OBJECTIVE: This study aims to compare differential renal function (DRF) results obtained from Tc-99m DTPA and Tc-99m DMSA scintigraphy in children with urinary tract infection (UTI) combined with varying degrees of hydro...OBJECTIVE: This study aims to compare differential renal function (DRF) results obtained from Tc-99m DTPA and Tc-99m DMSA scintigraphy in children with urinary tract infection (UTI) combined with varying degrees of hydronephrosis. We evaluate the diagnostic performance of both methods and provide recommendations for selecting individualized imaging strategies based on specific case characteristics. METHODS: A retrospective analysis was conducted on 57 children with UTI combined with ipsilateral hydronephrosis. Clinical data collected included gender, age, urinary ultrasound findings, and results from renal dynamic and static scintigraphy. Hydronephrosis was classified by ultrasound into mild (<15 mm), moderate (15-30 mm), and severe (>30 mm). The kidney volume ratio between the affected and unaffected sides was calculated. DRF percentages for each kidney were separately obtained from both scintigraphy methods, and the deviation in DRF of the affected kidney was calculated. Based on the degree of deviation, results were categorized as normal (<5%), differing (5%-10%), or significantly different (>10%). The non-parametric Mann-Whitney U test was used to compare DRF values between Tc-99m DMSA and Tc-99m DTPA. Spearman correlation analysis assessed the relationship between hydronephrosis and DRF deviation. Receiver operating characteristic (ROC) curves were used to determine diagnostic thresholds and assess the predictive value of renal pelvic and calyceal dilation for DRF deviations. RESULTS: Among the 57 children, the median DRF of the affected kidney was 50.84% (IQR: 43.24,55.00) by Tc-99m DMSA and45% (IQR: 35.35, 47.95) by Tc-99m DTPA, with the difference being statistically significant (Z = -4.074, p < 0.000). Of these, 34 children had a DRF deviation > 5%, and 16 had a deviation >10%. Positive correlations were observed between DRF deviation and renal pelvic dilation (r = 0.299, p = 0.024), calyceal dilation (r = 0.235, p = 0.078), and kidney volume ratio (r = 4.416, p = 0.001). A renal pelvic dilation >13.5 mm or calyceal dilation >8.8 mm predicted DRF deviations >5% with a sensitivity of 73.5% and 79.4%, respctively. For deviations >10%, a calyceal dilation long axis >23.2 mm yielded a diagnostic specificity of 100%. CONCLUSION: Tc-99m DMSA-derived DRF may be affected by the degree of hydronephrosis. In children with UTI combined with hydronephrosis, significant differences in DRF assessment exist between Tc-99m DMSA and Tc-99m DTPA. When renal pelvic dilation exceeds 13.5 mm or calyceal diameter reaches 23.2 mm, Tc-99m DMSA may overestimate renal function. In such cases, Tc-99m DTPA should be considered for more accurate functional evaluation.
OBJECTIVE: To assess the diagnostic feasibility of transperineal biopsy guided by fusion of PET/MRI with [18F]F-PSMA-1007 and real-time transrectal ultrasound (BP PET/MR PSMA + TRUS) in patients with PIRADS 3 lesions. To...OBJECTIVE: To assess the diagnostic feasibility of transperineal biopsy guided by fusion of PET/MRI with [18F]F-PSMA-1007 and real-time transrectal ultrasound (BP PET/MR PSMA + TRUS) in patients with PIRADS 3 lesions. To analyze imaging biomarkers and radiomic features for differentiating between patients with negative biopsy, clinically non-significant prostate cancer (cnsPCa), and clinically significant prostate cancer (csPCa). METHODS: A prospective study was conducted in 20 patients with PIRADS 3 lesions and PSA ≥ 4 ng/mL, with no concurrent suspicious lesions. All patients underwent a PET/MRI with [18F]F-PSMA-1007, followed by targeted biopsy using real-time ultrasound fusion. Diagnostic accuracy for prostate cancer (PCa) and the proportion of csPCa and cnsPCa diagnoses were calculated. Imaging biomarkers and machine learning models based on radiomic features were analyzed. RESULTS: The technique was feasible in 100% of cases. The overall detection rate of PCa was 80%, with 100% sensitivity and 36% specificity for csPCa. SUVpeak was the only biomarker that showed significant differences between patients with negative histology and PCa (AUC 0.81; sensitivity 75%; specificity 80%; cutoff value 3.5). No biomarker successfully differentiated between csPCa and cnsPCa. Both supervised classification models demonstrated high diagnostic performance (AUC > 0.95): Multimodal regression performed slightly better for binary classification (negative vs. PCa). Random Forest outperformed in three-class classification (negative vs. cnsPCa vs. csPCa). CONCLUSIONS: BP PET/MRI PSMA + TRUS is a feasible, safe, and potentially superior technique compared to MRI-only targeted biopsy, especially in PIRADS 3 lesions. Radiomic analysis improves discriminative ability over conventional imaging biomarkers, particularly for distinguishing between cnsPCa and csPCa.
