PURPOSE: Fibroblast activation protein (FAP) is highly expressed in cancer-associated fibroblasts and represents an emerging target for radioligand therapy (RLT). This study aimed to evaluate treatment outcomes of ¹⁷⁷Lu-...PURPOSE: Fibroblast activation protein (FAP) is highly expressed in cancer-associated fibroblasts and represents an emerging target for radioligand therapy (RLT). This study aimed to evaluate treatment outcomes of ¹⁷⁷Lu-FAP-2286 and to investigate whether changes in quantitative parameters on ⁶⁸Ga-FAP-2286 PET/CT are associated with treatment response and survival in patients with advanced solid tumors. METHODS: In this single-center retrospective study, patients with advanced solid tumors who completed 2 cycles of ¹⁷⁷Lu-FAP-2286 therapy and underwent both baseline and posttreatment ⁶⁸Ga-FAP-2286 PET/CT (8-16 wk after therapy) were included. Maximum standardized uptake value (SUVmax) and total tumor volume (TTV) were quantified using semiautomatic whole-body segmentation. Relative changes (ΔSUVmax and ΔTTV) were calculated. RECIST 1.1 served as the clinical reference standard. Receiver operating characteristic analysis assessed the ability of PET-derived changes to discriminate progressive disease. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: Thirty patients (median age, 65 y; range, 23-78 y) completed 2 cycles of ¹⁷⁷Lu-FAP-2286 therapy. According to RECIST 1.1, partial response, stable disease, and progressive disease occurred in 6 (20.0%), 11 (36.7%), and 13 (43.3%) patients, respectively. SUVmax and TTV decreased in 46.7% of patients. ΔSUVmax demonstrated moderate discrimination for RECIST-defined PD (AUC 0.72, P=0.04). Patients with ΔSUVmax <30% had significantly longer PFS than those with ΔSUVmax ≥30% (median 10.3 vs. 4.4 mo; log-rank P<0.001). Median OS was not reached in the ΔSUVmax <30% group compared with 9.8 months in the ΔSUVmax ≥30% group (log-rank P=0.003). In multivariable analysis, ΔSUVmax remained independently associated with PFS (HR: 5.2, 95% CI 1.5-7.8; P=0.010) and OS (HR: 4.3, 95% CI: 1.3-14.1; P=0.015). CONCLUSIONS: In patients with advanced solid tumors treated with 2 cycles of ¹⁷⁷Lu-FAP-2286, posttreatment changes in SUVmax on ⁶⁸Ga-FAP-2286 PET/CT were associated with treatment response and survival, suggesting potential utility as an imaging biomarker for early response assessment and prognostic stratification.
Inflammatory myofibroblastic tumor involving multiple parts of the body simultaneously is extremely rare. Here, we present FDG PET/CT findings of multiple inflammatory myofibroblastic tumors in a patient. 18F-FDG PET/CT...Inflammatory myofibroblastic tumor involving multiple parts of the body simultaneously is extremely rare. Here, we present FDG PET/CT findings of multiple inflammatory myofibroblastic tumors in a patient. 18F-FDG PET/CT showed intense 18F-FDG uptake in the liver and abdominal cavity. Finally, the diagnosis of multiple inflammatory myofibroblastic tumors was confirmed by pathologic examination.
Mas Pascasio C, Ruíz de Almirón de Andrés B, López Rodríguez E
… +1 more, Sanz Viedma S
Clin Nucl Med
· 2026 Jun · PMID 42377936
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F-18 DOPA PET/CT is well established in the evaluation of neuroendocrine tumors and pheochromocytoma/paraganglioma. Prostatic uptake is not part of its usual physiological biodistribution, and its significance in convent...F-18 DOPA PET/CT is well established in the evaluation of neuroendocrine tumors and pheochromocytoma/paraganglioma. Prostatic uptake is not part of its usual physiological biodistribution, and its significance in conventional prostate adenocarcinoma remains unclear. We report intense incidental prostatic F-18 DOPA uptake in a 60-year-old man undergoing evaluation for persistently elevated normetanephrines. PET/CT showed 2 highly avid foci in the posterior-inferior prostate. Multiparametric MRI was not suspicious, but biopsy revealed acinar adenocarcinoma, Gleason score 3+3, ISUP grade 1, without neuroendocrine marker expression. This finding represents a potential diagnostic pitfall and supports cautious interpretation of focal pelvic F-18 DOPA uptake.
