Nuklearmedizin. Nuclear medicine最新文献

Digitalization in the healthcare sector is becoming increasingly widespread. Yet, the degree of digitalization in nuclear medicine has not been systematically investigated. The "Digitalization and AI" working group of the German Society of Nuclear Medicine conducted a survey to assess the status quo of digitalization of the nuclear medicine health infrastructure in Germany.100 questions were defined on eleven topics covering the main work processes in nuclear medicine. The survey primarily included single-select multiple-choice questions, yes-no questions on the availability of specific digital structures and processes, and questions assessing the degree of digitalization of certain processes and current satisfaction. The level of satisfaction was measured with an ordinal scale (1, very good to 5, poor).In most subject areas, processes relied on a combination of paper-based and electronic procedures for the topics analyzed. Differences in satisfaction regarding the different types of processes for any of the questions were not observed, and the overall level of satisfaction among responding sites was quite high.The survey did not reveal a clear need of the responding sites for complete digitalization of clinical processes. Yet, the participants highlighted the lack of proper Wi-Fi (60%) and the desire for a platform for communication between hospitals, registered doctors and patients (74%). Nevertheless, it is important to take a focused and unbiased look at the daily clinical procedures in every institution and place it in the frame of the existing tools or solutions of peer institutions to discover aspects of digitalization that can create added value in terms of time efficiency, integrity and sustainability.

The gold standard for ruling out distant metastases as part of primary staging in lung cancer is whole-body ¹⁸F-FDG-PET/CT, but this method is resource-intensive. Recent evidence suggests that examining only the thorax and upper abdomen may be sufficient 1 2 3. If a limited ¹⁸F-FDG-PET/CT approach proves effective for proper staging, it could lead to quicker examinations and reduced radiation exposure. This study aimed to determine whether limited ¹⁸F-FDG-PET/CT is adequate for the primary staging of lung cancer.In this study, a retrospective analysis of 161 patients (87 men, 74 women; age range 31-88 y) with recent or suspected lung cancer who had undergone a whole-body ¹⁸F-FDG-PET/CT examination for primary staging at our clinic between 2018 and 2022 was conducted. None of these patients showed evidence of extrathoracic metastases before the ¹⁸F-FDG-PET/CT examination. The images were divided into three regions: "head-neck" (HN), "thorax-upper abdomen" (TUA), and "lower abdomen-hip" (LAH). TNM staging based on the HN plus TUA region was compared with TNM staging based on the whole body.Among the 161 subjects, 7 (4%) showed malignancy-suspect lesions in HN, 110 (68%) in TUA and 7 (4%) had suspected distant metastases in LAH. The TNM staging based on HN plus TUA corresponded to TNM staging based on the whole body in 161 (100%) examinations. This finding aligns with similar results in previous literature. ¹⁸F-FDG-PET/CT limited to HN and TUA yielded accurate staging in all cases. Adopting this method could facilitate the examination and correct staging of more individuals, reducing exam waiting times and physician reporting time and minimising radiation exposure.

Despite new therapies, castration-resistant prostate cancer (CRPC) is still incurable. Intercellular Adhesion Molecule 1 (ICAM-1) is a well-characterized cell surface protein involved in prostate cancer pathogenesis, differentially expressed during transition from hormone-sensitive to CRPC. This study aimed to investigate ICAM-1 as a target for imaging and radioimmunotherapy of CRPC.Anti-ICAM-1 antibody R6.5 was labeled with ¹¹¹In or ¹⁷⁷Lu, and a non-specific antibody with ¹⁷⁷Lu. In vitro uptake of R6.5 was tested in PC-3 prostate cancer cells. Biodistribution studies, SPECT/CT imaging, and autoradiography were performed in a PC-3 xenograft model.In vitro uptake of R6.5 ([¹⁷⁷Lu]Lu-R6.5) increased during 6 h of incubation. The uptake was higher at lower mAb concentration and could be blocked by 500 nM of unlabeled R6.5. In vivo and ex vivo biodistribution showed that [¹¹¹In]In-R6.5 and [¹⁷⁷Lu]Lu-R6.5 targeted the xenograft tumors better than the control Ab, however [¹¹¹In]In-R6.5 had better tumor uptake than [¹⁷⁷Lu]Lu-R6.5, probably due to less aggressive conjugation with chelator and smaller tumor sizes. From 24 h post-injection, the tumors in mice injected with [¹¹¹In]In-R6.5 and [¹⁷⁷Lu]Lu-R6.5 were visible on SPECT, optimal contrast at 48 h. Uptake was low in normal organs except the spleen and liver for all mAbs. Autoradiography showed [¹¹¹In]In-R6.5 and [¹⁷⁷Lu]Lu-R6.5 accumulated along the edges of viable tumor. The control Ab tended to accumulate in partly necrotic areas.This study demonstrates ICAM-1 as a potential target for theragnostics in CRPC.

