Background. - In Tunisia, intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) frequently causes severe late salivary toxicities, significantly impairing patients' quality of life (QOL). Objective assessment of salivary dysfunction using salivary gland scintigraphy using Tc 99m (Tc-99m-SS) remains underutilized. Objectives. - This study aimed to evaluate salivary dysfunction using Tc-99m-SS after IMRT, to correlate dysfunction with salivary gland dosimetric parameters, and to quantify its impact on patient QOL. Methods. - A single-center cross-sectional study conducted from June to December 2023, included NPC patients in complete remission after IMRT. The assessment combined Tc-99m-SS, measuring uptake rate (UR) and salivary ejection fraction (SEF), with salivary gland dosimetry (mean/maximum doses, V-15Gy, V-30Gy, V-40Gy, D-50%). QOL was assessed using the EORTC QLQ-H&N43 questionnaire (arabic version). Statistical analyses employed Pearson correlation and ANOVA. Results. - Among 37 patients (median age: 49 years), 89% reported xerostomia (59% grade 2). Tc-99m-SS (128 glands in 32 patients) identified moderate hypofunction in 48% of glands, significantly more pronounced in submandibular glands (ipsilateral median SEF: 4.5% vs. contralateral: 7%; P < 0.05). Xerostomia correlated with submandibular D-max (P = 0.034) and treatment spread (P = 0.025). Parotid SEF declined with increasing D-mean (r = -0.463; P = 0.013), V-30Gy (r = -0.475; P = 0.011), V-40Gy (r = -0.571; P = 0.002), and D-50% (r = -0.524; P = 0.004). QOL was most affected by dry mouth (54.5 +/- 31.82) and dental problems (42.64 +/- 36.61), both exacerbated by xerostomia (P < 0.05). Conclusion. - It is critical to systematically integrate Tc-99m-SS into post-IMRT monitoring. This approach would optimize glandular preservation strategies and sustainably improve patient well-being. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, Al training, and similar technologies.
Ten to 15% of patients with differentiated follicular thyroid carcinoma (DTC) develop micro-or macronodular lung metastases (LM). Iodine 131 is the key treatment of these metastases. The aim of the study was to assess the efficacy of radioiodine therapy in LM of DTC, and to identify predictive factors of response. This was a retrospective and descriptive study, including patients operated for DTC presenting synchronous or metachronous LM, between 1996 and 2019. The number of patients included was 29 (8 children and 21 adults). The mean age was 39 years (ranging from 5 to 82 years). Papillary carcinoma was the most frequent histological type. LM were miliary in 14 cases and nodular in 15. The administered activity was 3.7 GBq in 80% of cases. The number of courses of radioiodine therapy varied from 3 to 12, with an average of 6.1. The response to treatment was complete in 10 patients, partial in 4 others and absent in the last 15. The efficacy rate was 48%. Univariate analysis showed that young age at diagnosis, type of LM and initial iodine avidity were the most significant factors associated with therapeutic efficacy (P = 0.008; < 0.001 and < 0.001 respectively). Most LM of DTC respond to radioiodine therapy, either completely or partially, especially the iodine-avid micronodular metastases of young patients. Radioiodine therapy should be continued as long as lesions continue to present radioiodine uptake. 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Background: The increasing incidence of cancer cases has led to an increase in bone metastases (BM), posing a major public health problem. The aim of this study was to investigate the distribution of BM, skeletal events related (SRE) to metastases and their association with mortality. Methods: The study included data from 13,047 patients who underwent 18F-FDG PET/CT scans at Necmettin Erbakan University Faculty of Medicine Hospital between 2012 and 2022. Patients included in the study were those with solid tumors diagnosed with their first BM during the screening period and were between 18 and 99 years old. Patients with solid tumors without BM, primary bone tumors, childhood cancers, and incomplete data records were excluded. Results: Multiple BM were detected in 80.1% of patients. When we looked at cancer patients with BM, the first metastasis was most commonly to the spine (85.8%), the second bone metastasis was most commonly to the scapula (33.1%) and the third BM was most commonly to the femur (51.2%). SRE to metastasis occurred in 45.8% of patients. The average time from diagnosis to the first metastasis was 13.4 +/- 23.2 months, the average time to the second metastasis was 33.8 +/- 30.6 months, and the average time to the third metastasis was 49.3 +/- 33.6 months. Conclusion: Our study showed that the most common site of cancer involvement was the spine, secondary metastasis was most common in the scapula and tertiary metastasis was most common in the femur.