Huang X, Guo X, Li B
… +7 more, Yang H, Nie P, Lv M, Zhang N, Mao Y, Yang G, Wang Z
Clin Nucl Med
· 2026 Jun · PMID 42377932
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BACKGROUND: To compare HER2-targeted with ¹⁸F-FDG PET/CT for detecting axillary lymph node metastasis in patients with newly diagnosed HER2-positive or HER2-low breast cancer. METHODS: In this prospective study, HER2-exp...BACKGROUND: To compare HER2-targeted with ¹⁸F-FDG PET/CT for detecting axillary lymph node metastasis in patients with newly diagnosed HER2-positive or HER2-low breast cancer. METHODS: In this prospective study, HER2-expressed breast cancer participants underwent both 18F-FDG and Al18F-NOTA-HER2-BCH PET/CT within 1 week. On the basis of IHC and/or FISH, participants were categorized as HER2-positive (n=25) or HER2-low (n=26). Histopathology or imaging follow-up served as reference standards. Statistical analyses utilized the paired McNemar test for diagnostic performance, and the Wilcoxon signed-rank and Mann-Whitney U tests for paired and unpaired comparisons of uptake parameters, respectively. RESULTS: Between August 2024 and October 2025, 51 participants with breast cancer were enrolled. Among 40 participants with lymph node metastasis, Al18F-NOTA-HER2-BCH detected metastatic lymph nodes exclusively in one HER2-positive participant and more lesions than 18F-FDG in 11 cases. On a per-lesion analysis, Al18F-NOTA-HER2-BCH demonstrated significantly higher sensitivity, accuracy, and negative predictive value than 18F-FDG for detecting metastatic axillary lymph nodes in the HER2-positive cohort (94%, 94%, 93% vs. 79%, 85%, 84%, all P<0.001). This superiority was particularly pronounced for small lymph nodes (<5 mm), with a detection rate of 90% versus 62% for 18F-FDG (P<0.001). Al18F-NOTA-HER2-BCH PET/CT directly influenced nodal staging and subsequent treatment decisions in 4 of 25 (16.0%) HER2-positive participants. In the HER2-low cohort, however, the diagnostic performance of the 2 tracers did not differ significantly, although 18F-FDG PET/CT led to clinically relevant nodal upstaging in one case. CONCLUSIONS: Al18F-NOTA-HER2-BCH retains developmental potential for detecting axillary lymph node metastasis in HER2-positive breast cancer, complementing 18F-FDG.
Perozziello F, Renaud M, Cousin S
… +2 more, Préga-Renaud V, Meyer M
Clin Nucl Med
· 2026 Jun · PMID 42377929
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A 61-year-old woman currently undergoing first-line treatment by immunochemotherapy for metastatic small cell lung carcinoma (SCLC) presented for consultation with symptoms of permanent and isolated tremor of the right u...A 61-year-old woman currently undergoing first-line treatment by immunochemotherapy for metastatic small cell lung carcinoma (SCLC) presented for consultation with symptoms of permanent and isolated tremor of the right upper limb. Brain MRI was normal. The 18F-FDG PET/CT showed an isolated sub-scan hypermetabolism in the left precentral gyrus. Two weeks later, a new MRI was performed, showing cortical contrast enhancement correlated with the PET images. This case shows that PET/CT can be useful in detecting symptomatic metastatic lesions in cases where MRI is normal.
