Cardiac amyloidosis, characterized by extracellular deposition of amyloid fibrils within the myocardium, is an increasingly recognized cause of heart failure. With the advent of disease-modifying therapies, imaging has become central to diagnosis, subtype differentiation, prognostication, and treatment monitoring. This review provides a comprehensive update on multimodality imaging in cardiac amyloidosis, emphasizing its clinical utility across the disease continuum. Echocardiography, technetium-labeled bone scintigraphy, amyloid-specific positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography each contribute uniquely to detecting amyloid burden and assessing cardiac function. In addition to outlining a practical diagnostic approach, we highlight emerging imaging biomarkers for monitoring treatment response and predicting clinical outcomes. The integration of these modalities into clinical practice enhances diagnostic accuracy, enables individualized risk stratification, and supports optimized, evidence-based care for patients with cardiac amyloidosis.
{"title":"Advances in imaging-based diagnosis, prognosis, and response assessment in cardiac amyloidosis: a comprehensive multimodality review","authors":"Osamu Manabe, Seitaro Oda, Takashi Norikane, Tadao Aikawa, Yuka Otaki, Nagara Tamaki","doi":"10.1007/s12149-025-02092-x","DOIUrl":"10.1007/s12149-025-02092-x","url":null,"abstract":"<div><p>Cardiac amyloidosis, characterized by extracellular deposition of amyloid fibrils within the myocardium, is an increasingly recognized cause of heart failure. With the advent of disease-modifying therapies, imaging has become central to diagnosis, subtype differentiation, prognostication, and treatment monitoring. This review provides a comprehensive update on multimodality imaging in cardiac amyloidosis, emphasizing its clinical utility across the disease continuum. Echocardiography, technetium-labeled bone scintigraphy, amyloid-specific positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography each contribute uniquely to detecting amyloid burden and assessing cardiac function. In addition to outlining a practical diagnostic approach, we highlight emerging imaging biomarkers for monitoring treatment response and predicting clinical outcomes. The integration of these modalities into clinical practice enhances diagnostic accuracy, enables individualized risk stratification, and supports optimized, evidence-based care for patients with cardiac amyloidosis.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 10","pages":"1037 - 1052"},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02092-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Purpose</h3><p>Transarterial radioembolization (TARE) is one of the local treatment options for primary and metastatic liver tumors. However, our knowledge regarding the safety of repeated TARE remains limited. In this study, we aimed to evaluate the safety of repeated transarterial radioembolization with multi-compartment dosimetry.</p><h3>Methods</h3><p>In this retrospective single-center study, we analyzed the data of the patients who were treated with at least two separate sessions of radioembolization with <sup>90</sup>Y microspheres. Multi-compartment and voxel-wise dosimetry was performed for every treatment session and cumulative whole-liver normal tissue absorbed radiation dose (<i>D</i><sub>norm</sub>), V20-V100 values for whole-liver normal tissue were calculated. Toxicity was assessed with Common Terminology Criteria for Adverse Events (CTCAE) grading system for alanine aminotransferase (ALT)/aspartate aminotransferase (AST)/bilirubin levels and International Normalized Ratio (INR) before and after each treatment. In addition, albumin–bilirubin (ALBI) scores, grades, and changes in ALBI score (ΔALBI) were recorded. Difference between the ALBI scores before and after the treatment was compared with Wilcoxon tests, and relationships between ΔALBI and dosimetric variables were compared using linear regression analyses.</p><h3>Results</h3><p>A total of 24 patients (6 males, 18 females; median age: 57 years) were included in the analysis. The most common diagnosis was colorectal carcinoma liver metastases (46%). Seventeen patients (71%) underwent two TARE treatments, five (21%) underwent three, and two (8%) underwent four. The median interval between the first and second treatments was 138 days (range: 34–782), and between the second and third treatments was 210 days (range: 72–435). No CTCAE Grade 3 or 4 toxicities were observed. ALBI score analysis revealed no significant changes after the first two treatments, but a significant difference was noted after the third treatment (<i>P</i> = 0.043), with one patient progressing to ALBI Grade 3 with significant hypoalbuminemia. No significant relationship was found between ΔALBI and treatment intervals. ALT/AST elevations were mostly transient and mild, with only one case of Grade 2 hepatotoxicity in each of the first two treatments. In patients treated with glass microspheres in their first two treatments (<i>n</i> = 12), a significant linear correlation was found between cumulative <i>D</i><sub>norm</sub> and ΔALBI (<i>R</i><sup>2</sup> = 0.512, <i>P</i> = 0.007). Cumulative dose–volume histogram parameters, particularly V30, V40, and V50, showed significant correlations with ΔALBI. However, in patients treated with resin microspheres (<i>n</i> = 6), no statistically significant relationship was observed between cumulative <i>D</i><sub>norm</sub> and ΔALBI (<i>P</i> = 0.718).</p><h3>Conclusion</h3><p>Repeated TARE with a multi-compartment personalized dosimetric approach appears to
