Non-[F]FDG PET-Radiopharmaceuticals in Oncology.

Molecular imaging is a growing field, driven by technological advances, such as the improvement of PET-CT scanners through the introduction of digital detectors and scanners with an extended field of view, resulting in much higher sensitivity and a variety of new specific radiopharmaceuticals that allow the visualization of specific molecular pathways and even theragnostic approaches. In oncology, the development of dedicated tracers is crucial for personalized therapeutic approaches. Novel peptides allow the visualization of many different targets, such as PD-1 and PD-L1 expression, chemokine expression, HER expression, T-cell imaging, microenvironmental imaging, such as FAP imaging, and many more.

Radiomics and Artificial Intelligence Landscape for [F]FDG PET/CT in Multiple Myeloma.

[F]FDG PET/CT is a powerful imaging modality of high performance in multiple myeloma (MM) and is considered the appropriate method for assessing treatment response in this disease. On the other hand, due to the heterogeneous and sometimes complex patterns of bone marrow infiltration in MM, the interpretation of PET/CT can be particularly challenging, hampering interobserver reproducibility and limiting the diagnostic and prognostic ability of the modality. Although many approaches have been developed to address the issue of standardization, none can yet be considered a standard method for interpretation or objective quantification of PET/CT.

Enhancing the diagnostic capacity of [F]PSMA-1007 PET/MRI in primary prostate cancer staging with artificial intelligence and semi-quantitative DCE: an exploratory study.

Background: To investigate the ability of artificial intelligence (AI)-based and semi-quantitative dynamic contrast enhanced (DCE) multiparametric MRI (mpMRI), performed within [F]-PSMA-1007 PET/MRI, in differentiating benign from malignant prostate tissues in patients with primary prostate cancer (PC).

Results: A total of seven patients underwent whole-body [F]-PSMA-1007 PET/MRI examinations including a pelvic mpMRI protocol with T2w, diffusion weighted imaging (DWI) and DCE image series. Conventional analysis included visual reading of PET/MRI images and Prostate Imaging Reporting & Data System (PI-RADS) scoring of the prostate.

Impact of different parametric Patlak imaging approaches and comparison with a 2-tissue compartment pharmacokinetic model with a long axial field-of-view (LAFOV) PET/CT in oncological patients.

Aim: The recently introduced Long-Axial-Field-of-View (LAFOV) PET-CT scanners allow for the first-time whole-body dynamic- and parametric imaging. Primary aim of this study was the comparison of direct and indirect Patlak imaging as well as the comparison of different time frames for Patlak calculation with the LAFOV PET-CT in oncological patients. Secondary aims of the study were lesion detectability and comparison of Patlak analysis with a two-tissue-compartment model (2TCM).

Total Body PET-CT Protocols in Oncology.

Recently developed long axial field of view (LAFOV) PET-CT scanners, including total body scanners, are already in use in a few centers worldwide. These systems have some major advantages over standard axial field of view (SAFOV) PET-CT scanners, mainly due to up to 20 times higher sensitivity and therefore improved lesion detectability. Other advantages are the reduction of the PET acquisition time for a static whole-body measurement, the reduction of the administered radiotracer dose, and the ability to perform delayed scans with good image quality, which is important for imaging radionuclides with long half-lives and pharmaceuticals with long biodistribution times, such as Zr-labeled antibodies.

Long Axial Field-of-View (LAFOV) PET/CT in Prostate Cancer.

PSMA-targeted PET/CT is currently considered the most effective non-invasive diagnostic technique for imaging PSMA-positive lesions in prostate cancer (PC), and its introduction has significantly enhanced the role of nuclear medicine in both the diagnosis and therapy (theranostics) of this oncological entity. In line with developments in radiopharmaceuticals, significant progress has been made in the development of PET/CT systems. In particular, the advent of long axial field-of-view (LAFOV) PET/CT scanners has represented a major leap forward in molecular imaging, with early results from clinical applications of these systems showing significant improvements over previous standard axial field-of-view systems in terms of sensitivity, image quality and lesion quantification, while enabling whole-body dynamic PET imaging.

Artificial intelligence-based, volumetric assessment of the bone marrow metabolic activity in [F]FDG PET/CT predicts survival in multiple myeloma.

Purpose: Multiple myeloma (MM) is a highly heterogeneous disease with wide variations in patient outcome. [F]FDG PET/CT can provide prognostic information in MM, but it is hampered by issues regarding standardization of scan interpretation. Our group has recently demonstrated the feasibility of automated, volumetric assessment of bone marrow (BM) metabolic activity on PET/CT using a novel artificial intelligence (AI)-based tool.

Combined whole-body dynamic and static PET/CT with low-dose [F]PSMA-1007 in prostate cancer patients.

Aim: In addition to significant improvements in sensitivity and image quality, the recent introduction of long axial field-of-view (LAFOV) PET/CT scanners has enabled dynamic whole-body imaging for the first time. We aim herein to determine an appropriate acquisition time range for static low-dose [F]PSMA-1007 PET imaging and to investigate the whole-body pharmacokinetics of [F]PSMA-1007 by dynamic PET with the LAFOV Biograph Vision Quadra PET/CT in a group of prostate cancer patients.

Methodology: In total, 38 prostate cancer patients were enrolled in the analysis for staging or re-staging purposes.

Application of an artificial intelligence-based tool in [F]FDG PET/CT for the assessment of bone marrow involvement in multiple myeloma.

