Álvarez Mena N, Gómez Hidalgo J, Fierro Alanis MP
… +10 more, García-Talavera San Miguel P, Roteta Unceta Barrenechea A, Menéndez Sánchez S, Montalvá Pastor JE, Badell Martínez JA, Peñaherrera Cepeda AC, Carrera Salazar D, Quincoces Fernández G, Rodríguez-Fraile M, en nombre del Grupo de Oncología de la SEMNIM
Rev Esp Med Nucl Imagen Mol (Engl Ed)
· 2026 Feb · PMID 41720214
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This article critically reviews the available evidence on the role of PSMA-PET in evaluating therapeutic response in metastatic prostate cancer (mPC), comparing it with conventional criteria -serum PSA levels, Response E...This article critically reviews the available evidence on the role of PSMA-PET in evaluating therapeutic response in metastatic prostate cancer (mPC), comparing it with conventional criteria -serum PSA levels, Response Evaluation Criteria in Solid Tumours (RECIST 1.1), Prostate Cancer Working Group 3 (PCWG3)- and analyzing its integration into clinical practice. It addresses the biological basis of PSMA and how different treatments -androgen deprivation therapy (ADT), androgen receptor pathway inhibitors (ARPI), taxanes, [¹⁷⁷Lu]Lu-PSMA-617, [²²³Ra], stereotactic body radiotherapy (SBRT)- modulate its expression, which influences image interpretation and phenomena such as flare. This work describes specific assessment systems for PSMA-PET, including PSMA PET Progression Criteria (PPP), Response Evaluation Criteria in PSMA (RECIP 1.0), and EAU/EANM criteria, highlighting their superior prognostic value compared to RECIST and PCWG3, especially in metastatic castration-resistant prostate cancer (mCRPC). RECIP 1.0, initially validated for [¹⁷⁷Lu]Lu-PSMA-617, has demonstrated robust correlation with overall survival and interobserver reproducibility, improving risk stratification when combined with PSA. Quantitative parameters such as PSMA-VOL and TLP, key biomarkers for monitoring response and predicting outcomes, are analyzed. Furthermore, the evidence is reviewed by therapeutic modality, proposing practical recommendations on the optimal timing for PSMA-PET (baseline, intermediate, or delayed depending on treatment) and the need for standardized reporting (PROMISE, E-PSMA). The article also identifies current limitations: variability among radiopharmaceuticals, a lack of universal criteria, a scarcity of prospective studies, and challenges in multimodal integration with PSA and other biomarkers.
Non-invasive techniques for the evaluation of myocardial perfusion provide key functional information for the diagnosis of coronary disease and the stratification of risk in ischemic cardiopathy. Nonetheless, despite the...Non-invasive techniques for the evaluation of myocardial perfusion provide key functional information for the diagnosis of coronary disease and the stratification of risk in ischemic cardiopathy. Nonetheless, despite their adequate diagnostic performance, the myocardial perfusion images present limitations in the detection of balanced ischemia due to multivessel disease and in the assessment of microvascular pathology. Evaluation of the parameters of myocardial blood flow (MBF) and myocardial flow reserve may be useful in cases in which the technique is limited due to balanced coronary disease or in patients with healthy coronary arteries and suspicion of microvascular involvement. The greater spatial resolution and energy and greater sensitivity of the new generation cadmium-zinc-telluride gamma cameras compared to conventional equipment allow isotopic evaluation by single photon emission computed tomography of microvascular disease, which, previously, was mainly evaluated with the gold standard technique of positron emission tomography. The aim of this article of collaboration is to describe the protocol for the quantification of MBF developed by the Department of Nuclear Medicine of the Hospital Vall d'Hebron using a cardio-dedicated gamma camera (MyoSPECT™- GE HealthCare), highlighting the particularities of the acquisition of post-processing of the images as well as the possible artifacts.
