Sancho L, Roteta A, Torres I
… +7 more, de Arcocha M, Ramos R, Domínguez ML, Rosales JJ, Prieto E, Quincoces G, en nombre del Grupo de Oncología de la SEMNim
The state of the art and future perspectives of new radionuclides in Nuclear Medicine continue to evolve, driven by the development of isotopes with innovative applications in theragnostics. In this second part of the co...The state of the art and future perspectives of new radionuclides in Nuclear Medicine continue to evolve, driven by the development of isotopes with innovative applications in theragnostics. In this second part of the continuing education series, the clinical and therapeutic applications of terbium, actinium, and bismuth are analyzed in depth. The use of the four terbium isotopes (terbium-149, terbium-152, terbium-155, and terbium-161) is described, offering a versatile system for both diagnosis and treatment due to their chemical similarity to lutetium-177, along with the challenges related to their production and availability. Additionally, actinium-225, a powerful alpha-emitting radionuclide, is reviewed for its growing role in Targeted Alpha Therapy (TAT), particularly in prostate cancer and neuroendocrine tumors. Finally, bismuth-213, derived from actinium-225, is analyzed for its short half-life, making it a viable option for localized and selective therapies. Despite technical and production challenges, these radionuclides are driving the evolution of precision medicine, expanding therapeutic and diagnostic possibilities in Nuclear Medicine.
Sebastián Palacid F, Álvarez Mena N, García Aragón M
… +6 more, Zambrano Infantino RDC, Jaramillo López BM, Gómez Hidalgo J, Pérez López B, Redondo Del Río MP, Ruano Pérez R
PURPOSE: To evaluate the feasibility of identifying various distribution patterns of [Tc]Tc-DPD in patients with cardiac transthyretin amyloidosis using gated SPECT-CT. MATERIALS AND METHODS: Gated SPECT-CT was performed...PURPOSE: To evaluate the feasibility of identifying various distribution patterns of [Tc]Tc-DPD in patients with cardiac transthyretin amyloidosis using gated SPECT-CT. MATERIALS AND METHODS: Gated SPECT-CT was performed in patients with a positive scintigraphy result for cardiac amyloidosis due to transthyretin (TTR-CA). Patients were categorized into several groups based on sex, degree of radiopharmaceutical uptake according to the Perugini's visual scale and ventricular ejection fraction (LVEF). Cardiac polar maps were obtained using Emory Cardiac Toolbox™ software and scored by segments according to radiopharmaceutical uptake on a scale from 0 (no uptake) to 4 (very high uptake intensity). The Mann-Whitney U and Pearson's Chi-square statistical tests were employed to identify significant differences in distribution patterns according to the different variables under study. RESULTS: 65 patients were evaluated. The gender variable determined the main statistically significant differences, highlighting distinct distribution patterns of the radiopharmaceutical at the cardiac level: while women showed lower accumulation of [Tc]Tc-DPD in the middle anterior (p=0.035) and basal anterior (p=0.001) segments, whereas men demonstrated higher accumulation in the basal anteroseptal (p=0.009) and basal inferoseptal (p=0.009) segments, and lower scores in the lateroapical segment (p=0.039). CONCLUSIONS: Gated SPECT-CT is an essential tool for assessing the distribution pattern of [Tc]Tc-DPD of patients with TTR-CA, offering valuable insights into the pathophysiology of the disease.
OBJECTIVE: The maximum [F]FDG uptake of a cancer lesion has been found to relocate from the center to the periphery during progression. This behavior suggests that the normalized distances from the hotspot of radiotracer...OBJECTIVE: The maximum [F]FDG uptake of a cancer lesion has been found to relocate from the center to the periphery during progression. This behavior suggests that the normalized distances from the hotspot of radiotracer uptake to the tumor centroid (NHOC) and to the tumor perimeter (NHOP) could serve as novel geometric PET parameters indicative of tumor aggressiveness. This study aimed to explore the prognostic relevance of NHOC and NHOP in [F]FDG PET/CT for predicting the response to concurrent chemoradiotherapy (CCRT) and progression-free survival (PFS) in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: We retrospectively reviewed 116 HNSCC patients who received CCRT and were assessed with pre-treatment (PET1) and three months post-treatment PET/CT (PET2). Along with conventional PET parameters, NHOC and NHOP for primary tumors on PET1 and the percent changes in NHOC and NHOP between PET1 and PET2 were measured. RESULTS: Of all the PET1 parameters assessed, NHOC was the most effective in predicting the CCRT response, achieving an area under the receiver operating characteristic curve of 0.645. In multivariate logistic regression and survival analysis, NHOC identified as an independent predictor for both complete metabolic response (P = .028) and PFS (P = .006). In a subgroup of 46 patients exhibiting residual primary tumors on PET2, both the percent changes in NHOC (P = .048) and NHOP (P = .041) were significantly associated with PFS. CONCLUSIONS: NHOC and the percent changes in NHOC and NHOP following CCRT may serve as effective [F]FDG PET/CT parameters for predicting clinical outcomes in HNSCC patients.