A 73-year-old male patient with prostate cancer underwent a staging Gallium-68 (Ga-68) prostatespecific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI). Ga-68 PSMA PET/MRI revealed cervical and mediastinal lymph nodes, and a thyroid mass with moderately increased uptake, as well as extensive metastases of prostate cancer. The thyroid mass and lymph nodes were assessed suspicious for a second primary thyroid cancer due to their relatively lower radiotracer uptake. Pathological examination demonstrated multifocal medullary thyroid carcinoma (MTC) with multiple lymph node metastases. Our case highlights incidental detection of MTC on Ga-68 PSMA PET, likely related to PSMA expression in tumor-associated neovasculature. PSMA-targeted imaging and radioligand therapy could provide new diagnostic and therapeutic opportunities in patients with MTC. (C) 2026 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
The role of 18F-FDG PET/CT in lymphoma staging and treatment response assessment is well established in the literature. Beyond these conventional applications, it can also serve as a powerful tool for guiding biopsy decisions in diagnostically challenging cases. We present the case of a 67-year-old man with suspected lymphoma, in whom initial diagnostic procedures-including bone marrow aspiration-failed to yield conclusive results. A multidisciplinary team utilized 18F-FDG PET/CT to identify an accessory spleen exhibiting metabolic activity comparable to the primary spleen. Given its accessibility and diagnostic potential, the accessory spleen was surgically excised, leading to a definitive diagnosis of mantle cell lymphoma. This case underscores the strategic role of PET/CT in biopsy site selection, offering a safer and less invasive diagnostic alternative and reinforcing its crucial role in lymphoma management. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Magnetic resonance imaging (MRI) plays a key role in the initial evaluation of squamous cell carcinomas of the upper aerodigestive tract (UADT), especially for supraglottic and oral locations. Thanks to its high soft tissue contrast and multiparametric capabilities, MRI provides precise analysis of deep spaces, tumor extension, bone and perineural invasion, and nodal involvement. This article reviews relevant radiologic anatomy, key MRI sequences, their interpretation, and technical limitations. Clinical cases illustrate diverse tumor presentations such as lingual, tonsillar, and parapharyngeal lesions. Despite being susceptible to artifacts, MRI remains a reference imaging modality in many supraglottic regions for staging, lesion characterization, and operability assessment. A structured reporting approach is also presented, integrating the TNM classification and unresectability criteria. (c) 2025 Published by Elsevier Masson SAS.
Giant Cell Arteritis (GCA), the most common large-vessel vasculitis, poses a significant diagnostic and therapeutic challenge in elderly patients. The recognition of both classical cranial and atypical extracranial forms requires a multidisciplinary approach involving nuclear medicine. This session, bringing together clinicians and imaging specialists, aimed to characterize the role of FDG-PET (18F-fluorodeoxyglucose positron emission tomography) in the spectrum of GCA and polymyalgia rheumatica. Following a review of clinical features and updated recommendations (ACR 2022), the speakers highlighted the diagnostic and prognostic value of PET imaging, particularly in extracranial forms, aortitis, and atypical localizations. The limitations of PET, especially reduced sensitivity under corticosteroids, were addressed. The use of visual (grading) and semi-quantitative scores (TVS, PETVAS) was reviewed, along with the potential of alternative tracers such as FAPI. PET imaging is now emerging as a key component of rapid care pathways, aligned with evolving therapeutic strategies including biologics. This article provides a comprehensive synthesis of current evidence on this topic. (c) 2025 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
[F-18]Fluorodeoxyglucose positron emission tomography (FDG-PET) has become a key imaging modality in the management of squamous cell carcinomas of the upper aerodigestive tract (UADT). Its utility spans multiple stages of clinical decision-making. In the initial diagnostic work-up, FDG-PET is indicated for the detection of occult primary tumors in cases of isolated cervical lymphadenopathy, for distant metastasis staging in advanced stages (stage III-IV), and for identifying synchronous primaries. It leads to tumor upstaging in approximately 20% of cases and modifies the therapeutic strategy in a similar proportion, particularly for localized disease. Its diagnostic yield is limited in early-stage tumors without nodal involvement. In the post-treatment setting, FDG-PET provides a highly reliable assessment of therapeutic response, with a negative predictive value approaching 