Nazir N, Hassan A, Ashraf A
… +2 more, Ilyas H, Ur Rehman A
Clin Nucl Med
· 2026 Jun · PMID 42377923
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We report a case of Langerhans cell histiocytosis (LCH) in a 2-year-old boy who presented with scalp swelling. Imaging work-up revealed dural involvement, which is a rare manifestation in LCH. Dural LCH can present with...We report a case of Langerhans cell histiocytosis (LCH) in a 2-year-old boy who presented with scalp swelling. Imaging work-up revealed dural involvement, which is a rare manifestation in LCH. Dural LCH can present with imaging features that closely resemble meningioma or inflammatory pachymeningitis. Combined MRI and FDG PET imaging provides complementary information. MRI explains the structural and anatomic details of dural involvement, and PET aids in evaluating metabolic activity, facilitating early recognition, accurate staging, and treatment response assessment in CNS LCH.
Clin Nucl Med
· 2026 Jun · PMID 42377916
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A 53-year-old woman with left lower back pain, anemia, proteinuria, and hematuria was found to have bilateral adrenal masses on ultrasonography. The subsequent contrast-enhanced MRI and 18F-FDG PET/CT revealed bilateral...A 53-year-old woman with left lower back pain, anemia, proteinuria, and hematuria was found to have bilateral adrenal masses on ultrasonography. The subsequent contrast-enhanced MRI and 18F-FDG PET/CT revealed bilateral adrenal masses with locally extensive intravenous tumor thrombi. Postoperative pathology confirmed a malignant perivascular epithelioid cell tumor (PEComa) in the left adrenal region, with tumor thrombi involving the left renal vein, left ovarian vein, inferior vena cava, and right adrenal vein.
Clin Nucl Med
· 2026 Jun · PMID 42377904
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A 5-year-old girl diagnosed with high-risk neuroblastoma enrolled in our clinical trial underwent 18F-MFBG PET/CT, showing multiple discrete focal "hot spots." Bone marrow aspiration confirmed metastatic neuroblastoma in...A 5-year-old girl diagnosed with high-risk neuroblastoma enrolled in our clinical trial underwent 18F-MFBG PET/CT, showing multiple discrete focal "hot spots." Bone marrow aspiration confirmed metastatic neuroblastoma involvement. After 5 cycles of immunotherapy and chemotherapy, follow-up 18F-MFBG PET/CT revealed a marked shift in biodistribution: the multiple discrete focal "hot spots" pattern resolved, and diffuse and intense skeletal tracer uptake-consistent with a superscan pattern emerged-including both newly developed lesions-indicative of progressive disease. The present case showed the temporal evolution of 18F-MFBG uptake from multiple focal "hot spots" to a superscan.
Saber Tanha A, Askari E, Moeini Nodeh M
… +2 more, Aghaee A, Raeisi N
Clin Nucl Med
· 2026 Jun · PMID 42377403
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We describe a 71‑year‑old man with squamous cell lung carcinoma who underwent metastasis work-up with CT scan and 99mTc‑MDP bone scintigraphy, which suggested limited extrathoracic skeletal involvement. Subsequent 99mTc‑...We describe a 71‑year‑old man with squamous cell lung carcinoma who underwent metastasis work-up with CT scan and 99mTc‑MDP bone scintigraphy, which suggested limited extrathoracic skeletal involvement. Subsequent 99mTc‑FAPI‑46 scintigraphy revealed a substantially greater disease burden, identifying a more extensive nodal and skeletal metastases. These findings resulted in a decisive stage migration from an initially presumed oligometastatic to a clearly polymetastatic stage IV disease, with direct implications for therapeutic intent. This case underscores the potential clinical utility of 99mTc‑FAPI‑46 scan as a cost‑effective staging modality, particularly in settings where PET/CT is unavailable or financially prohibitive.