{"title":"Safety of repeated trans-arterial radioembolization with multi-compartment dosimetry","authors":"Cigdem Soydal, Burak Demir, Mine Araz, Irem Mesci, Emre Can Çelebioğlu, Nuriye Ozlem Kucuk","doi":"10.1007/s12149-025-02094-9","DOIUrl":"10.1007/s12149-025-02094-9","url":null,"abstract":"<div><h3>Purpose</h3><p>Transarterial radioembolization (TARE) is one of the local treatment options for primary and metastatic liver tumors. However, our knowledge regarding the safety of repeated TARE remains limited. In this study, we aimed to evaluate the safety of repeated transarterial radioembolization with multi-compartment dosimetry.</p><h3>Methods</h3><p>In this retrospective single-center study, we analyzed the data of the patients who were treated with at least two separate sessions of radioembolization with <sup>90</sup>Y microspheres. Multi-compartment and voxel-wise dosimetry was performed for every treatment session and cumulative whole-liver normal tissue absorbed radiation dose (<i>D</i><sub>norm</sub>), V20-V100 values for whole-liver normal tissue were calculated. Toxicity was assessed with Common Terminology Criteria for Adverse Events (CTCAE) grading system for alanine aminotransferase (ALT)/aspartate aminotransferase (AST)/bilirubin levels and International Normalized Ratio (INR) before and after each treatment. In addition, albumin–bilirubin (ALBI) scores, grades, and changes in ALBI score (ΔALBI) were recorded. Difference between the ALBI scores before and after the treatment was compared with Wilcoxon tests, and relationships between ΔALBI and dosimetric variables were compared using linear regression analyses.</p><h3>Results</h3><p>A total of 24 patients (6 males, 18 females; median age: 57 years) were included in the analysis. The most common diagnosis was colorectal carcinoma liver metastases (46%). Seventeen patients (71%) underwent two TARE treatments, five (21%) underwent three, and two (8%) underwent four. The median interval between the first and second treatments was 138 days (range: 34–782), and between the second and third treatments was 210 days (range: 72–435). No CTCAE Grade 3 or 4 toxicities were observed. ALBI score analysis revealed no significant changes after the first two treatments, but a significant difference was noted after the third treatment (<i>P</i> = 0.043), with one patient progressing to ALBI Grade 3 with significant hypoalbuminemia. No significant relationship was found between ΔALBI and treatment intervals. ALT/AST elevations were mostly transient and mild, with only one case of Grade 2 hepatotoxicity in each of the first two treatments. In patients treated with glass microspheres in their first two treatments (<i>n</i> = 12), a significant linear correlation was found between cumulative <i>D</i><sub>norm</sub> and ΔALBI (<i>R</i><sup>2</sup> = 0.512, <i>P</i> = 0.007). Cumulative dose–volume histogram parameters, particularly V30, V40, and V50, showed significant correlations with ΔALBI. However, in patients treated with resin microspheres (<i>n</i> = 6), no statistically significant relationship was observed between cumulative <i>D</i><sub>norm</sub> and ΔALBI (<i>P</i> = 0.718).</p><h3>Conclusion</h3><p>Repeated TARE with a multi-compartment personalized dosimetric approach appears to ","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1306 - 1318"},"PeriodicalIF":2.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-17DOI: 10.1007/s12149-025-02099-4
Yu Li, Kun Chen, Luqiang Jin, Hailin Huang
Rationale and objective
To develop and validate the predictive value of 18F-FDG PET/CT radiomics models based on data preprocessing methods for axillary lymph-node (ALN) status after neoadjuvant chemotherapy (NAC) for breast cancer.
Materials and methods
According to the status of ALN after NAC, we divided the breast cancer patients of the three scanners into the pathological complete remission (pCR) and non-pCR groups, respectively. Totally 630 models were obtained based on various data preprocessing, feature filtering, and modeling approaches. On the one hand, different data preprocessing methods were compared to analyze the advantages of different preprocessing methods. On the other hand, the AUC of predicting ALN status was compared among all models, and the model with the best prediction was obtained. Finally, the optimal model is combined with the clinical and the corresponding Nomogram is plotted.
Results
The comparison of the data preprocessing modalities revealed that the model prediction of tumor-to-liver ratio (TLR) radiomics was better than origin radiomics (OR), and the effect of Combat and Limma was better than without batch effects. All preprocessing modalities could be used as a potential method that can further optimize the model. The optimal model had a predicted AUC of 0.798 for ALN status after NAC for breast cancer in the test set and an AUC of 0.811 when combined with clinical characteristics.
Conclusion
It is necessary to pre-process the data before conducting a study on multicenter data, and the model developed in this way can effectively predict the status of ALN after NAC in breast cancer.