100% when performed at least 12 weeks after the end of radiotherapy. It is also helpful in detecting subclinical recurrence and may be considered in patients with poor initial prognostic features. Systematic integration of FDG-PET into follow-up protocols may increase curative treatment opportunities and, according to retrospective data, improve 3-year overall survival. While still under evaluation, the role of FDG-PET in guiding individualized radiotherapy strategies - such as metabolic boosting or adaptive planning - has not yet demonstrated a clear impact on local-regional control or survival. For local imaging, MRI remains superior to CT in assessing tissue contrast, bone marrow invasion, perineural spread, and lymph node characterization. This educational module, illustrated with interactive clinical case-based multiple choice questions, aims to clarify the validated indications and limitations of this imaging modality at various stages of the care pathway. (c) 2025 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Squamous cell carcinomas of the upper aerodigestive tract (UADT) represent a major public health issue, particularly in Brittany, a region with a high incidence. Morphological and functional imaging plays a key role in their management. Large-scale, single-center retrospective studies conducted at Brest University Hospital have assessed the impact of 18F-FDG PET/CT on initial restaging and routine follow-up of head and neck cancers. For initial staging, a cohort of 477 patients was analyzed, all of whom underwent PET in addition to the conventional work-up. The results showed a modification of the TNM classification (including the discovery of synchronous cancers) in 46 % of cases, with 20 % having a moderate or major therapeutic impact. PET restaging had a significant effect on 3-year overall survival, independently of the initial stage or treatment escalation/de-escalation strategies. For follow-up, in a case-control cohort of 782 patients, PET demonstrated excellent diagnostic performance (regardless of the post-treatment interval), notably with a negative predictive value greater than 98 %, and enabled early detection of subclinical recurrences and metachronous cancers. A significant improvement in 3-year overall survival was observed in the group monitored with PET, and this was confirmed in an external validation cohort. These findings support a more systematic use of PET in initial management, particularly for patients at high risk of recurrence, and suggest the value of imaging follow-up during the first two years. The main limitations lie in the retrospective nature of the studies and the current lack of consensus guidelines in the initial work up of early stages. This article presents only the principal results of these studies, which are the subject of an original publication.
Positron emission tomography (PET) is playing an increasingly central role in neuro-oncology, complementing MRI to refine diagnosis, guide treatment, and assess therapeutic response in primary brain tumors. This article provides a focused overview of current PET indications for gliomas, brain metastases, meningiomas, and primary central nervous system lymphomas. In glioma patients, amino acid tracers (F-DOPA, FET) are recommended during all the course of the disease. They contribute to the initial characterization of lesions, support therapeutic planning (biopsy, radiotherapy), differentiate post-treatment changes from true progression, and enable early treatment response assessment. For brain metastases, the key indication is distinguishing progression from treatment related changes. Here, like for gliomas, amino acid PET outperforms FDG-PET. In meningiomas, somatostatin receptor imaging (e.g., DOTATOC) facilitates diagnostic confirmation, radiotherapy planning, recurrence detection, and patient selection for radionuclide therapy. Lastly, FDG-PET is particularly valuable for primary CNS lymphomas, both for initial differential diagnosis and response monitoring, as in systemic lymphomas. Through the targeted use of specific radiotracers, PET imaging is emerging as a cornerstone of precision medicine in the management of brain tumors, while requiring thoughtful integration into existing diagnostic and therapeutic pathways. (c) 2025 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
18F-fluorodeoxyglucose Positron emission tomography (FDG-PET) has profoundly transformed the management of cancers of the upper aerodigestive tract (UADT), notably due to its performance in detecting metastases, its ability to guide therapeutic decisions after restaging, and its increasing role in post-treatment surveillance. Its use is based on guidelines first established in 2002, which have evolved with research advances and technological innovations up to the most recent publications in 2018. Interpreting PET images in the head and neck area remains complex and is subject to numerous pitfalls - whether physiological, due to intercurrent pathological conditions, or related to artifacts. These factors may lead to false positives or negatives results, potentially impacting clinical decision-making. This article aims to summarize these challenges, provide a comprehensive review of the current indications for FDG-PET in UADT cancers (initial staging, therapeutic evaluation, recurrence detection, and surveillance), and explore future perspectives offered by technological innovations such as LAFOV PET and PET-MRI. (c) 2025 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license