In this study, standard 2D lung lobe quantification is compared with two 3D lung lobe quantification software tools to investigate the clinical benefit of a 3D approach. The accuracy of 2D versus 3D lung lobe quantification is evaluated based on the calculated numerical ventilation-perfusion ratio (VQR) using a receiver operating curve (ROC) analysis.A study group of 50 consecutive patients underwent a planar lung scintigraphy (anterior/posterior) as well as ventilation/perfusion single photon emission computed tomography (SPECT/CT) to exclude acute pulmonary embolism. All data were acquired with SPECT OPTIMA NM/CT 640 (GE Healthcare). 2D analysis was performed for all ventilation/perfusion scans using a lung analysis tool (Syngo Workstation, Siemens Healthineers). 3D quantification analysis was performed using QLUNG (Q. Lung, Xeleris 4.0, GE Healthcare) and LLQ (Hermes Hybrid 3D Lung Lobar Quantification, Hermes Medical Solutions). The area under the ROC curve (AUC) served as a decision criterion to find the best agreement between clinical PE findings and calculated PE candidates of the 2D and 3D methods. The significance of the ROC curves was evaluated using the DeLong comparison.A significant difference between 2D/3D could be determined. Both 3D approaches showed robust and comparable results. The AUC range of [0.10, 0.67] was given for 2D lobar analysis, QLUNG AUC range revealed in [0.39,0.74] and LLQ AUC range was [0.42,0.72]. Averaged over all lung lobes an AUC=0.39 was given for 2D analysis and AUC=0.58 was given for LLQ/QLUNG.We could demonstrate the better performance of 3D analysis compared to 2D analysis. Consequently, is recommended to use a 3D approach in clinical practice.

This study aims to evaluate the prognostic significance of various previously reported PSMA-PET parameters in patients undergoing ¹⁷⁷Lu-PSMA radioligand therapy (RLT). While individual studies have investigated the prognostic value of one or few of these factors, comprehensive analyses are rare.Data of 82 patients undergoing ¹⁷⁷Lu-PSMA-radiologand-therapy (RLT) were analyzed. Total tumor volume (tumor volume), average SUVmean of all tumor lesions (SUVmean) and the quotient of sum of SUVmean of all tumor lesions to SUVmean of the parotid glands (tumor-parotid-ratio; TPR) and of the kidneys (tumor-kidney-ratio; TKR) were included in analysis.This study showed that a tumor volume of <290.6 ml is associated with a better survival in patients undergoing PSMA-RLT (median PFS: 4.2, median OS: 13.2 months) compared to patients with higher tumor volume (median PFS: 3.4,median OS: 6.2 months; p-value = 0.01 for PFS and <0.001 for OS). The average SUVmean correlated inversely with survival. Patients with a SUVmean > 10.7 had a median PFS of 4.2 and OS of 11.4 months while patients with SUVmean <10.7 had a median PFS of 1.6 and OS of 5 months (p-value <0.001 for both). The assessment of TPR showed no significant difference regarding OS and PFS. TKR showed a better PFS in patients with ratio > 0.33 (p-value 0.009) but no significant difference regarding OS.The present study confirms that pretherapeutic PSMA-PET before RLT with ¹⁷⁷Lu-PSMA has a prognostic value.

The early diagnosis of atherosclerotic changes to prevent ischemic events represents a clinical challenge.Prostate-specific membrane antigen (PSMA) as an established diagnostic in the field of prostate cancer also appears to detect neovascularization and inflammation in other diseases. We hypothesized that it might be also suited for detection of inflammation in atherosclerosis.We analyzed data of 78 prostate cancer patients who received a PSMA ligand PET/CT for re-staging. The cardiovascular risk factors (CVRF) of each patient were documented. Target-to-background-ratios (TBR) were calculated from the individual uptake values for three different sections of thoracic aorta [ascending (AA) and descending aorta (AD), aortic arch (AoAC)]. Statistical analyses included a linear regression analysis with the PSMA ligand uptake values of the different arterial segments versus different CVRF as independent variables.The meanTBRmax was measured highest in the AoAC (1.66 ± 0.33) compared to both other vessel sections (AA: 1.46 ± 0.21, p=0.001; AD: 1.59 ± 0.41, p=0.371). There was a correlation between the PSMA ligand uptake in all measured segments of the aorta and BMI, but only a significant correlation in the ascending aorta (r=0.347, p=0.001). This was confirmed in a subgroup analysis, which showed significantly higher uptake values in preadiposity (BMI >25) and obesity (BMI >30) patients in the ascending aorta (p=0.048).PSMA ligand uptake in the ascending aorta was linked to BMI. PET detection of vascular PSMA ligand uptake may be indicative of vessel wall inflammation to some extent. However, PSMA ligands appear to be less suitable than other tracers for this purpose, given their absent correlation with most established CVRFs.