OBJECTIVE: To assess the diagnostic impact of using automatic segmentation and quantitative analysis of lung perfusion SPECT/CT in the evaluation of pulmonary reperfusion in patients undergoing follow-up for pulmonary th...OBJECTIVE: To assess the diagnostic impact of using automatic segmentation and quantitative analysis of lung perfusion SPECT/CT in the evaluation of pulmonary reperfusion in patients undergoing follow-up for pulmonary thromboembolism (PTE). MATERIALS AND METHODS: A prospective study was conducted from October 2021 to October 2024. We included 132 patients with PTE diagnosed by lung perfusion scintigraphy with SPECT/CT, who underwent a follow-up scan at 6 months. Reperfusion was assessed visually and quantitatively. Three grades were visually established: no reperfusion, partial reperfusion, and complete reperfusion. For quantitative analysis, automatic segmentation was performed, obtaining volumes and total counts in the baseline and follow-up SPECT/CT scans. Two parameters were established for comparison: the relative decrease in defect volume (RDV) and the relative increase in total perfused volume counts (RIC). Reperfusion was classified as: no reperfusion, partial reperfusion (minor and major), and complete reperfusion. The scintigraphic results were correlated with demographic variables, extension and size of the PTE and other complementary diagnostic tools (pulmonary function tests and echocardiogram). RESULTS: 82 patients were women (mean age 70 ± 16 years) and 50 were men (64 ± 15 years). Comparing the agreement between visual and quantitative analysis (weighted Cohen's Kappa index), a slight, but non-statistically significant, agreement was demonstrated between evaluators (κ = 0.04; p = 0.464). Pearson's assessment revealed a very high and positive assessment between RDV and RIC (r = 0.77; p < 0.001). Patients with abnormal complementary diagnostics tools at follow-up were not more likely to have residual thrombosis (p > 0.05 in the visual and quantitative analyses). The remaining variables also did not show statistical significance in the persistence of PTE. CONCLUSIONS: In the assessment of post-PTE pulmonary reperfusion, quantitative analysis of lung perfusion SPECT/CT is superior to visual analysis. Furthermore, it suggests that it is a particularly useful tool in patients in whom visual analysis does not show improvement, as it could prevent unnecessary and prolonged treatment if reperfusion is observed through quantification.
OBJECTIVE: The three treatment modalities for patients with hyperthyroidism are antithyroid drugs (ATDs), surgery, and radioactive iodine (RAI) therapy. The study aims to determine the predictors of a response to RAI in...OBJECTIVE: The three treatment modalities for patients with hyperthyroidism are antithyroid drugs (ATDs), surgery, and radioactive iodine (RAI) therapy. The study aims to determine the predictors of a response to RAI in patients with hyperthyroidism. MATERIALS AND METHODS: We retrospectively assessed 914 patients who received RAI for the treatment of hyperthyroidism between January 2000 and December 2023, with a follow-up of at least 6 months after the first dose. RESULTS: Hypothyroidism was ultimately achieved in 62.9% of the patients. Multiple variables are possible predictors in univariable logistic regression analysis. However, only shorter duration of ATD therapy (odds ratio 0.996; 95% confidence interval [CI], 0.093-0.999; P=.003, multivariable logistic regression analysis) and a diagnosis of Graves' disease (GD) (odds ratio 1.803; 95% confidence interval [CI], 1.042-3.141; P=.035, multivariable logistic regression analysis) are the independent predictors of post-treatment hypothyroidism, with decreasing age also being a late-response independent predictor of hypothyroidism 24 months after the treatment (odds ratio 0.983; 95% confidence interval [CI], 0.968-0.998; P=.028, multivariable logistic regression analysis). The median time to hypothyroidism was 10.0±0.7 months (Kaplan-Meier method), with a statistically significant difference in hypothyroidism-free survival (HFS) between patients with GD on one side and solitary toxic adenoma (STA) and toxic multinodular goiter (TMG) on the other (P<.001, log-rank test). CONCLUSIONS: GD and a shorter duration of previous ATD therapy are independent predictors of post-therapeutic hypothyroidism in patients treated for hyperthyroidism with RAI, with younger age also being an independent predictor of a late response.
