Clin Nucl Med
· 2026 May · PMID 42113553
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Adult T-cell leukemia/lymphoma (ATL) is a rare and aggressive mature T-cell neoplasm with a very poor prognosis, caused by human T-cell leukemia virus type 1. In this report, we present the 18F-FDG and 68Ga-pentixafor PE...Adult T-cell leukemia/lymphoma (ATL) is a rare and aggressive mature T-cell neoplasm with a very poor prognosis, caused by human T-cell leukemia virus type 1. In this report, we present the 18F-FDG and 68Ga-pentixafor PET/CT imaging findings in a case of ATL, which involved extranodal hepatic lesions and multiple nodal lesions.
Clin Nucl Med
· 2026 Jun · PMID 42081703
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68Gallium-prostate-specific membrane antigen (PSMA) PET/CT has evolved as a pivotal imaging modality for prostatic carcinoma. Prostate-specific membrane antigen (PSMA) is a zinc-dependent peptidase and a type II membrane...68Gallium-prostate-specific membrane antigen (PSMA) PET/CT has evolved as a pivotal imaging modality for prostatic carcinoma. Prostate-specific membrane antigen (PSMA) is a zinc-dependent peptidase and a type II membrane protein that is expressed in prostate cancer and also tumor neovasculature of various nonprostatic malignancies. Recently, there have been many studies to demonstrate the expression of PSMA in vivo in nonprostatic malignancies like glioma, renal cell carcinoma, differentiated thyroid carcinoma, lung cancer, breast cancer, and salivary gland tumors, among others, and explore the diagnostic and therapeutic utility in these malignancies. While they have shown promising results with some even providing better imaging results than 18F-fluorodeoxyglucose PET/CT, it is important to evaluate the indications where PSMA PET/CT can be utilized efficiently. We must also be mindful of the benign conditions where PSMA uptake can be observed while we analyze the scans. In this review, we have described the clinical exploration of PSMA-based PET/CT in the imaging of various cancers and potential therapeutic applications.
Clin Nucl Med
· 2026 Jun · PMID 42081702
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A 68-year-old woman with history of bilateral breast cancer was referred for F-18 fluoroestradiol (F-18 FES) PET/CT to evaluate sclerotic osseous lesions seen on surveillance CT scan. F-18 FES PET/CT showed no focal abno...A 68-year-old woman with history of bilateral breast cancer was referred for F-18 fluoroestradiol (F-18 FES) PET/CT to evaluate sclerotic osseous lesions seen on surveillance CT scan. F-18 FES PET/CT showed no focal abnormal increased radiotracer uptake at the bilateral breast, and no suspicious radiotracer-avid lymph nodes or osseous lesions. The same F-18 FES PET/CT showed focal increased radiotracer uptake at the stomach fundus. A follow-up F-18 FDG PET/CT showed no suspicious focal hypermetabolic activity in the stomach. An endoscopic biopsy identified gastric adenocarcinoma.
