and ρ = 0.81. CenTauRz captured the regional heterogeneity of tau accumulation, whereas STOC provided a staging framework aligned with Braak progression.

Conclusion: The agreement of CenTauRz and STOC with visually assessed Braak stages was strong. Combinations of semi-quantitative methods might serve as complementary tools for tau PET images and improve interpretive reliability and objectivity.

Purpose: To evaluate the prognostic utility of a novel quantitative imaging metric, whole-body metabolic burden (WB-MB), derived from [¹¹C]-Methionine PET/CT, in patients with multiple myeloma (MM), and to assess its correlation with clinical biomarkers and survival outcomes.

Methods: In this prospective, single-center study, 34 patients with biopsy-confirmed MM underwent whole-body [¹¹C]-Methionine PET/CT for staging or restaging. WB-MB was calculated using a semi-quantitative method incorporating both the extent and intensity of methionine uptake across 12 anatomical regions. Liver- and aorta-normalized WB-MB ratios (WB-MB/liver and WB-MB/aorta) were also computed. Correlations with laboratory biomarkers were analyzed using regression models, and prognostic performance was assessed through Kaplan-Meier survival analysis and hazard ratios for progression-free survival (PFS) and overall survival (OS).

Results: WB-MB showed significant inverse correlation with hemoglobin and positive correlations with LDH, beta-2 microglobulin (B2M), and serum kappa free light chain levels. No significant associations were observed with platelet count, WBC, or lambda light chains. WB-MB, WB-MB/liver, and WB-MB/aorta were all significantly associated with OS and PFS (p < 0.05), while maximum SUVmean was not. A WB-MB threshold of 164.79 was identified as predictive for PFS. Notably, no deaths occurred in patients with WB-MB < 101 during follow-up.

Conclusion: WB-MB scoring with [¹¹C]-Methionine PET/CT is a promising, reproducible imaging biomarker for evaluating disease burden and prognosis in MM. It correlates with key laboratory markers and outperforms static SUV-based metrics in predicting survival outcomes. Further multicenter studies are needed to validate these findings and explore integration into therapeutic decision-making.