OBJECTIVE: This study aimed to investigate the relationship between semiquantitative positron emission tomography (PET) parameters and intratumoral heterogeneity (ITH) on F-fluorodeoxyglucose positron emission tomography...OBJECTIVE: This study aimed to investigate the relationship between semiquantitative positron emission tomography (PET) parameters and intratumoral heterogeneity (ITH) on F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging and survival data of non-metastatic triple-negative breast cancer (TNBC) patients. METHODS: Sixty-two consecutive female patients who underwent pretreatment F-FDG PET/CT with non-metastatic TNBC were enrolled. Heterogeneity index (HI) variables derived from the metabolic tumor volume (MTV) and standardized uptake value (SUV) parameters of primary lesions were evaluated. A novel modified method introducing a percentage-based (30-40-50%) MTV slope comparison was proposed. The association between conventional F-FDG PET/CT parameters, HI values, and survival results was analyzed retrospectively. RESULTS: Tumors with higher HI values were associated with shorter survival times. For overall survival (OS), HI2 and HI3 were statistically significant (p=0.009, p=0.016). Regarding radiological progression-free survival (rPFS), HI1 and HI3 were statistically significant (p=0.01, p=0.025). A significant weak correlation between HI1 (p=0.005, ρ=0.34) and a strong correlation was found for HI2 (p<0.0001, ρ=0.89), HI3 and tumor size were not statistically significantly correlated (p=0.063, ρ=0.23). T stage was statistically significantly associated with rPFS and OS ((p=0.038, p=0.003). In contrast, no statistically significant difference was found for the N stage, anatomical, and clinical staging (p>0.05). CONCLUSION: This study concluded that ITH predicts survival for non-metastatic TNBC patients. This conclusion was reached with the heterogeneity index variables obtained by different methods. However, our results revealed that HI2 depends on tumor size. Our modified method (HI3) predicts survival independently of tumor size.
Casanueva-Eliceiry S, Manyalich-Blasi M, Farré-Melero A
… +12 more, Niñerola-Baizán A, Saavedra D, Mora-Porta M, Hanzu FA, Orois A, Squarcia M, Rodrigo-Calvo M, Tormo-Ratera M, Quintero-Martinez K, Fuster-Pelfort D, Vidal-Pérez O, Vidal-Sicart S
BACKGROUND AND OBJECTIVES: To compare the diagnostic accuracy of [F]-Fluorocholine (FCH) PET/CT with conventional [mTc]Tc-MIBI scintigraphy and cervical ultrasound (USG) for the preoperative localization of hyperfunction...BACKGROUND AND OBJECTIVES: To compare the diagnostic accuracy of [F]-Fluorocholine (FCH) PET/CT with conventional [mTc]Tc-MIBI scintigraphy and cervical ultrasound (USG) for the preoperative localization of hyperfunctioning parathyroid tissue (HFPT) in patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: This prospective study included 90 patients diagnosed with PHPT who underwent [F]F-CH PET/CT, [mTc]Tc-MIBI SPECT/CT and Neck USG. The diagnostic accuracy of each imaging modality was assessed using intraoperative findings and histopathological confirmation as the gold standard. The localization accuracy was evaluated based on specific quadrant detection, laterality, and ectopic gland identification. The study also explored the correlation between imaging findings and biochemical parameters, including preoperative and postoperative PTH and calcium levels. RESULTS: [F]F-CH PET/CT demonstrated superior accuracy in detecting pathological parathyroid glands compared to [Tc]Tc-MIBI SPECT/CT and USG. [¹⁸F]F-CH PET/CT correctly identified 98.9% of patients with pathological glands, with a specific location accuracy of 93.2%, 65.9% and 38.8% for [¹⁸F]F-CH PET/CT, [Tc]Tc-MIBI SPECT/CT and USG, respectively. For ectopic adenomas, FCH PET/CT achieved an accuracy of 100% (4/4), while MIBI and neck ultrasound identified these in 50% (2/4) and 0% (0/4) of cases, respectively. There were two cases of multiglandular disease, [F]F-CH PET/CT and [99mTc]Tc-MIBI each detected one gland in one case (50%) while USG detected none; in the other case, [F]F-CH PET/CT and USG identified both glands (100%), and [99mTc]Tc-MIBI detected none. Significant correlations were observed between SUVmax values from [F]F-CH PET/CT and gland size, weight, and preoperative PTH levels. CONCLUSIONS: [F]F-CH PET/CT outperformed conventional imaging modalities in the preoperative localization of HFPT, particularly in challenging cases such ectopic or multiglandular disease. These findings support its potential as an effective and reliable imaging tool for the management of primary hyperparathyroidism.