OBJECTIVE: To assess whether parameters derived from ¹⁸F-FDG PET/CT imaging could be used for prognostic evaluation in pediatric patients with bone and soft tissue sarcomas. MATERIAL AND METHODS: This retrospective study...OBJECTIVE: To assess whether parameters derived from ¹⁸F-FDG PET/CT imaging could be used for prognostic evaluation in pediatric patients with bone and soft tissue sarcomas. MATERIAL AND METHODS: This retrospective study included pediatric patients diagnosed with sarcoma who underwent ¹⁸F-FDG PET/CT between February 2013 and January 2021. A total of 63 patients were evaluated. Anatomical tumor volume, standardized uptake values (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Progression-free survival (PFS) and overall survival (OS) were calculated. Cox regression analysis was performed to identify independent predictors. RESULTS: The mortality rate was 31.7%, and the median OS was 54.9 months. Lung (p<0.001) and lymph node metastases (p=0.049) were associated with shorter OS. Younger age at diagnosis (p=0.014), higher anatomical tumor volume (p=0.002), and lung metastasis (p=0.004) were independently associated with increased mortality risk. High MTV was independently associated with higher progression risk (p<0.001). CONCLUSION: Anatomical tumor volume and lung metastasis predict mortality, while MTV predicts progression in pediatric sarcoma. Further prospective studies are needed to validate these findings.
OBJECTIVES: Programmed death-ligand 1 (PD-L1) expression serves as a critical biomarker for selecting patients eligible for treatment with immune checkpoint inhibitors. Herein, we investigated the association between PD-...OBJECTIVES: Programmed death-ligand 1 (PD-L1) expression serves as a critical biomarker for selecting patients eligible for treatment with immune checkpoint inhibitors. Herein, we investigated the association between PD-L1 expression and various FDG PET/CT-derived metabolic parameters in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This retrospective study included 81 NSCLC patients who underwent pre-treatment F-18 FDG PET/CT imaging and histopathological evaluation of PD-L1 expression. PD-L1 tumour proportion score (TPS) was determined using the SP263 immunohistochemical assay. PD-L1 positivity was defined as TPS ≥ 1%. Quantitative PET/CT parameters-SUVmax, SUVmean, SULpeak, SULmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity indices (coefficient of variation [COV] and SUV-based heterogeneity index [HI])-were analyzed in relation to PD-L1 TPS. RESULTS: PD-L1 positivity was identified in 30 patients (37%). Although SUVmax, SUVmean, SULpeak, and SULmax values tended to be higher in PD-L1-positive patients, these differences were not statistically significant. Conversely, MTV and TLG were higher in the PD-L1-negative group. Among all parameters, HI was significantly elevated in the PD-L1-positive group (P = .031), and remained significant across PD-L1 expression strata (P = .037). In metastatic patients, HI and COV showed significant positive correlation with PD-L1 expression (r = 0.34 and 0.33, respectively). ROC analysis identified a HI cut-off of 1.59 to predict PD-L1 positivity with 90% sensitivity and 50% specificity (AUC = 0.674). CONCLUSIONS: Tumor heterogeneity indices, particularly HI and COV derived from FDG PET/CT, demonstrated stronger predictive value for PD-L1 expression than conventional metabolic parameters. These findings suggest that metabolic heterogeneity may serve as a useful noninvasive imaging biomarker for guiding immunotherapy in NSCLC.