{"title":"Development and validation of an 18F-FDG PET/CT radiomic nomogram for predicting axillary lymph-node status after neoadjuvant chemotherapy for breast cancer: a multicenter study","authors":"Yu Li, Kun Chen, Luqiang Jin, Hailin Huang","doi":"10.1007/s12149-025-02099-4","DOIUrl":"10.1007/s12149-025-02099-4","url":null,"abstract":"<div><h3>Rationale and objective</h3><p>To develop and validate the predictive value of <sup>18</sup>F-FDG PET/CT radiomics models based on data preprocessing methods for axillary lymph-node (ALN) status after neoadjuvant chemotherapy (NAC) for breast cancer.</p><h3>Materials and methods</h3><p>According to the status of ALN after NAC, we divided the breast cancer patients of the three scanners into the pathological complete remission (pCR) and non-pCR groups, respectively. Totally 630 models were obtained based on various data preprocessing, feature filtering, and modeling approaches. On the one hand, different data preprocessing methods were compared to analyze the advantages of different preprocessing methods. On the other hand, the AUC of predicting ALN status was compared among all models, and the model with the best prediction was obtained. Finally, the optimal model is combined with the clinical and the corresponding Nomogram is plotted.</p><h3>Results</h3><p>The comparison of the data preprocessing modalities revealed that the model prediction of tumor-to-liver ratio (TLR) radiomics was better than origin radiomics (OR), and the effect of Combat and Limma was better than without batch effects. All preprocessing modalities could be used as a potential method that can further optimize the model. The optimal model had a predicted AUC of 0.798 for ALN status after NAC for breast cancer in the test set and an AUC of 0.811 when combined with clinical characteristics.</p><h3>Conclusion</h3><p>It is necessary to pre-process the data before conducting a study on multicenter data, and the model developed in this way can effectively predict the status of ALN after NAC in breast cancer.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1326 - 1336"},"PeriodicalIF":2.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02099-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-17DOI: 10.1007/s12149-025-02096-7
Kazunari Ishii
{"title":"2024 Hisada Prize (Award for Articles in Annals of Nuclear Medicine)","authors":"Kazunari Ishii","doi":"10.1007/s12149-025-02096-7","DOIUrl":"10.1007/s12149-025-02096-7","url":null,"abstract":"","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 10","pages":"1025 - 1026"},"PeriodicalIF":2.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-15DOI: 10.1007/s12149-025-02093-w
Saad Ruzzeh, Ahmed Saad Abdlkadir, Hasan Al-Alawi, Egesta Lopci, Mike Sathekge, Serin Moghrabi, Shahed Obeidat, Akram Al-Ibraheem
The C-X-C motif chemokine receptor 4 (CXCR4) has emerged as a critical molecular imaging target in various malignancies due to its central role in tumor progression, metastasis, and resistance to therapy. Among the imaging modalities developed to exploit this target, [68Ga]Ga-Pentixafor—a positron emission tomography (PET) radiopharmaceutical—has shown potential in diagnostic imaging. However, its diagnostic utility in solid tumors remains relatively underexplored, particularly in comparison to the widely utilized [18F]fluorodeoxyglucose ([18F]FDG) PET/CT. Comprehensive literature search was performed across PubMed, Scopus, Web of Science and Embase, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included those reporting CXCR4-targeted PET imaging in solid tumors, with data on lesion detection, semiquantitative uptake values including maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR). Data extraction focused on study design, patient demographics, tumor types, imaging protocols, and key findings. The quality of included studies was assessed using standardized risk-of-bias tools using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. This systematic review analyzed data from 26 studies, encompassing 831 patients with various solid malignancies to assess the diagnostic utility of [68Ga]Ga-Pentixafor PET/CT. Tracer uptake varied significantly among tumor types, with higher SUVmax values observed in adrenocortical carcinoma, small cell lung cancer, and desmoplastic small round cell tumors, while lower uptake was noted in breast cancer, glioblastoma, and melanoma. Certain malignancies, such as prostate cancer, pleural mesothelioma, and colorectal carcinoma, exhibited minimal or absent CXCR4 expression on PET imaging. A correlation between in vivo PET uptake and histopathologic CXCR4 expression was evident in specific tumor types, though heterogeneity in receptor expression was reported. When compared to [18F]FDG PET/CT, [68Ga]Ga-Pentixafor PET/CT demonstrated lower lesion detectability, highlighting its potential as a theranostic tool for CXCR4-targeted therapies rather than a primary diagnostic modality. [68Ga]Ga-Pentixafor PET/CT represents a promising, yet evolving, tool in oncology. While its diagnostic performance may not rival that of [18F]FDG PET/CT across all tumor types, its theranostic potential underscores its value in the precision medicine landscape.