Purpose: [F]FDG PET/CT is an imaging modality of high performance in multiple myeloma (MM). Nevertheless, the inter-observer reproducibility in PET/CT scan interpretation may be hampered by the different patterns of bone marrow (BM) infiltration in the disease. Although many approaches have been recently developed to address the issue of standardization, none can yet be considered a standard method in the interpretation of PET/CT.

The prognostic value of [F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria.

Purpose: To investigate the prognostic value of [F]FDG PET/CT as part of response monitoring in metastatic melanoma patients treated with immune checkpoint inhibitors (ICIs).

Methods: Sixty-seven patients underwent [F]FDG PET/CT before start of treatment (baseline PET/CT), after two cycles (interim PET/CT) and after four cycles of ICIs administration (late PET/CT). Metabolic response evaluation was based on the conventional EORTC and PERCIST criteria, as well as the newly introduced, immunotherapy-modified PERCIMT, imPERCIST5 and iPERCIST criteria.

Long axial field of view (LAFOV) PET-CT: implementation in static and dynamic oncological studies.

Long axial field of view (LAFOV) PET-CT scanners have been recently developed and are already in clinical use in few centers worldwide. Although still limited, the hitherto acquired experience with these novel systems highlights an increased sensitivity as their main advantage, which results in an increased lesion detectability. This attribute, alternatively, allows a reduction in PET acquisition time and/or administered radiotracer dose, while it renders delayed scanning of satisfying diagnostic accuracy possible.

A decision support system for the identification of metastases of Metastatic Melanoma using whole-body FDG PET/CT images.

Metastatic Melanoma (MM) is an aggressive type of cancer which produces metastases throughout the body with very poor survival rates. Recent advances in immunotherapy have shown promising results for controlling disease's progression. Due to the often rapid progression, fast and accurate diagnosis and treatment response assessment is vital for the whole patient management.

Positron Emission Tomography-Based Immunoimaging for Cancer Patient Stratification: Toward a More Holistic Approach.

Immunotherapy with immune checkpoint inhibitors (ICIs) changed the treatment management in several solid metastatic tumors with very poor prognosis, in particular in melanoma stage IV since its introduction in 2011. However, it is not yet fully understood why some patients respond to ICIs and others not, and it is also unclear why melanomas are the most sensitive tumors to ICI treatment. Selection criteria for patient stratification are needed and several approaches are under evaluation.

Perspectives on joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards for [F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors.

Response assessment in the context of immunomodulatory treatments represents a major challenge for the medical imaging community and requires a multidisciplinary approach with involvement of oncologists, radiologists, and nuclear medicine specialists. There is evolving evidence that [F]FDG PET/CT is a useful diagnostic modality for this purpose. The clinical indications for, and the principal aspects of its standardization in this context have been detailed in the recently published "Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.

A comparative assessment of intra- and inter- observer repeatability of three widely used software packages for the quantification of defect size in stress myocardial perfusion scintigraphy.

Objective: To assess the intra- and inter-observer repeatability of popular software packages for the quantitative determination of abnormality size in stress myocardial perfusion scintigraphy.

Subjects And Methods: A total of 182 tomographic stress myocardial perfusion scans were processed in duplicate by an experienced and trainee observer to assess SSSext (summed stress score multiplied by 100/68) and total defect extent (TDE), as % of the left ventricle, with 4 dimension-myocardial (4DM), emory cardiac toolbox (ECTb) and quantitative perfusion SPECT (QPS) packages. The Bland-Altman (B-A) analysis and Lin's concordance correlation coefficient (CCC) were used to assess agreement.

Unusual Extramedullary Manifestation in Multiple Myeloma: Bilateral Synchronous Testicular Infiltration.

A 73-year-old man with multiple myeloma (initial diagnosis 21 months earlier) was referred to our center for a whole-body 18 F-FDG PET/CT. We detected a bilateral synchronous testicular manifestation, which was confirmed by histopathology after orchiectomy. Besides hypermetabolic lesions in the spine and ribs (most likely old fractures), known osteolysis showed no uptake.

Hybrid imaging with [Ga]PSMA-11 PET-CT and PET-MRI in biochemically recurrent prostate cancer.

Aim: To compare [Ga]PSMA-11 PET-CT, [Ga]PSMA-11 PET-MRI and MRI in a cohort of prostate cancer (PCa) patients in biochemical recurrence after initial curative therapy.

Materials And Methods: Fifty-three patients with biochemically recurrent PCa underwent whole-body [Ga]PSMA-11 PET-CT 1 hour post-injection (p.i.

Adverse effects under immune checkpoint inhibitors on [18F]FDG PET/CT imaging.

Despite their undisputed contribution to the management of various tumors and the prolongation of patient survival, immune checkpoint inhibitors (ICIs) exert their effect at the cost of toxicity. In the context of the activation of the host immune system triggered by ICIs, collateral, inflammatory side effects, commonly addressed as immune-related adverse events (irAEs) often occur. Early detection of irAEs can be critical for adequate decisions on patient management that may subsequently improve patient outcome.

Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0.

Purpose: The goal of this guideline/procedure standard is to assist nuclear medicine physicians, other nuclear medicine professionals, oncologists or other medical specialists for recommended use of [F]FDG PET/CT in oncological patients undergoing immunotherapy, with special focus on response assessment in solid tumors.

Methods: In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard.

Conclusions: The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [F]FDG PET/CT during immunotherapy.