Aghaee A, Anvari K, Kabiri M
… +7 more, Shafiei S, Mehravanfar A, Ramezani M, Soltani S, Jafari M, Fazeli Z, Barashki S
Rev Esp Med Nucl Imagen Mol (Engl Ed)
· 2025 Nov · PMID 41314283
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OBJECTIVE: This study aimed to determine the functional expression of somatostatin receptors in patients with primary brain tumors including meningiomas and gliomas using Tc-HYNIC-octreotide SPECT/CT imaging. METHOD: Thi...OBJECTIVE: This study aimed to determine the functional expression of somatostatin receptors in patients with primary brain tumors including meningiomas and gliomas using Tc-HYNIC-octreotide SPECT/CT imaging. METHOD: This cross-sectional study was conducted at Ghaem Hospital, Mashhad, in 2023. Patients with histopathologically confirmed primary brain tumors (gliomas and meningiomas) who had previously received treatment and presented with suspected tumor recurrence based on imaging findings were included. After injection of Tc-HYNIC-Octreotide, whole-body SPECT/CT imaging of the head and other suspicious areas was performed. Two nuclear medicine specialists independently reviewed scans. Radiopharmaceutical uptake was assessed qualitatively by comparing absorption in lesions to liver and splenic uptake, with scoring based on the Krenning score. The uptake in lesions (target) and their corresponding mirrored normal brain regions (non-target) was calculated using ROI measurements. RESULTS: Out of 24 patients, scans from 18 (mean age: 51.39±12.25 years; range: 35-74) were analyzed due to technical issues and missing images. Of these, 10 (55.6%) were women. Somatostatin receptor expression was observed in all lesions. Meningioma had significantly higher receptor expression compared to gliomas (P=.003). Maximum and target-to-non-target uptake differences were significantly greater in meningioma than in astrocytoma (P=.047, P=.044) and glioblastomas (P=.025, P=.026). Gliomas, including astrocytoma and glioblastomas, consistently showed low receptor expression, and no significant differences in receptor expression were observed between astrocytoma and glioblastomas. CONCLUSION: This study demonstrates that Tc-HYNIC-octreotide SPECT/CT imaging is an effective method for detecting somatostatin receptor expression in brain tumors, offering a low-cost and accessible alternative to more enhanced imaging techniques, both meningioma and glial tumors express somatostatin receptors, but receptor expression is significantly higher in meningioma.
INTRODUCTION: In response to the increasing demand for radioguided procedures, the integration of the Nursing Care Assistants (NCA) profile was proposed as support professionals in the preoperative marking of breast canc...INTRODUCTION: In response to the increasing demand for radioguided procedures, the integration of the Nursing Care Assistants (NCA) profile was proposed as support professionals in the preoperative marking of breast cancer (BC) patients using I-125 seeds. OBJECTIVES: To analyze the clinical impact and professional development resulting from the integration of NCA into these procedures, assessing the operational efficiency of the Radioguided Surgery Team (RGST) and the training process that enabled them to assume new competencies. MATERIALS AND METHODS: A four-phase theoretical-practical training program was implemented (theoretical instruction, practical mentoring, clinical simulation, and supervised autonomous practice), aimed at training NCA to assist in the localization and marking of non-palpable lesions and metastatic axillary lymph nodes using I-125 seeds. After completing the training, their impact was evaluated through a comparative analysis of RGST activity in 2023 and 2024. RESULTS: During the study period, NCA autonomously performed 116 marking procedures with I-125 seeds without incidents, accounting for 11.8% of total procedures in 2023 (32/270) and 23% in 2024 (84/366). Operational support was required on 21 working days in 2023 (8.5%) and 49 days in 2024 (19.6%), indicating a significant increase in their involvement. CONCLUSIONS: The incorporation of the NCA profile into radioguided marking procedures has proven to be an effective strategy for optimizing healthcare resources, enhancing the operational efficiency of the RGST, and promoting the professional development of this role within highly specialized clinical settings.