C-X-C基序趋化因子受体4 （CXCR4）由于在肿瘤进展、转移和治疗抵抗中发挥核心作用，已成为各种恶性肿瘤的关键分子成像靶点。在利用该靶点开发的成像模式中，[68Ga] ga - pentixafor（正电子发射断层扫描（PET）放射性药物）在诊断成像中显示出潜力。然而，与广泛应用的[18F]氟脱氧葡萄糖（[18F]FDG） PET/CT相比，其在实体肿瘤诊断中的应用仍相对不足。全面的文献检索在PubMed， Scopus， Web of Science和Embase上进行，遵循系统评价和元分析的首选报告项目（PRISMA）指南。符合条件的研究包括报告实体肿瘤中cxcr4靶向PET成像的研究，包括病变检测、半定量摄取值（包括最大标准化摄取值（SUVmax））和肿瘤与背景比（TBR）的数据。数据提取侧重于研究设计、患者人口统计学、肿瘤类型、成像方案和主要发现。纳入研究的质量使用标准化的偏倚风险工具进行评估，使用诊断准确性研究质量评估-2 （QUADAS-2）工具。本系统综述分析了26项研究的数据，包括831例不同实体恶性肿瘤患者，以评估[68Ga]Ga-Pentixafor PET/CT的诊断价值。示踪剂的摄取在不同类型的肿瘤中差异显著，在肾上腺皮质癌、小细胞肺癌和促结缔组织增生小圆细胞瘤中观察到较高的SUVmax值，而在乳腺癌、胶质母细胞瘤和黑色素瘤中观察到较低的摄取。某些恶性肿瘤，如前列腺癌、胸膜间皮瘤和结直肠癌，PET成像显示极少或不表达CXCR4。在特定肿瘤类型中，体内PET摄取与组织病理学CXCR4表达之间存在明显的相关性，尽管有报道称受体表达存在异质性。与[18F]FDG PET/CT相比，[68Ga]Ga-Pentixafor PET/CT显示出较低的病变检出率，突出了其作为cxcr4靶向治疗的治疗工具的潜力，而不是主要诊断方式。[68Ga]Ga-Pentixafor PET/CT是一种很有前途的，但仍在发展中的肿瘤学工具。虽然其在所有肿瘤类型中的诊断性能可能无法与[18F]FDG PET/CT相媲美，但其治疗潜力强调了其在精准医学领域的价值。
{"title":"Evaluating the diagnostic utility of [⁶⁸Ga]Ga-Pentixafor in solid tumors: a systematic review","authors":"Saad Ruzzeh, Ahmed Saad Abdlkadir, Hasan Al-Alawi, Egesta Lopci, Mike Sathekge, Serin Moghrabi, Shahed Obeidat, Akram Al-Ibraheem","doi":"10.1007/s12149-025-02093-w","DOIUrl":"10.1007/s12149-025-02093-w","url":null,"abstract":"<div><p>The C-X-C motif chemokine receptor 4 (CXCR4) has emerged as a critical molecular imaging target in various malignancies due to its central role in tumor progression, metastasis, and resistance to therapy. Among the imaging modalities developed to exploit this target, [68Ga]Ga-Pentixafor—a positron emission tomography (PET) radiopharmaceutical—has shown potential in diagnostic imaging. However, its diagnostic utility in solid tumors remains relatively underexplored, particularly in comparison to the widely utilized [18F]fluorodeoxyglucose ([18F]FDG) PET/CT. Comprehensive literature search was performed across PubMed, Scopus, Web of Science and Embase, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included those reporting CXCR4-targeted PET imaging in solid tumors, with data on lesion detection, semiquantitative uptake values including maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR). Data extraction focused on study design, patient demographics, tumor types, imaging protocols, and key findings. The quality of included studies was assessed using standardized risk-of-bias tools using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. This systematic review analyzed data from 26 studies, encompassing 831 patients with various solid malignancies to assess the diagnostic utility of [68Ga]Ga-Pentixafor PET/CT. Tracer uptake varied significantly among tumor types, with higher SUVmax values observed in adrenocortical carcinoma, small cell lung cancer, and desmoplastic small round cell tumors, while lower uptake was noted in breast cancer, glioblastoma, and melanoma. Certain malignancies, such as prostate cancer, pleural mesothelioma, and colorectal carcinoma, exhibited minimal or absent CXCR4 expression on PET imaging. A correlation between in vivo PET uptake and histopathologic CXCR4 expression was evident in specific tumor types, though heterogeneity in receptor expression was reported. When compared to [18F]FDG PET/CT, [68Ga]Ga-Pentixafor PET/CT demonstrated lower lesion detectability, highlighting its potential as a theranostic tool for CXCR4-targeted therapies rather than a primary diagnostic modality. [68Ga]Ga-Pentixafor PET/CT represents a promising, yet evolving, tool in oncology. While its diagnostic performance may not rival that of [18F]FDG PET/CT across all tumor types, its theranostic potential underscores its value in the precision medicine landscape.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 10","pages":"1053 - 1073"},"PeriodicalIF":2.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting metastatic conjunctival melanoma (CM).
Methods
This retrospective study enrolled 67 patients with histopathologically confirmed CM who underwent 18F-FDG PET/CT for follow-up or suspected recurrence. Parameters including short-axis diameter of lesions, maximum standardized uptake value (SUVmax), the target-to-nontarget (T/NT) ratios of cervical lymph nodes, and bone lesion characterization (osteolytic, osteoblastic, or unchanged) were evaluated. Metastases were confirmed via either histopathology or ≥ 6-month imaging follow-up. Diagnostic sensitivity, specificity, accuracy, and metastatic patterns were analyzed at patient level.