PURPOSE: This study retrospectively evaluated the relationship between disease stage and metabolic parameters, along with asphericity, derived from F-FDG PET/CT images in patients with Small Cell Lung Cancer (SCLC). METH...PURPOSE: This study retrospectively evaluated the relationship between disease stage and metabolic parameters, along with asphericity, derived from F-FDG PET/CT images in patients with Small Cell Lung Cancer (SCLC). METHODS: We analyzed primary tumor metabolic parameters, including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), as well as Asphericity (ASP). Disease staging was determined from F-FDG PET/CT images as either limited-stage (LS) or extensive-stage (ES). Statistical analyses assessed the correlation among these metabolic parameters and ASP, their relationship with disease stage, their ability to predict disease stage. RESULTS: The study included 134 SCLC patients (mean age: 62.3; 112 males, 22 females). Of these, 61.2% had ES and 38.8% had LS disease. MTV, TLG, and ASP values were significantly higher in the ES group than in the LS group (p < 0.001). In the multivariate binary logistic regression analysis, Age (p = 0.025), Gender (p = 0.033), and ASP (p = 0.001) were identified as independent predictors of disease stage. Notably, a one-unit increase in ASP was associated with a 6.35-fold increase in the likelihood of Extensive-Stage disease (OR = 6.350). In ROC analysis, MTV, TLG, and ASP significantly distinguished disease stages (p < 0.001) with optimal cut-off values of 45.05, 382.81, and 0.536, respectively. CONCLUSION: Relying solely on SUVmax for SCLC patient evaluation may be insufficient. Incorporating other metabolic parameters like MTV and TLG, in addition to ASP, which was identified as a strong independent predictor, may enhance the understanding of tumor behavior during staging. These additional parameters can significantly aid in comprehensive patient assessment.
Cases-Pellisé C, Villa Palacios JL, Álvarez-Pérez RM
… +8 more, Triviño-Ibáñez EM, Brero Sánchez L, Pachón Garrudo V, Cejudo Liébana I, Sánchez Sánchez R, Jiménez-Hoyuela García JM, Freire-Macías JM, Rodríguez-Fernández A
Rev Esp Med Nucl Imagen Mol (Engl Ed)
· 2026 Jan · PMID 41485606
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OBJECTIVE: To analyze the impact of [18F]F-Choline PET/CT findings on therapeutic management compared to conventional imaging techniques in the high-risk prostate cancer (PC) staging. MATERIALS AND METHODS: Observational...OBJECTIVE: To analyze the impact of [18F]F-Choline PET/CT findings on therapeutic management compared to conventional imaging techniques in the high-risk prostate cancer (PC) staging. MATERIALS AND METHODS: Observational, longitudinal and retrospective study including patients with high-risk PC who underwent a [18F]F-choline PET/CT after initial staging with conventional imaging techniques (bone scan and abdomen-pelvis CT) between January 2018 and December 2023. Findings were classified as limited disease (lymph node involvement in pelvis and/or axial skeleton) or extended disease (extrapelvic lymph node involvement, involvement of extra-axial skeleton and/or distant sites). Finally, the impact of the results on therapeutic management and on disease volume reclassification (CHAARTED criteria) was analyzed. RESULTS: One hundred and nineteen patients were included (mean age: 68.43 ± 9.33 years, diagnostic prostate-specific antigen 64.22 ± 159.40 ng/mL). [18F]F-choline PET/CT was positive in 71.4% of patients (50.4% with limited disease and 21.0% with extended disease) versus 21.2% detected by conventional techniques (P < .001). Based on PET findings, 18% of patients had high-volume disease compared to 5% based on conventional imaging (P = .002). [18F]F-choline PET/CT findings led to a change in therapeutic management in 54 patients (45.4%). Among them, 11 (9.2%) received radiotherapy to the pelvic lymph nodes, 14 patients (11.8%) hormone therapy, 23 patients (19.3%) were candidates for therapy with new antiandrogens, and 6 cases (5%) received systemic chemotherapy. CONCLUSION: [18F]F-choline PET/CT is superior to conventional imaging techniques in high-risk prostate cancer staging, detecting 18% of patients with high-volume disease and leading to a change in therapeutic management in 45% of cases. CRITICAL RELEVANCE STATEMENT: [18F]F-choline PET/CT is superior to conventional imaging techniques in high-risk prostate cancer staging.