Bilski M, Mastroleo F, Chyrek AJ
… +22 more, Kuncman Ł, Lelek P, Stankiewicz M, Gomez-Iturriaga A, Miszczyk M, Burchardt W, Kluska A, Napieralska A, Kukiełka A, Konat-Bąska K, Stando R, Dec M, Piliszczuk E, Matys R, Bajon T, Trojanowski M, Chicheł A, Wojcieszek P, Fijuth J, Zilli T, Kishan A, Jereczek-Fossa BA
Clin Nucl Med
· 2026 Jun · PMID 42081701
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PURPOSE: To evaluate the impact of PSMA PET versus conventional imaging for staging, and the effect of dose escalation (DE) to metastatic lymph nodes in cN1 prostate cancer patients treated with EBRT and ADT. METHODS: A...PURPOSE: To evaluate the impact of PSMA PET versus conventional imaging for staging, and the effect of dose escalation (DE) to metastatic lymph nodes in cN1 prostate cancer patients treated with EBRT and ADT. METHODS: A retrospective multicenter analysis included 197 propensity score-matched patients (77 staged with PSMA PET, 120 with conventional imaging) treated with EBRT and ADT, with or without DE to lymph node metastases. Matching criteria were T stage, nodal involvement, imaging modality, Gleason score, and ADT duration. Primary endpoint was metastasis-free survival (MFS); secondary endpoints included overall survival (OS), locoregional control (LRC), and toxicity. RESULTS: Median follow-up was 42 months (IQR: 25-59). Median EQD2 (alpha/beta=1.5) to elective nodes was 46 Gy, and to metastatic nodes, 66 Gy (PSMA PET) and 63 Gy (conventional imaging). The 3-year MFS was 80.5% (95% CI: 71.3-90.8%) for PSMA PET and 77.2% (95% CI: 69.5-85.8%) for conventional imaging; 5-year MFS was 59.3% versus 65.8% (P=0.57). OS at 5 years was 82.2% (PSMA PET) and 77.4% (conventional imaging) (P=0.72). On multivariable analysis, ISUP grade group 3-5 predicted earlier metastasis (HR: 4.03, 95% CI: 1.61-10.06; P=0.003); higher prostate dose (EQD2 ≥113 Gy) improved MFS (HR: 0.53, 95% CI: 0.30-0.95; P=0.033); long-term ADT (≥24 mo) improved OS (HR: 0.38, 95% CI: 0.19-0.78; P=0.009). No significant difference in toxicity was observed between groups. CONCLUSIONS: PSMA PET staging and nodal dose escalation >60 Gy were safe but did not improve MFS, OS, or LRC. ISUP grade group 3-5 and higher prostate dose significantly influenced outcomes.
Sah BR, Eyrikh A, Husmann L
… +8 more, Farokhnia A, Muehlematter UJ, Beintner-Skawran S, Kotasidis F, Nogami M, Inukai JI, Maurer A, Huellner MW
Clin Nucl Med
· 2026 Jun · PMID 42081700
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OBJECTIVES: We aimed to explore the diagnostic efficacy of whole-body dynamic (WBD) acquisition using [18F]-Fluorodeoxyglucose-positron-emission-tomography/computed-tomography ([18F]FDG-PET/CT) for the assessment of gian...OBJECTIVES: We aimed to explore the diagnostic efficacy of whole-body dynamic (WBD) acquisition using [18F]-Fluorodeoxyglucose-positron-emission-tomography/computed-tomography ([18F]FDG-PET/CT) for the assessment of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) compared with the standard static PET/CT. METHODS: Twenty-five patients with suspected GCA and/or PMR were prospectively enrolled in this single-center study. WBD PET imaging was performed before treatment using a standard PET/CT scanner with a multibed multipass dynamic whole-body acquisition approach (dPET). Reconstructed datasets were used to generate metabolic rate of [18F]FDG (MRFDG) images based on standard Patlak analysis. In case of pathologic FDG uptake, VOIs placed in vessel walls and joints were used for quantitation and definition of the target-to-background ratio (TBR): uptake in VOIs of vessel walls and joints (maximum values), to VOIs in blood pool (GCA), or to VOIs in normal muscles (PMR) (mean values). The final diagnosis based on the available imaging and laboratory results (except dPET), served as the standard of reference. RESULTS: Seventeen of the 25 patients (68%) showed pathologic FDG uptake, of which 5 (20%) were finally diagnosed with GCA alone, 6 (24%) with PMR alone, and another 6 (24%) with both conditions. TBR difference between dPET and static PET was significant in both diseases(GCA P<0.003, PMR P<0.003), and TBRs of dPET and static PET were significantly higher in both diseases compared with the healthy controls. CONCLUSIONS: WBD [18F]FDG-PET/CT provided a significantly higher TBR in patients with GCA and PMR compared with standard static PET imaging. WBD [18F]FDG-PET/CT may potentially enhance the diagnostic accuracy in detecting GCA and PMR.