Results
A total of 16 patients were confirmed metastasis. The median interval from surgery to metastasis was 20.3 months (range 1–100 months), with 56.3% (9/16) occurring within the first postoperative year. PET/CT detected metastases in 13 patients, missed metastases in 3 patients (2 with small preauricular lymph nodes and 1 with tiny pulmonary metastases), and misdiagnosed 1 patient with parotid benign nodules as metastatic. PET/CT demonstrated a sensitivity of 81.3%, specificity of 98.0%, and accuracy of 94.0%. The most common metastatic sites included lymph nodes (62.5%), bone (37.5%), lung (31.3%), and liver (25.0%), with PET/CT demonstrating detection rates of 95.5%, 100%, 86.7%, and 100%, respectively. PET/CT also identified metastases in rare sites, including the thyroid, cerebellum, adrenal glands, pericardium, pancreas, and subcutaneous/soft tissue. Lymph node metastases in CM predominately occurred in ipsilateral regional nodes (90.1%), with rare bilateral involvement (9.1%). Metastatic lymph nodes in the cervical and submandibular regions showed significantly higher mean SUVmax (11.6 ± 10.5 vs. 2.9 ± 0.9; p = 0.005) and T/NT ratios (6.9 ± 8.2 vs. 3.0 ± 1.0; p = 0.011) compared to inflammatory lymph nodes. SUVmax of metastatic lymph nodes, lung metastases, and liver metastases showed positive correlations with lesion size (p < 0.05 for all). Among metastatic lymph nodes, 53.2% had a short-axis diameter < 10 mm, and 59.1% of bone metastases exhibited no abnormal CT density.
Conclusion
18F-FDG PET/CT provides high diagnostic accuracy in detecting systemic metastases of CM during follow-up assessments, particularly for small lymph nodes, early bone metastases, and uncommon sites.
{"title":"Diagnostic value of 18F-FDG PET/CT in the follow-up of conjunctival melanoma","authors":"Huan Ma, Chuangui Li, Qian Zhang, Jiayue Liu, Wei Zhao, Xiaoyi Guo, Nina Zhou, Daxi Xue","doi":"10.1007/s12149-025-02097-6","DOIUrl":"10.1007/s12149-025-02097-6","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the diagnostic performance of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) in detecting metastatic conjunctival melanoma (CM).</p><h3>Methods</h3><p>This retrospective study enrolled 67 patients with histopathologically confirmed CM who underwent <sup>18</sup>F-FDG PET/CT for follow-up or suspected recurrence. Parameters including short-axis diameter of lesions, maximum standardized uptake value (SUVmax), the target-to-nontarget (T/NT) ratios of cervical lymph nodes, and bone lesion characterization (osteolytic, osteoblastic, or unchanged) were evaluated. Metastases were confirmed via either histopathology or ≥ 6-month imaging follow-up. Diagnostic sensitivity, specificity, accuracy, and metastatic patterns were analyzed at patient level.</p><h3>Results</h3><p>A total of 16 patients were confirmed metastasis. The median interval from surgery to metastasis was 20.3 months (range 1–100 months), with 56.3% (9/16) occurring within the first postoperative year. PET/CT detected metastases in 13 patients, missed metastases in 3 patients (2 with small preauricular lymph nodes and 1 with tiny pulmonary metastases), and misdiagnosed 1 patient with parotid benign nodules as metastatic. PET/CT demonstrated a sensitivity of 81.3%, specificity of 98.0%, and accuracy of 94.0%. The most common metastatic sites included lymph nodes (62.5%), bone (37.5%), lung (31.3%), and liver (25.0%), with PET/CT demonstrating detection rates of 95.5%, 100%, 86.7%, and 100%, respectively. PET/CT also identified metastases in rare sites, including the thyroid, cerebellum, adrenal glands, pericardium, pancreas, and subcutaneous/soft tissue. Lymph node metastases in CM predominately occurred in ipsilateral regional nodes (90.1%), with rare bilateral involvement (9.1%). Metastatic lymph nodes in the cervical and submandibular regions showed significantly higher mean SUVmax (11.6 ± 10.5 vs. 2.9 ± 0.9; <i>p</i> = 0.005) and T/NT ratios (6.9 ± 8.2 vs. 3.0 ± 1.0; <i>p</i> = 0.011) compared to inflammatory lymph nodes. SUVmax of metastatic lymph nodes, lung metastases, and liver metastases showed positive correlations with lesion size (<i>p</i> < 0.05 for all). Among metastatic lymph nodes, 53.2% had a short-axis diameter < 10 mm, and 59.1% of bone metastases exhibited no abnormal CT density.</p><h3>Conclusion</h3><p><sup>18</sup>F-FDG PET/CT provides high diagnostic accuracy in detecting systemic metastases of CM during follow-up assessments, particularly for small lymph nodes, early bone metastases, and uncommon sites.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1337 - 1346"},"PeriodicalIF":2.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amyloid-β (Aβ) aggregates have been recognized as therapeutic targets for Alzheimer’s disease (AD). Targeted alpha therapy (TAT) using α-particles has the potential to be applied as a novel treatment approach for AD by reducing the quantity of Aβ aggregates. In this study, we developed a novel astatine-211-labeled pyridyl benzofuran (PBF) derivative, [211At]APBF-2, as a small molecule-based Aβ-TAT agent and evaluated its potential for in vivo use.