AIM: We aim to establish normal values and standardize a hypoallergenic and mediterranean diet for gastric emptying scintigraphy (GES). MATERIAL AND METHODS: In a prospective cohort of healthy volunteers, we performed GE...AIM: We aim to establish normal values and standardize a hypoallergenic and mediterranean diet for gastric emptying scintigraphy (GES). MATERIAL AND METHODS: In a prospective cohort of healthy volunteers, we performed GES of a [Tc]TcDTPA labelled hypoallergenic meal (egg, potato, rice and olive oil). Anterior and posterior images were simultaneously acquired at 0, 30, 60, 110, 120, 130, 180, 230, 240 and 250 min. Cross-sectional analysis was performed between demographic data and gastric retention values. A score covariance analysis model was used to observer changes between measurements over time. RESULTS: 50 participants (29 women) were included. Mean values and standard deviation (5-95th) for gastric retention percentages at 60, 120, 180, 240 min were 51.40 ± 8.63 (36.5-66.1), 21.66 ± 9.40 (6.5-38.2), 7.58 ± 5.77 (1.5-19.1) and 2.94 ± 2.08 (1-7.3), respectively. Male participants had a significative faster gastric emptying compared to women in practically all the acquisitions. Male participants and smoker participants generated a significative decrease of gastric retention values in generalized linear model (male coefficient -4.818, IC95% -7.24 to -2.39, P-value < .001; and smoker coefficient of -3.484, IC95% -6.29 to -0.67, P-value < .05). CONCLUSION: This study standardizes and establishes normal values for GES with the first hypoallergenic solid meal based on consensus recommendations and a mediterranean diet; suitable for most patients with allergic or sensitive-conditions to other meal components.
OBJECTIVES: We evaluated the influence of baseline volumetric 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters and inflammatory prognostic markers on complete response (...OBJECTIVES: We evaluated the influence of baseline volumetric 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters and inflammatory prognostic markers on complete response (CR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT). MATERIALS AND METHODS: In total, 90 patients with LARC, including those with and without CR, were evaluated based on baseline volumetric PET/CT parameters, such as maximum standard uptake value, metabolic tumor volume (MTV), tumor lesion glycolysis, and inflammatory prognostic markers, including the lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio. RESULTS: Of the 90 patients, 62 (68.9%) were male and 28 (31.1%) were female. The median age was 61 (31-81) years. A complete response was observed in 20 (22%) patients following nCRT. Of these, 5 demonstrated a clinical complete response, whereas 15 exhibited a complete response after surgery. A low pretreatment PLR, low MTV levels, and stage 2 disease were identified as significant predictors of complete response. The optimal cutoff values were 16.5 for MTV (sensitivity 80%, specificity 62%) and 121 for PLR (sensitivity 73%, specificity 65%). CONCLUSION: Our findings suggest that stage 2 disease, low pretreatment MTV, and low PLR levels may be predictive of a CR to nCRT in patients with LARC.
UNLABELLED: I-FP-CIT SPECT is a key tool in the differential diagnosis of movement disorders (MD), but its appropriate indication is essential to optimize resources and avoid unnecessary tests. AIM: To evaluate the adequ...UNLABELLED: I-FP-CIT SPECT is a key tool in the differential diagnosis of movement disorders (MD), but its appropriate indication is essential to optimize resources and avoid unnecessary tests. AIM: To evaluate the adequacy and impact of I-FP-CIT SPECT in the diagnosis and management of MD according to clinical guidelines. PATIENTS AND METHODS: Retrospective study involving 249 patients with suspected parkinsonism (PK) of uncertain origin. All underwent I-FP-CIT SPECT and had a clinical follow-up of exceeding 12 months. Requests were classified based on their adherence to clinical guidelines. Variables analyzed included sex, age, justification for the request, management after SPECT, and final diagnosis. RESULTS: 91.57% of the requests were appropriate, while 8.43% did not adhere to the guidelines. Diagnosis changed in 48.6% of cases and management in 70.68% after the scan, especially in inconclusive cases and initiation of therapy. General neurologists evaluated more cases and made more appropriate requests (96.3% vs 76.67%; p<0.001). However, MD specialists, despite less appropriate use of the guidelines, achieved a higher number of conclusive diagnoses in complex cases. CONCLUSION: I-FP-CIT SPECT has significant clinical impact when used in accordance with clinical guidelines, improving the diagnosis and management of MD. Unjustified scans reduce its utility. Collaboration between general neurologists and MD specialists is fundamental; the latter, although showing less adherence to guidelines in requesting the test, achieve a higher number of conclusive diagnoses in complex cases.