PURPOSE: The aim of this study was to evaluate the utility of radiomics based on [F]FDG PET/CT imaging for the prediction of histological differentiation grade in patients with non-small cell lung cancer (NSCLC) of eithe...PURPOSE: The aim of this study was to evaluate the utility of radiomics based on [F]FDG PET/CT imaging for the prediction of histological differentiation grade in patients with non-small cell lung cancer (NSCLC) of either adenocarcinoma or squamous cell carcinoma subtype. MATERIALS AND METHODS: A single-center retrospective observational study was conducted, including 150 patients with histologically confirmed NSCLC who underwent [F]FDG PET/CT imaging prior to complete surgical resection of the tumor. Patients were excluded if they showed no significant FDG uptake, lacked differentiation data, or had insufficient tumor volume. Image segmentation and feature extraction were performed using LIFEx software, obtaining both textural and morphological features. Predictive variables were selected using classical statistical techniques and LASSO regression, and model performance was evaluated using ROC curve analysis. RESULTS: Among the 150 patients included, 25 had well-differentiated tumors, 88 moderately differentiated, and 37 had poorly differentiated. Comparison between well-differentiated tumors and those with moderate or poor differentiation revealed statistically significant differences in several radiomic features. The LASSO model identified seven variables with high discriminative power. The model achieved a sensitivity of 76%, specificity of 99.2%, positive predictive value of 95%, negative predictive value of 95.4%, and an overall accuracy of 95.3%. CONCLUSIONS: Radiomic features extracted from [F]FDG PET/CT images can predict tumor differentiation grade in NSCLC with high specificity. This non-invasive approach may serve as a valuable adjunct to histopathological evaluation, potentially aiding clinical decision-making.
García-Ruiz AU, Martínez-Rodríguez I, Martínez-Amador N
… +12 more, Gómez-de la Fuente FJ, Sánchez-Salmón A, Jiménez-Bonilla J, de Arcocha-Torres M, Mendi Barcina V, Rodríguez-Izquierdo F, Carvalho-Duarte NV, Botanch-Domingo MP, Cabrera-Portillo L, Andrade-Mejía PD, Clavijo-Umbarila A, Quirce R
Rev Esp Med Nucl Imagen Mol (Engl Ed)
· 2025 Oct · PMID 41057137
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PURPOSE: To evaluate the contribution of sentinel node biopsy using lymphoscintigraphy in breast cancer (BC) with clip-marked lymph node involvement and neoadjuvant chemotherapy (NACT) in axillary staging and reduction o...PURPOSE: To evaluate the contribution of sentinel node biopsy using lymphoscintigraphy in breast cancer (BC) with clip-marked lymph node involvement and neoadjuvant chemotherapy (NACT) in axillary staging and reduction of potential false negatives from exclusively radiological localization. MATERIAL AND METHODS: A retrospective study of 20 women with BC and nodal involvement marked with clip and NACT. Lymphoscintigraphy was complemented with SPECT/CT in 12 patients. The correlation between lymphoscintigraphic sentinel lymph node (SLN) and the clip-marked node was analyzed. RESULTS: Lymphoscintigraphy detected 34 axillary SLNs. SPECT/CT showed uptake in 10 of 16 clip-marked nodes (62.5%). During surgery, 39 nodes were removed; 33 (84.6%) were SLNs, 18 with clip, and 15 without clip. One SLN was not located surgically. Six clip-marked nodes (15.3%) showed no uptake. In 8 of 20 patients (40%), drainage to a single SLN was detected; this corresponded to the clip-marked node in 5 cases (non-metastatic) and non-clip-marked nodes in 3 cases (1 metastatic). In 12 of 20 patients (60%), lymphoscintigraphy showed drainage to more than one SLN. A total of 26 SLNs were detected: 13 SLNs with clip (5 metastatic) and 13 without clip (4 metastatic). Lymphoscintigraphy detected 5 SLNs in 4 of 20 patients (20%) that did not match the clip-marked node and were metastatic. The detection and removal rate of GCL was 97% and false negative rate was 16,67%. CONCLUSION: Lymphoscintigraphy in BC with positive axilla before NACT detected metastases in a significant percentage of patients not identified with clip, being an essential tool for accurate axillary staging.