Gastroesophageal reflux in young children is most commonly evaluated with gastroesophageal scintigraphy (milk scan); however, reflux may be incidentally identified on other nuclear medicine examinations. We report a case...Gastroesophageal reflux in young children is most commonly evaluated with gastroesophageal scintigraphy (milk scan); however, reflux may be incidentally identified on other nuclear medicine examinations. We report a case of gastroesophageal reflux extending to the upper esophagus incidentally detected on hepatobiliary scintigraphy performed for evaluation of suspected biliary dyskinesia in a 17-month-old boy.
Succinate dehydrogenase-deficient renal cell carcinoma is a rare and recently recognized distinct subtype of renal cell carcinoma. Usefulness of FDG PET/CT in the management of this tumor is rarely reported. We describe...Succinate dehydrogenase-deficient renal cell carcinoma is a rare and recently recognized distinct subtype of renal cell carcinoma. Usefulness of FDG PET/CT in the management of this tumor is rarely reported. We describe FDG PET/CT findings in a case of succinate dehydrogenase-deficient renal cell carcinoma with lung metastases. The lung metastases <2 cm showed high FDG uptake with SUVmax of 19.1, which may be due to extreme Warburg effect resulting from succinate dehydrogenase mutation. This case indicates FDG PET/CT may be useful for detecting and staging of this novel tumor, which needs to be investigated in future studies.
68Ga-Trivehexin PET/CT is an αvβ6 integrin-targeted imaging modality that has demonstrated promising potential in various malignancies. In addition, recent studies highlighted its high potential for detecting parathyroid...68Ga-Trivehexin PET/CT is an αvβ6 integrin-targeted imaging modality that has demonstrated promising potential in various malignancies. In addition, recent studies highlighted its high potential for detecting parathyroid pathologies. In this case report, we present the preoperative 68Ga-Trivehexin PET/CT findings of a patient diagnosed with papillary thyroid carcinoma (PTC) and a parathyroid adenoma, emphasizing the potential role of this novel tracer in PTC imaging.
PURPOSE: Sarcomas are aggressive mesenchymal malignancies with high recurrence rates and poor prognosis, particularly in advanced, metastatic stages where conventional therapies have been exhausted. Fibroblast activation...PURPOSE: Sarcomas are aggressive mesenchymal malignancies with high recurrence rates and poor prognosis, particularly in advanced, metastatic stages where conventional therapies have been exhausted. Fibroblast activation protein (FAP), highly expressed in the tumor microenvironment of sarcomas, presents a promising theranostic target. This study aimed to evaluate the safety and efficacy of ¹⁷⁷Lu-FAPI-2286 radioligand therapy (RLT) in patients with advanced metastatic sarcoma and to compare the diagnostic utility of ⁶⁸Ga-FAPI-46 PET/CT with ¹⁸F-FDG PET/CT in these patients. METHODS: This single-center exploratory study enrolled 6 patients (median age, 29 y) with histologically confirmed treatment-refractory metastatic sarcoma. All patients underwent baseline ⁶⁸Ga-FAPI-46 and ¹⁸F-FDG PET/CT, followed by 2 to 4 cycles of ¹⁷⁷Lu-FAPI-2286 (3.7-7.4 GBq per cycle). Organ-level dosimetry was performed using serial planar and SPECT/CT imaging. Treatment response was evaluated using PET response criteria in solid tumors (PERCIST), and toxicity was graded according to CTCAE v5.0. Quantitative image-derived metrics, including the standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), FAP expression tumor volume (FTV), total lesion FAP expression (TLF), and tumor-to-liver ratio (TLR) were extracted. RESULTS: On the basis of the quantitative imaging data from the 6 sarcoma patients, there was no statistically significant difference between ⁶⁸Ga-FAPI-46 and ¹⁸F-FDG across the measured parameters (SUVmean, SUVmax, MTV/FTV, TLG/TLF, and TLR). However, ¹⁸F-FDG showed slightly higher MTVs. RLT was well-tolerated, with no grade ≥3 treatment-related toxicities observed. Adverse events were limited to low-grade hematological toxicities, including grade 2 leukopenia (n=1), grade 1 anemia (n=2), and grade 1 thrombocytopenia (n=1). Among 6 patients, 3 died due to disease progression before follow-up imaging could be completed. Among the 3 evaluable patients, one patient showed a mixed response pattern with metabolic improvement, but volumetric progression [partial response (PR) based on a decrease in SUVmax and SUVmean, progressive disease (PD) based on an increase in FTV, and stable disease (SD) based on minimal change in TLF], another patient showed SD, and the last patient demonstrated PD. The median overall survival was 4 months (95% CI: 0-8.8 mo). CONCLUSION: 177Lu-FAPI-2286 RLT was safe, well-tolerated, and demonstrated disease stabilization in heavily pretreated sarcoma patients. 68Ga-FAPI-46 PET/CT provides superior delineation of FAP-rich tumor areas, but smaller tumor volumes compared with 18F-FDG PET/CT. Prospective multicenter studies are warranted to confirm these findings and optimize FAP-targeted theranostic strategies in sarcoma.