Methods
[211At]APBF-2 was synthesized in a one-step astatination process using the tributyltin precursor. In the Aβ aggregation inhibition assay, [211At]APBF-2 was added to a sample containing Aβ1–42 monomers and thioflavin-T (ThT) and the mixture was incubated for 24 h. The quantity of Aβ aggregates was evaluated by measuring ThT fluorescence intensity. The biodistribution of [211At]APBF-2 (25 kBq/100 μL) was evaluated using ddY mice (n = 5).
Results
[211At]APBF-2 was synthesized in radiochemical yield of 57% with a radiochemical purity of over 95%. In the in vitro assay, [211At]APBF-2 showed a dose-dependent decrease in ThT fluorescence intensity, suggesting the ability of [211At]APBF-2 to inhibit Aβ aggregation. In the biodistribution study using normal mice, the initial brain uptake of [211At]APBF-2 was observed (2.95% injected dose/g at 2 min), demonstrating favorable Blood–brain barrier permeability.
Conclusions
These results suggest the feasibility of using [211At]APBF-2 as an Aβ-TAT agent for in vivo applications.
{"title":"Feasibility of targeted alpha therapy for Alzheimer’s disease using 211At-labeled agent targeting amyloid-β aggregates","authors":"Rikuto Kashiyama, Hiroyuki Watanabe, Takahiro Akasaka, Hiroyuki Fujimoto, Masashi Murakami, Kazuhiro Ooe, Atsushi Toyoshima, Kazuma Nakashima, Masahiro Ono","doi":"10.1007/s12149-025-02095-8","DOIUrl":"10.1007/s12149-025-02095-8","url":null,"abstract":"<div><h3>Objective</h3><p>Amyloid-β (Aβ) aggregates have been recognized as therapeutic targets for Alzheimer’s disease (AD). Targeted alpha therapy (TAT) using α-particles has the potential to be applied as a novel treatment approach for AD by reducing the quantity of Aβ aggregates. In this study, we developed a novel astatine-211-labeled pyridyl benzofuran (PBF) derivative, [<sup>211</sup>At]APBF-2, as a small molecule-based Aβ-TAT agent and evaluated its potential for in vivo use.</p><h3>Methods</h3><p>[<sup>211</sup>At]APBF-2 was synthesized in a one-step astatination process using the tributyltin precursor. In the Aβ aggregation inhibition assay, [<sup>211</sup>At]APBF-2 was added to a sample containing Aβ<sub>1–42</sub> monomers and thioflavin-T (ThT) and the mixture was incubated for 24 h. The quantity of Aβ aggregates was evaluated by measuring ThT fluorescence intensity. The biodistribution of [<sup>211</sup>At]APBF-2 (25 kBq/100 μL) was evaluated using ddY mice (<i>n</i> = 5).</p><h3>Results</h3><p>[<sup>211</sup>At]APBF-2 was synthesized in radiochemical yield of 57% with a radiochemical purity of over 95%. In the in vitro assay, [<sup>211</sup>At]APBF-2 showed a dose-dependent decrease in ThT fluorescence intensity, suggesting the ability of [<sup>211</sup>At]APBF-2 to inhibit Aβ aggregation. In the biodistribution study using normal mice, the initial brain uptake of [<sup>211</sup>At]APBF-2 was observed (2.95% injected dose/g at 2 min), demonstrating favorable Blood–brain barrier permeability.</p><h3>Conclusions</h3><p>These results suggest the feasibility of using [<sup>211</sup>At]APBF-2 as an Aβ-TAT agent for in vivo applications.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1319 - 1325"},"PeriodicalIF":2.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1007/s12149-025-02098-5
Romain-David Seban, Louis Rebaud, Lounes Djerroudi, Anne Vincent-Salomon, Francois-Clement Bidard, Laurence Champion, Irene Buvat
Objective
Tumor-infiltrating lymphocytes (TILs) are key immune biomarkers associated with prognosis and treatment response in early-stage breast cancer (BC), particularly in the triple-negative subtype. This study aimed to evaluate whether [18F]FDG PET/CT imaging and routine cell blood count (CBC)-derived biomarkers can serve as non-invasive surrogates for TILs, using machine-learning models.
Material and methods
We retrospectively analyzed 358 patients with biopsy-proven early-stage invasive BC who underwent pre-treatment [18F]FDG PET/CT imaging. PET-derived biomarkers were extracted from the primary tumor, lymph nodes, and lymphoid organs (spleen and bone marrow). CBC-derived biomarkers included neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). TILs were assessed histologically and categorized as low (0–10%), intermediate (11–59%), or high (≥ 60%). Correlations were assessed using Spearman’s rank coefficient, and classification and regression models were built using several machine-learning algorithms.