Quintero K, Vila E, Ferrer-Mileo L
… +11 more, Vas D, Ribal MJ, Garcia-Herreros M, Navarro N, Tormo-Ratera M, Aversa C, Vilaseca A, Farré-Melero A, Fuster D, Paredes P, grupo de Medicina Nuclear Clínic Barcelona (MNCB)
OBJECTIVE: To evaluate the correlation between response assessment measured by PET/CT with [F] F-fluorocholine (Choline PET/CT) and serum levels of PSA in patients with prostate cancer under antiandrogenic treatment. MET...OBJECTIVE: To evaluate the correlation between response assessment measured by PET/CT with [F] F-fluorocholine (Choline PET/CT) and serum levels of PSA in patients with prostate cancer under antiandrogenic treatment. METHODOLOGY: A retrospective study included patients with CRPC (castration-resistant prostate cancer) and HSPC (hormone sensitive prostate cancer) treated with enzalutamide, abiraterone, or apalutamide between June 2018 and July 2021, who underwent baseline and a follow-up Choline PET/CT. The difference in maximum SUVmax (ΔSUV) between both studies and the PSA value before and at follow-up were recorded. The response to treatment was compared by PSA vs. PET, assessing their association, agreement, and correlation. RESULTS: Thirty patients were included (median age 74 years, range 68-78), 12 with CSPC and 18 with CRPC; 22 had nodal disease, and 15 had active bone disease. The average time between pre-treatment and follow-up PET/CT was 11 months (range 3.5-23). Patients with extra-nodal metastatic disease at the beginning of treatment showed a higher correlation between PSA and ΔSUV (OR 4.375). In patients with bone disease at the start of treatment, 80% were classified as non-responders on PET response assessment, while only 40% were non-responders by PSA. The correlation between PET and PSA was mild (Kendall's tau_b 0.26), and the classification into Responders/Non-responders had only slight agreement (Cohen's kappa 0.30). CONCLUSION: Choline PET/CT shows low concordance with the PSA values obtained during the follow-up of response to anti-androgen therapy, especially in patients with bone involvement.
AIM: To assess the correlation between the result of the PET/CT study with [F]FDG and the histological outcome in patients with esophageal cancer undergoing chemoradiotherapy and subsequent surgery. MATERIAL AND METHODS:...AIM: To assess the correlation between the result of the PET/CT study with [F]FDG and the histological outcome in patients with esophageal cancer undergoing chemoradiotherapy and subsequent surgery. MATERIAL AND METHODS: 41 patients (35 men) diagnosed with esophageal cancer during a 10-year interval were retrospectively evaluated. PERCIST criteria and SULpeak (ΔSULpeak) variation between pre- and post-treatment PET/CT studies were used. After neoadjuvant treatment and subsequent surgery, histological response and patient survival were determined, correlating the findings with the result of the metabolic study. Different parameters related to patient and tumors lesion characteristics were compared with respect to histologic response. ROC curves and the Kaplan-Meier method were applied for the analysis of prognostic factors and survival curves. RESULTS: The mean follow-up was 34.9 months, with 21 relapses-progressions and 25 deaths. Significant differences were demonstrated between histologic responses regarding PERCIST criteria and ΔSULpeak. Both showed adequate sensitivity and moderate specificity in relation to their histological correlation. No significant differences were found with respect to other parameters studied. Survival analysis showed significantly different progression-free survival curves for the ΔSULpeak and histologic outcome. CONCLUSION: PERCIST criteria and ΔSULpeak differentiated between patients with and without histological response. ΔSULpeak and histological results proved to be prognostic factors. The results could help to personalize treatment and, together with other determinations, allow an active surveillance approach could be contemplated.