We report a case of a 68-year-old man with incidentally discovered prostate adenocarcinoma following open transvesical prostatectomy for presumed benign prostatic hyperplasia. Initial ⁶⁸Ga-PSMA PET/CT demonstrated focal...We report a case of a 68-year-old man with incidentally discovered prostate adenocarcinoma following open transvesical prostatectomy for presumed benign prostatic hyperplasia. Initial ⁶⁸Ga-PSMA PET/CT demonstrated focal uptake in the left seminal vesicle, raising concern for seminal-vesicle invasion. Delayed imaging showed persistent but decreasing activity paralleling urinary clearance, and multiparametric MRI confirmed postoperative changes without evidence of tumor extension. The finding was ultimately attributed to urinary reflux into the seminal vesicle, a potential false-positive pitfall in patients with prior outlet-reconstructive surgery. Awareness of this phenomenon and multimodality correlation are essential to avoid misinterpretation and inappropriate management.
Clin Nucl Med
· 2026 Jun · PMID 42080620
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A 53-year-old woman presented with epigastric pain. Gastroscopy and abdominal CT suggested a tumorous lesion in the gastric antrum with possible local perforation. 18 F-FDG PET/CT was performed for staging, revealing int...A 53-year-old woman presented with epigastric pain. Gastroscopy and abdominal CT suggested a tumorous lesion in the gastric antrum with possible local perforation. 18 F-FDG PET/CT was performed for staging, revealing intense FDG uptake in the gastric antral wall and in segments I and IV of the liver, highly suggestive of primary gastric cancer with hepatic metastases. Surgical exploration, however, discovered an ingested toothpick that had perforated the gastric antrum and migrated into the liver, forming an inflammatory abscess. Pathology confirmed only inflammatory changes, with no evidence of malignancy. This case highlights that an inflammatory focus secondary to a migrating foreign body can mimic metastatic malignancy on 18 F-FDG PET/CT.