Clin Nucl Med
· 2026 Jun · PMID 42377402
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An 18F-MFBG PET/CT scan was conducted to evaluate the therapeutic response following treatment with chemotherapy, surgery, and radiotherapy. This study demonstrated increased 18F-MFBG accumulation in the right perirenal...An 18F-MFBG PET/CT scan was conducted to evaluate the therapeutic response following treatment with chemotherapy, surgery, and radiotherapy. This study demonstrated increased 18F-MFBG accumulation in the right perirenal space, accompanied by a cloud-like shadow on the corresponding CT images, which was within the radiation therapy field. The lesion remained positive on subsequent follow-up 18F-MFBG PET/CT imaging. This abnormal MFBG accumulation was within the radiation therapy field. Based on the clinical history, this persistent 18F-MFBG uptake was considered to be related to prior radiotherapy, and should be considered in the differential diagnosis.
Clin Nucl Med
· 2026 Jun · PMID 42348272
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A 6-year-old girl with high-risk neuroblastoma achieved a complete response following multimodal therapy. During routine post-therapeutic surveillance, 123I-MIBG SPECT/CT revealed progressive focal tracer uptake within t...A 6-year-old girl with high-risk neuroblastoma achieved a complete response following multimodal therapy. During routine post-therapeutic surveillance, 123I-MIBG SPECT/CT revealed progressive focal tracer uptake within the right T8-T9 intervertebral foramen. Serial imaging demonstrated interval enlargement of the lesion. On contrast-enhanced MRI, the mass exhibited homogeneous hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and intense, uniform enhancement after intravenous gadolinium administration. Radiologic assessment initially favored a schwannoma. Histopathologic examination of the resected specimen confirmed metastatic neuroblastoma involving the dorsal root ganglion.
Otomi Y, Otsuka H, Otani T
… +3 more, Kasai R, Matsushita T, Harada M
Clin Nucl Med
· 2026 Jun · PMID 42348257
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Pancreatic uptake can be observed on routine 99mTc-MIBI and 99mTc-tetrofosmin myocardial perfusion SPECT/CT. We present representative cases demonstrating visually prominent pancreatic activity relative to hepatic and sp...Pancreatic uptake can be observed on routine 99mTc-MIBI and 99mTc-tetrofosmin myocardial perfusion SPECT/CT. We present representative cases demonstrating visually prominent pancreatic activity relative to hepatic and splenic uptake. Hybrid SPECT/CT enabled confident anatomic localization of pancreatic activity and differentiation from adjacent hepatobiliary and intestinal activity. Recognition of this finding may facilitate interpretation of extracardiac tracer activity during routine myocardial perfusion imaging and reduce uncertainty related to subdiaphragmatic tracer distribution.
Querellou S, Guellec D, Abgral R
… +2 more, Vinsonneau U, Le Roux PY
Clin Nucl Med
· 2026 Jun · PMID 42341206
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A 72-year-old man with a history of apical myocardial infarction 12 years earlier, complicated by a chronic left ventricular aneurysm, underwent 18F-FDG PET/CT and 68Ga-FAPI-46 PET/CT imaging. 18F-FDG PET/CT, performed w...A 72-year-old man with a history of apical myocardial infarction 12 years earlier, complicated by a chronic left ventricular aneurysm, underwent 18F-FDG PET/CT and 68Ga-FAPI-46 PET/CT imaging. 18F-FDG PET/CT, performed without cardiac preparation, showed a well-defined photopenic defect corresponding to the aneurysm, consistent with a nonviable transmural scar. In contrast, 68Ga-FAPI PET/CT demonstrated intense uptake along the aneurysmal wall with a ring-like pattern at the basal border zone. This discordant pattern suggests persistent fibroblast activation despite metabolic quiescence, indicating that chronic ventricular aneurysms may remain biologically active rather than inert fibrotic sequelae.
Clin Nucl Med
· 2026 Jun · PMID 42341201
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We report the 18F-FDG PET/CT findings of IgG4-related autoimmune hepatitis mimicking hepatic malignancy in a 52-year-old man. The patient presented with intermittent fever, abdominal pain, and significantly elevated tumo...We report the 18F-FDG PET/CT findings of IgG4-related autoimmune hepatitis mimicking hepatic malignancy in a 52-year-old man. The patient presented with intermittent fever, abdominal pain, and significantly elevated tumor markers. Initial evaluation with contrast-enhanced CT suggested hepatic malignancy. 18F-FDG PET/CT demonstrated heterogeneous hepatic FDG uptake and multiregional hypermetabolic lymphadenopathy. Diagnosis was confirmed by cervical lymph node biopsy and a favorable clinical response to glucocorticoid therapy.