Results
Tumor SUVmax and tumor SUVmean showed the highest correlation with TIL levels (ρ = 0.29 and 0.30 respectively, p < 0.001 for both), but overall associations between TILs and PET or CBC-derived biomarkers were weak. No CBC-derived biomarker showed significant correlation or discriminative performance. Machine-learning models failed to predict TIL levels with satisfactory accuracy (maximum balanced accuracy = 0.66). Lymphoid organ metrics (SLR, BLR) and CBC-derived parameters did not significantly enhance predictive value.
Discussion
In this study, neither [18F]FDG PET/CT nor routine CBC-derived biomarkers reliably predict TILs levels in early-stage BC. This observation was made in presence of potential scanner-related variability and for a restricted set of usual PET metrics. Future models should incorporate more targeted imaging approaches, such as immunoPET, to non-invasively assess immune infiltration with higher specificity and improve personalized treatment strategies.
{"title":"Are [18F]FDG PET/CT imaging and cell blood count-derived biomarkers robust non-invasive surrogates for tumor-infiltrating lymphocytes in early-stage breast cancer?","authors":"Romain-David Seban, Louis Rebaud, Lounes Djerroudi, Anne Vincent-Salomon, Francois-Clement Bidard, Laurence Champion, Irene Buvat","doi":"10.1007/s12149-025-02098-5","DOIUrl":"10.1007/s12149-025-02098-5","url":null,"abstract":"<div><h3>Objective</h3><p>Tumor-infiltrating lymphocytes (TILs) are key immune biomarkers associated with prognosis and treatment response in early-stage breast cancer (BC), particularly in the triple-negative subtype. This study aimed to evaluate whether [18F]FDG PET/CT imaging and routine cell blood count (CBC)-derived biomarkers can serve as non-invasive surrogates for TILs, using machine-learning models.</p><h3>Material and methods</h3><p>We retrospectively analyzed 358 patients with biopsy-proven early-stage invasive BC who underwent pre-treatment [18F]FDG PET/CT imaging. PET-derived biomarkers were extracted from the primary tumor, lymph nodes, and lymphoid organs (spleen and bone marrow). CBC-derived biomarkers included neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). TILs were assessed histologically and categorized as low (0–10%), intermediate (11–59%), or high (≥ 60%). Correlations were assessed using Spearman’s rank coefficient, and classification and regression models were built using several machine-learning algorithms.</p><h3>Results</h3><p>Tumor SUVmax and tumor SUVmean showed the highest correlation with TIL levels (ρ = 0.29 and 0.30 respectively, p < 0.001 for both), but overall associations between TILs and PET or CBC-derived biomarkers were weak. No CBC-derived biomarker showed significant correlation or discriminative performance. Machine-learning models failed to predict TIL levels with satisfactory accuracy (maximum balanced accuracy = 0.66). Lymphoid organ metrics (SLR, BLR) and CBC-derived parameters did not significantly enhance predictive value.</p><h3>Discussion</h3><p>In this study, neither [18F]FDG PET/CT nor routine CBC-derived biomarkers reliably predict TILs levels in early-stage BC. This observation was made in presence of potential scanner-related variability and for a restricted set of usual PET metrics. Future models should incorporate more targeted imaging approaches, such as immunoPET, to non-invasively assess immune infiltration with higher specificity and improve personalized treatment strategies.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1347 - 1358"},"PeriodicalIF":2.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1007/s12149-025-02091-y
Jinchuan Chen, Qian Wang, Yuan Li, Junxian Song
Objective
To analyze the imaging characteristics of FDG PET/CT in pericardial effusions from various etiologies and evaluate its diagnostic utility for differentiating these etiologies.
Methods
A retrospective analysis was conducted on 71 patients who underwent FDG PET/CT imaging for etiological diagnosis of pericardial effusion from 2014 to 2024 in our hospital. Clinical, laboratory, and imaging data from FDG PET/CT were evaluated to characterize pericardial effusions attributable to malignant conditions, bacterial infections, other benign etiologies, and idiopathic causes, thus assessing the diagnostic efficacy of FDG PET/CT.
Results
Pericardial lesions exhibited significant thickening and markedly increased FDG uptake in 89.5% of malignant cases and 77.8% of bacterial infection cases. When integrated with extrapericardial imaging findings, FDG PET/CT directly identified the underlying etiology in 68.4% of malignant and 44.4% of bacterial infection cases. Employing an integrated "clinical-laboratory-imaging" diagnostic approach, the positive diagnostic rate of FDG PET/CT increased to 56.3%, and FDG PET/CT was able to achieve etiologically suggestive imaging diagnoses in 100% of malignant cases, 77.8% of bacterial cases, and 47.8% overall. Ultimately, FDG PET/CT contributed to clinical management in 88.7% of patients.
Conclusion
FDG PET/CT is valuable for the etiological diagnosis of pericardial effusions. Developing a comprehensive "clinical-laboratory-imaging" diagnostic model can substantially enhance the effectiveness of FDG PET/CT in determining the underlying causes of pericardial effusion.