Rosar F, Burgard C, Hoang SPT
… +8 more, Blickle A, Bartholomä M, Maus S, Hein C, Bastian MB, Speicher T, Schaefer-Schuler A, Ezziddin S
Clin Nucl Med
· 2026 Jun · PMID 42080618
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INTRODUCTION: To enhance the effectiveness of radioligand therapy (RLT), new prostate-specific membrane antigen (PSMA) targeting radiopharmaceuticals utilizing alternative radionuclides are under active investigation. On...INTRODUCTION: To enhance the effectiveness of radioligand therapy (RLT), new prostate-specific membrane antigen (PSMA) targeting radiopharmaceuticals utilizing alternative radionuclides are under active investigation. One promising alternative to the established 177 Lu is the use of 161 Tb. A key advantage of 161 Tb is its emission of a higher proportion of low-energy conversion and Auger electrons, which may contribute to enhanced therapeutic effectiveness. This study provides a first exploratory evaluation of the efficacy and safety of [ 161 Tb]Tb-PSMA-617 in patients with progression after [ 177 Lu]Lu-PSMA-617, aiming to generate early clinical insights. METHODS: The study included 15 patients with mCRPC, who were enrolled in the "prospective registry to assess outcome and toxicity of targeted radionuclide therapy in patients with mCRPC in clinical routine" (REALITY Study; NCT04833517). All patients had received conventional PSMA RLT using [ 177 Lu]Lu-PSMA-617, which resulted in initial biochemical response (PSA decline ≥50%), followed by a biochemical relapse, prompting the re-initiation of PSMA RLT using [ 161 Tb]Tb-PSMA-617. Patients received a median of 3 (range: 2-7) cycles with mean administered activity of 5.4 ± 1.1 GBq and mean cumulative activity of 19.2 ± 6.4 GBq [ 161 Tb]Tb-PSMA-617. Treatment response was assessed both biochemically by serum PSA levels and through molecular imaging by total lesion PSMA (TLP) on [ 68 Ga]Ga-PSMA-11 PET/CT scans. Adverse events were assessed at baseline and follow-up using the "Common Terminology Criteria for Adverse Events" (Version 5.0). RESULTS: [ 161 Tb]Tb-PSMA-617 RLT showed response rates of 66.7% (10/15 patients) based on biochemical assessment and 86.7% (13/15 patients) based on molecular imaging assessment. Beginning with the initiation of [ 161 Tb]Tb-PSMA-617 RLT, the median progression-free survival (PFS) was 6.4 months, and the median overall survival (OS) was 15.5 months. In total, 6 CTCAE grade deteriorations from grade 2 to grade 3 or from grade 3 to grade 4 were observed. No discontinuation of PSMA RLT due to adverse events was reported. CONCLUSIONS: [ 161 Tb]Tb-PSMA-617 RLT emerges as a promising treatment option, demonstrating encouraging response rates, preliminary clinical outcomes, and a favorable safety profile as second-line RLT in progressing patients who previously benefited from [ 177 Lu]Lu-PSMA-617 RLT.
An 18F-MFBG PET/CT scan was performed in a 5-year-old girl diagnosed with high-risk neuroblastoma to further characterize indeterminate lesions previously identified on 123I-MIBG SPECT/CT. She was enrolled in our clinica...An 18F-MFBG PET/CT scan was performed in a 5-year-old girl diagnosed with high-risk neuroblastoma to further characterize indeterminate lesions previously identified on 123I-MIBG SPECT/CT. She was enrolled in our clinical trial. Moderate 18F-MFBG uptake was observed in pelvic lymph nodes and the left third sacral foramen. Histopathologic examination following surgical resection revealed mature ganglion cells embedded within Schwannian stroma in both lesions-findings consistent with benign neural differentiation, rather than residual or recurrent neuroblastoma. This case illustrates that false-positive 18F-MFBG PET/CT findings in pediatric neuroblastoma may arise from tracer accumulation associated with neural maturation.
Peptide receptor radionuclide therapy (PRRT) using beta (177Lu-DOTATATE) and alpha (225Ac-DOTATATE) therapy seems to be a safe and effective treatment option for advanced gastroenteropancreatic (GEP) neuroendocrine tumor...Peptide receptor radionuclide therapy (PRRT) using beta (177Lu-DOTATATE) and alpha (225Ac-DOTATATE) therapy seems to be a safe and effective treatment option for advanced gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). However, treatment efficacy needs to be balanced with long-term outcomes and adverse events, especially in young patients with a longer life expectancy. Local therapy may be a more effective and safe option in achieving a cure in such cases. The index case shows the efficacy of endoscopic ultrasound (EUS)-guided ethanol ablation of residual metastatic lymph nodes in achieving a complete response after beta followed by alpha PRRT in a young patient.