Usmani S, Al Riyami K, Ismaila A
… +3 more, Jain A, Al Busaidi A, Kheruka SC
Clin Nucl Med
· 2026 Jun · PMID 42341200
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A 42-year-old woman with invasive lobular carcinoma of the left breast underwent staging with 68Ga-FAPI PET/CT, which demonstrated intense uptake in the primary breast lesion and ipsilateral nodal metastases. Incidentall...A 42-year-old woman with invasive lobular carcinoma of the left breast underwent staging with 68Ga-FAPI PET/CT, which demonstrated intense uptake in the primary breast lesion and ipsilateral nodal metastases. Incidentally, symmetric intense pelvic tracer uptake was identified, corresponding on fused PET/CT to 2 distinct uterine horns consistent with uterus didelphys. The characteristic bilateral rounded appearance on PET images produced a striking "Mickey Mouse" sign, reflecting physiological FAPI accumulation within duplicated uterine stromal tissue. Subsequent ultrasonography confirmed uterus didelphys with normal endometrial and myometrial morphology. Recognition of physiological FAPI uptake patterns in congenital Müllerian anomalies is essential to avoid misinterpretation as pelvic metastatic disease.
Clin Nucl Med
· 2026 Jun · PMID 42341194
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68Ga-DOTA-ibandronic acid (IBA) represents a novel positron emission tomography (PET) tracer for bone imaging, primarily employed in the diagnosis of malignant tumor metastases and the guidance of subsequent 177Lu-DOTA-I...68Ga-DOTA-ibandronic acid (IBA) represents a novel positron emission tomography (PET) tracer for bone imaging, primarily employed in the diagnosis of malignant tumor metastases and the guidance of subsequent 177Lu-DOTA-IBA targeted radionuclide therapy. In a clinical case involving a patient with lung adenocarcinoma and multiple osseous metastases, increased 68Ga-DOTA-IBA uptake was observed in the metastatic bone lesions. Unexpectedly, increased uptake was also noted in the bilateral lacrimal and salivary glands. This finding underscores the importance of evaluating potential radiation exposure to lacrimal and salivary glands before initiating 177Lu-DOTA-IBA-based radiopharmaceutical therapy.
Clin Nucl Med
· 2026 Jun · PMID 42341192
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Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly aggressive form of non-small cell lung cancer. Rectal metastasis of PSC is an extremely rare condition. We herein report a rare case of PSC accompanied by rectal...Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly aggressive form of non-small cell lung cancer. Rectal metastasis of PSC is an extremely rare condition. We herein report a rare case of PSC accompanied by rectal metastasis detected by 18F-FDG PET/CT. This case highlights the diagnostic value of 18F-FDG PET/CT in detecting uncommon metastatic sites in PSC.
Clin Nucl Med
· 2026 May · PMID 42341191
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We report a case of marked biatrial 18F-FDG uptake on PET/CT coinciding with the onset of symptomatic atrial flutter in a 77-year-old man with relapsed diffuse large B-cell lymphoma receiving ibrutinib. Serial imaging de...We report a case of marked biatrial 18F-FDG uptake on PET/CT coinciding with the onset of symptomatic atrial flutter in a 77-year-old man with relapsed diffuse large B-cell lymphoma receiving ibrutinib. Serial imaging demonstrated normal atrial uptake before arrhythmia, marked uptake during atrial flutter, and complete normalisation following successful radiofrequency ablation. Atrial tachyarrhythmia represents an important and reversible cause of increased atrial FDG uptake and should prompt clinical and electrocardiographic correlation to avoid misinterpretation as cardiac disease involvement.