Lojo-Ramírez JA, Rodríguez-Vergara CA, Fernández-Rodríguez P
… +5 more, Guerra-Gómez M, Marín Cabañas AM, Jiménez-Hoyuela García JM, Franco-Macías E, García-Solís D
OBJETIVE: The detection of amyloid deposition has become a pivotal element in the diagnostic workup of Alzheimer's disease (AD). Among the available PET radiotracers, [F]Florbetaben has proven to be a reliable tool for i...OBJETIVE: The detection of amyloid deposition has become a pivotal element in the diagnostic workup of Alzheimer's disease (AD). Among the available PET radiotracers, [F]Florbetaben has proven to be a reliable tool for identifying amyloid-beta plaques, validated through both clinical assessments and histopathological correlation. This study aimed to assess the diagnostic accuracy and reliability of two key imaging methods: visual interpretation and semi-quantitative analysis using the Centiloid (CL) scale. METHODS: We included 208 patients who were attended at the outpatient Memory Clinic of a tertiary hospital, with mild cognitive impairment or mild dementia, suspected of AD. We performed receiver-operating-characteristic (ROC) analyses to compare the discriminative power of visual and quantification between AD and non-AD patients, characterized through the previously established standard of truth (SoT) as clinical follow-up. RESULTS: A total of 198 cases (95.0%) demonstrated concordance between both diagnostic methods (visual and CL-based quantification) and the SoT, with a weighted kappa coefficient k = 0.903 (p < 0.001), indicating almost perfect agreement. When comparing visual diagnosis to the SoT, the sensitivity was 96.8%, specificity was 96.5%, and diagnostic accuracy was 96.6%. Both approaches exhibited excellent diagnostic performance, effectively correlating with the final clinical diagnoses. CONCLUSION: Our findings highlight that both visual assessment and semi quantitative analysis are reliable tools for the detection and monitoring of amyloid deposition in AD, particularly for early diagnosis and disease progression tracking.
OBJECTIVE: To construct and validate a model for predicting lymph node metastasis (LNMs) of gastric cancer (GC) based on 18F-FDG PET/CT multi-parameter data and multiple machine learning (ML) algorithms. METHODS: We cond...OBJECTIVE: To construct and validate a model for predicting lymph node metastasis (LNMs) of gastric cancer (GC) based on 18F-FDG PET/CT multi-parameter data and multiple machine learning (ML) algorithms. METHODS: We conducted a retrospective analysis of clinical records and 18F-FDG PET/CT images from 167 GC patients treated with radical gastrectomy. The dataset was randomly divided into two cohorts (training and validation cohort) with a ratio of 7:3. Seven machine learning algorithms were used to develop models. The model's performance was evaluated using metrics such as the receiver operating characteristic curve (ROC), sensitivity, specificity, accuracy, negative and positive predictive value, F1 score, calibration curve, and decision curve. Shapley Additive Explanations (SHAP) analysis was conducted to determine feature importance and enhance model interpretability. Additionally, Kaplan-Meier analysis was used to evaluate the prognosis of GC patients. RESULTS: The Artificial Neural Network algorithm(ANN)model outperformed other algorithms in the validation set, with an AUC of 0.814 (95% CI: 0.707-0.921), a sensitivity of 0.872, a specificity of 0.500 and an accuracy of 0.784. Both calibration and decision curve analyses demonstrated excellent calibrated ability and favorable clinical applicability. Through SHAP method, tumor invasion depth (clinical T stage), platelet count (PLT), and total lesion glycolysis (TLG) emerged as the most influential predictors in the ML model. Furthermore, the model exhibited robust risk stratification capability for overall survival (OS). CONCLUSION: The ML model utilizing 18F-FDG PET/CT metabolic parameters showed good efficacy and reliability in predicting LNS preoperatively in GC patients.
This work presents the key aspects of the sentinel lymph node biopsy (SLNB) procedure in breast cancer, based on the protocol used at Hospital Clínic de Barcelona. The aim is to facilitate its generalization in other hos...This work presents the key aspects of the sentinel lymph node biopsy (SLNB) procedure in breast cancer, based on the protocol used at Hospital Clínic de Barcelona. The aim is to facilitate its generalization in other hospital settings and training environments, promoting the standardization of the technique. It is also intended to serve as a useful resource for resident physicians and other medical trainees.