A 63-year-old man was referred for left knee pain, with suspicion of complex regional pain syndrome. Following a normal plain radiograph, 99mTc-HDP bone scintigraphy using new 3D-ring CZT system (StarGuide) was performed...A 63-year-old man was referred for left knee pain, with suspicion of complex regional pain syndrome. Following a normal plain radiograph, 99mTc-HDP bone scintigraphy using new 3D-ring CZT system (StarGuide) was performed. Blood pool SPECT/CT demonstrated intense hyperemia along the patellar tendon, suggesting infrapatellar bursitis, while late-phase SPECT/CT revealed focal increased uptake on the tibial tuberosity, suggestive of associated patellar tendinopathy. Our case highlights the potential of blood pool SPECT/CT using new 3D-ring CZT system to identify relevant extraosseous conditions such as knee bursitis.
A man in his 60s with asbestos exposure and pleural plaques was incidentally found to have a chest wall mass on computed tomography (CT). Positron emission tomography/CT (PET/CT) demonstrated intense 18F-fluorodeoxygluco...A man in his 60s with asbestos exposure and pleural plaques was incidentally found to have a chest wall mass on computed tomography (CT). Positron emission tomography/CT (PET/CT) demonstrated intense 18F-fluorodeoxyglucose (FDG) uptake, raising concern for malignancy, including malignant pleural mesothelioma. CT and magnetic resonance imaging (MRI), however, showed a predominantly fat-containing lesion, suggesting hibernoma. Video-assisted thoracoscopic resection was performed, and histopathology confirmed hibernoma. Recognition of macroscopic fat on CT/MRI is essential to avoid misdiagnosis of FDG-avid benign lipomatous tumors.
Esophageal cancer usually shows focal intense FDG uptake on FDG PET. Diffuse FDG uptake pattern of the esophageal cancer has been rarely reported. We describe FDG PET/CT findings in a case of poorly differentiated esopha...Esophageal cancer usually shows focal intense FDG uptake on FDG PET. Diffuse FDG uptake pattern of the esophageal cancer has been rarely reported. We describe FDG PET/CT findings in a case of poorly differentiated esophageal squamous cell carcinoma diffusely involving the entire esophagus. FDG PET/CT showed diffuse irregular thickening of the entire esophageal wall with diffusely intense FDG uptake with SUVmax of 15 and multiple FDG-avid lymph nodes and osteolytic bone metastases.
Clin Nucl Med
· 2026 Jun · PMID 42080610
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A 68-year-old woman with cervical cancer and pulmonary metastases presented with limb paresthesia and pain one week after chemotherapy. Whole-body bone scintigraphy performed to evaluate for bone metastases revealed rib...A 68-year-old woman with cervical cancer and pulmonary metastases presented with limb paresthesia and pain one week after chemotherapy. Whole-body bone scintigraphy performed to evaluate for bone metastases revealed rib metastases, along with poor visualization of the right distal lower extremity, raising suspicion for possible arterial flow obstruction in the right lower limb. Further imaging confirmed extensive thrombosis in the right common iliac artery and its distal branches. This case suggests that decreased uptake in the skeletal structures and surrounding soft tissues on whole-body bone scintigraphy may indicate a risk of arterial thrombosis.
Malignant mesothelioma is a rare but highly aggressive malignancy associated with a poor prognosis. Similar to many other solid tumors, cytotoxic chemotherapy has traditionally been the standard treatment for patients wi...Malignant mesothelioma is a rare but highly aggressive malignancy associated with a poor prognosis. Similar to many other solid tumors, cytotoxic chemotherapy has traditionally been the standard treatment for patients with locally advanced or metastatic malignant pleural mesothelioma (MPM). However, with increasing recognition of immune dysregulation, immune-directed therapies have assumed a growing role in the management of mesothelioma. Here, we report a case of epithelioid-type malignant pleural mesothelioma that demonstrated primary resistance to ipilimumab plus nivolumab, followed by a marked metabolic response on 18F-FDG PET/CT after switching to bevacizumab plus pemetrexed plus carboplatin.