{"title":"Diagnostic value of FDG PET/CT in determining the etiology of pericardial effusion","authors":"Jinchuan Chen, Qian Wang, Yuan Li, Junxian Song","doi":"10.1007/s12149-025-02091-y","DOIUrl":"10.1007/s12149-025-02091-y","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the imaging characteristics of FDG PET/CT in pericardial effusions from various etiologies and evaluate its diagnostic utility for differentiating these etiologies.</p><h3>Methods</h3><p>A retrospective analysis was conducted on 71 patients who underwent FDG PET/CT imaging for etiological diagnosis of pericardial effusion from 2014 to 2024 in our hospital. Clinical, laboratory, and imaging data from FDG PET/CT were evaluated to characterize pericardial effusions attributable to malignant conditions, bacterial infections, other benign etiologies, and idiopathic causes, thus assessing the diagnostic efficacy of FDG PET/CT.</p><h3>Results</h3><p>Pericardial lesions exhibited significant thickening and markedly increased FDG uptake in 89.5% of malignant cases and 77.8% of bacterial infection cases. When integrated with extrapericardial imaging findings, FDG PET/CT directly identified the underlying etiology in 68.4% of malignant and 44.4% of bacterial infection cases. Employing an integrated \"clinical-laboratory-imaging\" diagnostic approach, the positive diagnostic rate of FDG PET/CT increased to 56.3%, and FDG PET/CT was able to achieve etiologically suggestive imaging diagnoses in 100% of malignant cases, 77.8% of bacterial cases, and 47.8% overall. Ultimately, FDG PET/CT contributed to clinical management in 88.7% of patients.</p><h3>Conclusion</h3><p>FDG PET/CT is valuable for the etiological diagnosis of pericardial effusions. Developing a comprehensive \"clinical-laboratory-imaging\" diagnostic model can substantially enhance the effectiveness of FDG PET/CT in determining the underlying causes of pericardial effusion.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 12","pages":"1297 - 1305"},"PeriodicalIF":2.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Theranostics, a novel integrated approach that combines cancer diagnosis and therapy by switching the radionuclide, has attracted growing attention. Various oncology PET probes other than FDG have been developed for the highly sensitive and precise detection of many types of cancer with the advancements in PET scanners, supporting the innovative development in theranostics. In therapeutic applications, radioligand therapy targeting somatostatin receptors (SSTR) and prostate-specific membrane antigen (PSMA) has already demonstrated significant clinical benefits. Terbium-161 (161Tb) has emerged as a new beta and Auger electron emitter, showing greater therapeutic efficacy compared to 177Lu. Alpha emitters, such as astatine (211At), are currently being evaluated in investigator-initiated clinical trials, with preliminary efficacy data reported for [211At]NaAt in patients with radioiodine-refractory thyroid cancer. Novel pan-tumor targeting agents, such as TROP-2, Nectin-4, LAT1, GPC-1, and EphA2, are also under development, and clinical translation of radioligand therapy is anticipated. These innovations in theranostics are expected to further broaden the scope of precision medicine in oncology.
{"title":"Recent advances in theranostics and oncology PET: emerging radionuclides and targets","authors":"Tadashi Watabe, Kenji Hirata, Mami Iima, Masahiro Yanagawa, Tsukasa Saida, Akihiko Sakata, Satoru Ide, Maya Honda, Ryo Kurokawa, Kentaro Nishioka, Mariko Kawamura, Rintaro Ito, Koji Takumi, Seitaro Oda, Shunsuke Sugawara, Keitaro Sofue, Daiju Ueda, Shinji Naganawa","doi":"10.1007/s12149-025-02090-z","DOIUrl":"10.1007/s12149-025-02090-z","url":null,"abstract":"<div><p>Theranostics, a novel integrated approach that combines cancer diagnosis and therapy by switching the radionuclide, has attracted growing attention. Various oncology PET probes other than FDG have been developed for the highly sensitive and precise detection of many types of cancer with the advancements in PET scanners, supporting the innovative development in theranostics. In therapeutic applications, radioligand therapy targeting somatostatin receptors (SSTR) and prostate-specific membrane antigen (PSMA) has already demonstrated significant clinical benefits. Terbium-161 (<sup>161</sup>Tb) has emerged as a new beta and Auger electron emitter, showing greater therapeutic efficacy compared to <sup>177</sup>Lu. Alpha emitters, such as astatine (<sup>211</sup>At), are currently being evaluated in investigator-initiated clinical trials, with preliminary efficacy data reported for [<sup>211</sup>At]NaAt in patients with radioiodine-refractory thyroid cancer. Novel pan-tumor targeting agents, such as TROP-2, Nectin-4, LAT1, GPC-1, and EphA2, are also under development, and clinical translation of radioligand therapy is anticipated. These innovations in theranostics are expected to further broaden the scope of precision medicine in oncology.</p></div>","PeriodicalId":8007,"journal":{"name":"Annals of Nuclear Medicine","volume":"39 9","pages":"909 - 921"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12149-025-02090-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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