OBJECTIVE: To assess the clinical value of [F]F-PSMA negative PET/CT, in patients diagnosed with prostate cancer treated with prostatectomy with elevated PSA less than 1 ng/mL, on the outcome of salvage radiotherapy. MET...OBJECTIVE: To assess the clinical value of [F]F-PSMA negative PET/CT, in patients diagnosed with prostate cancer treated with prostatectomy with elevated PSA less than 1 ng/mL, on the outcome of salvage radiotherapy. METHOD: We prospectively included 98 patients diagnosed with prostate cancer treated with prostatectomy with biochemical recurrence [mean PSA 0.51 ng/mL (range 0.17-1.0 ng/mL)] who were referred for an [F]F-PSMA -PET/CT study. The [F]F-PSMA -PET/CT scan was negative in 53/98 patients (54.09%). Differences were analysed between those patients who were or were not candidates for pelvic salvage radiotherapy (PSRT) decided upon multidisciplinary committee and patient consent, with a minimum follow-up time for 1 year. Response to treatment was defined as a 50% reduction in PSA levels. Recurrence was ascertained upon clinical, analytical and imaging follow-up outcomes. RESULTS: 54.7% (29/53) of the patients with a negative [F]F-PSMA -PET/CT underwent PSRT. Of these, 93.1% (27/29) patients demonstrated response to treatment (PSMA false negatives). The remaining two patients showed fluctuating PSA levels without detecting disease on the [F]F-PSMA -PET/CT follow-up study. 45.3% (24/53) of patients with negative [F]F-PSMA -PET/CT did not undergo PSRT. Of these, progressive PSA elevation was observed in 62.5% (15/24) (PSMA false negatives), localising recurrence on the [F]F-PSMA -PET/CT follow-up study in 4 patients. The remaining 9 patients (37.5%) showed fluctuating PSA levels without detecting disease on the [F]F-PSMA -PET/CT follow-up study. Our series confirmed 42 (42.85%) [F]F-PSMA -PET/CT false negatives cases. CONCLUSION: Patients diagnosed with prostate cancer with post-prostatectomy biochemical recurrence and a negative [F]F-PSMA -PET/CT study are likely to benefit from pelvic salvage radiotherapy, with response seen in 93.1% of our cases.
[F]FDG PET/TC is an emerging tool in the evaluation of inflammatory arthropathies, characterised by their insidious course and clinical overlap. It allows detection of subclinical inflammation, assessment of systemic inv...[F]FDG PET/TC is an emerging tool in the evaluation of inflammatory arthropathies, characterised by their insidious course and clinical overlap. It allows detection of subclinical inflammation, assessment of systemic involvement and quantification of metabolic parameters useful in early diagnosis and therapeutic monitoring. In rheumatoid arthritis, it correlates with clinical indices (Disease Activity Score), serological markers (CRP, anti-citrullinated protein antibodies) and ultrasound findings, and facilitates the identification of complications such as cardiovascular and pulmonary involvement. In spondyloarthritis, its ability to identify enthesitis and peripheral synovitis is promising, although less studied. In addition, [F]FDG PET/TC evaluates the response to biological treatments, helping to optimise therapeutic decisions. However, its implementation faces challenges such as lack of standardised indications, incidental findings and technical artefacts. Although not routinely recommended, its usefulness in specific settings underlines the need for further studies to consolidate its role in the management of these diseases. In this manuscript, we present a brief review providing general and practical information about the role of [F]FDG PET/TC in inflammatory osteoarticular pathology, while "Role and applications of [F]FDG PET/CT in the assessment of osteoarticular infection and inflammation - Part I" has addressed its role in infectious osteoarticular disease.
This continuing education analyzes recent advances in Nuclear Medicine focused on the development of new radiopharmaceuticals that improve both the diagnosis and treatment of complex diseases. The focus is on teragnosis,...This continuing education analyzes recent advances in Nuclear Medicine focused on the development of new radiopharmaceuticals that improve both the diagnosis and treatment of complex diseases. The focus is on teragnosis, which combines diagnosis and treatment by means of pairs of radiopharmaceuticals directed to the same molecular target, which allows the personalization of treatments. This first part specifically reviews the teragnostic pairs copper-64/copper-67, lead-212/lead-203 and scandium-44/scandium-47, highlighting their physical characteristics, methods of production and potential clinical applications. Despite the challenges in their production, their versatility and effectiveness are driving their clinical application in oncology and other diseases. The text also addresses the development of new radiopharmaceuticals and their impact on precision medicine, pointing out future directions and opportunities for research in this field.