INTRODUCTION: Transarterial radioembolization (TARE) using holmium-166 (¹⁶⁶Ho) microspheres is a treatment for unresectable primary and secondary liver malignancies. The pre-therapeutic simulation procedure using a scout...INTRODUCTION: Transarterial radioembolization (TARE) using holmium-166 (¹⁶⁶Ho) microspheres is a treatment for unresectable primary and secondary liver malignancies. The pre-therapeutic simulation procedure using a scout dose is critical to predict microsphere distribution and exclude extrahepatic leakage. This single-center observational study aimed to evaluate the dosimetric agreement between ¹⁶⁶Ho-scout and ¹⁶⁶Ho-therapy, and to correlate tumor-absorbed dose with treatment response at both tumor and patient levels. METHODS: Prospective, observational study included patients with BCLC 2022 stage A/B hepatocellular carcinoma or oligometastatic liver disease undergoing ¹⁶⁶Ho-TARE were included. Voxel-based dosimetry was performed using Q-suite. Contrast-enhanced CT was acquired 3 months post-treatment. Treatment response was assessed by RECIST/mRECIST criteria. RESULTS: Twenty patients underwent the pre-treatment procedure; 18 proceeded to therapy. No significant differences were observed between scout and therapy procedures in whole-liver (P=.331) and tumor doses (P=.063), indicating reliable pre-therapeutic evaluation. Fourteen patients with 16 treated lesions were included in the dose-response analysis (median volume: 22,1 [10,5-80,3]mL; dose: 22,1 [10,5-80,3]Gy). The objective tumor response rate at 3 months was 94%. However, no significant differences were found in absorbed dose metrics (P=.315) or dose-volume histogram values (D50, D70, D85) between responsive and non-responsive (NR) lesions. Patient-level analysis showed a 29% progression rate, with NR patients more likely to have secondary liver tumors (P=.011). CONCLUSION: This study including a Portuguese cohort treated with ¹⁶⁶Ho-TARE showed a high tumor response rate. However, the limited sample size reduces the robustness of the conclusions. Further data from ongoing follow-up are awaited.
OBJECTIVE: To establish a renal tubular uptake rate (RTUR) model based on renal dynamic imaging (RDI) for detecting early tubular injury and to explore its clinical application value. MATERIALS AND METHODS: RDI data coll...OBJECTIVE: To establish a renal tubular uptake rate (RTUR) model based on renal dynamic imaging (RDI) for detecting early tubular injury and to explore its clinical application value. MATERIALS AND METHODS: RDI data collected from August 2020 to June 2025 were analyzed. A total of 292 eligible cases (441 kidneys) were included. Participants were categorized into: - Control group: 56 cases (112 kidneys) - Renal insufficiency group: 93 cases (186 kidneys) - Fully compensated group: 62 cases (62 kidneys) - Partially compensated group: 35 cases (35 kidneys) - Decompensated group: 46 cases (46 kidneys). RTUR CALCULATION FORMULA: RTUR = (Ascent slope of renal scintigraphy/Total injected radioactive drug activity) × 10 × 100%. ANALYSIS CONTENT: Distribution of RTUR values across five groups; correlation between GFR and RTUR in 441 kidneys. Differences in RTUR between the control group and other four groups; diagnostic efficacy and clinical value of RTUR. RESULTS: Compared with the control group, significant differences in RTUR were observed in the renal insufficiency group, fully compensated group, and decompensated group (P < .01). GFR in 441 kidneys showed a strong positive correlation with RTUR (r = 0.739, P < .001). ROC analysis indicated that RTUR ≤ 5.225% identified renal insufficiency (sensitivity 77.7%, specificity 70.4%), while RTUR ≥ 9.135% diagnosed complete renal compensation with 82.3% sensitivity. CONCLUSION: The RTUR model enables stable quantitative assessment of renal tubular reabsorption rate, facilitating diagnosis of renal insufficiency and complete renal compensation. It holds promise as a novel quantitative indicator for evaluating tubular function. Renal GFR exhibits a strong correlation with RTUR.