In France, neurocognitive disorders affect approximately 1.2 million individuals, including 850,000 with Alzheimer's disease (AD). Patients typically present for first memory consultations at an advanced stage, with a mean Mini-Mental State Examination (MMSE) score below 20. Recent advances in diagnosis have largely relied on the development of biomarkers, particularly cerebrospinal fluid (CSF) analysis and positron emission tomography (PET) imaging. CSF biomarkers enable the detection of amyloid plaques (decreased A(342 peptide or abnormal A(342/A(340 ratio) and phosphorylated Tau proteins (increased), indicative of Alzheimer's pathology (A+/T+ status). Their sensitivity and specificity both exceed 90% for the diagnosis of symptomatic AD. Magnetic resonance imaging (MRI), though routinely used, has variable diagnostic value; hippocampal atrophy, in particular, lacks specificity in atypical forms and in prodromal stages of AD. Fluorodeoxyglucose (FDG) PET imaging, by contrast, can detect early cerebral hypometabolism predictive of clinical progression, and it plays a crucial role in differential diagnosis, especially in frontotemporal lobar degeneration (FTLD) and Lewy body disease (LBD). Amyloid-PET imaging enables in vivo visualization of amyloid deposits with a high negative predictive value. Although it can detect amyloid accumulation years before symptom onset, a positive result does not necessarily indicate active AD. In non-Alzheimer's disorders such as FTLD or parkinsonian syndromes, alternative imaging tools are preferred, including FDG-PET, dopamine transporters scintigraphy or meta-iodobenzyl-guanidine (MIBG) scintigraphy, depending on clinical suspicion. The diagnostic process follows a structured, phenotype-based sequence in which lumbar puncture, FDG-PET, or amyloid-PET are selected according to clinical presentation, contraindications, or inconclusive results. This structured approach underscores the importance of early, personalized, biomarker-guided diagnosis to optimize patient care and to promote access to disease-modifying therapies targeting pathological lesions in AD. (c) 2025 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Background International recommendations for the non-invasive diagnosis of transthyretin cardiac amyloidosis (TTR-CA) rely on visual analysis according to the Perugini 4-point-grading described with planar scintigraphy. Objective To evaluate the diagnostic performance of quantitative metrics with Tc-99m-DPD whole-body SPECT/CT for TTR-CA. Methods Consecutive patients imaged on the Veriton-CT with whole-body Tc-99m-DPD SPECT/CT were retrospectively analyzed and compared with the TTR-CA diagnosis established by the reference center. Results One hundred and ninety-four patients were included (47 with TTR-CA) and diagnostic performance of quantitative measure of cardiac amyloid burden normalized to the whole body, was high with an area under the curve (AUC) of 0.956 (95% CI = [0.916; 0.995]), a sensitivity of 87.2%, and a specificity of 93.2%; comparable to Perugini grading with an AUC of 0.936 (95% CI = [0.088; 0.984]), a sensitivity of 87.2%, and a specificity of 100%. Conclusion Semi-automated quantitative analysis with whole-body Tc-99m-DPD SPECT/CT is not inferior to Perugini visual analysis for the diagnosis of ATTR-CA.(c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
The aim of this study was to assess the knowledge and perception of nuclear medicine among physicians practicing in Benin. This was a descriptive and analytical cross-sectional study conducted from December 2023 to July 2024. Knowledge of nuclear medicine was evaluated using a scoring system based on questions addressing the definition, components, and indications of this specialty. A total of 316 participants were included in the study. Their median age was 29.81 years (range: 22-56 years). Among them, 49.05% were specialists or in the process of specialization. Additionally, 22.15% of the participants had completed internships abroad. Regarding knowledge levels, 0.32% of respondents demonstrated a good level, 12.34% a moderate level, 22.47% an insufficient level, and 64.87% a poor level. Factors associated with an acceptable level of knowledge included having completed an internship abroad and the presence of a nuclear medicine department in the country where general medical training was received. Regarding perception, 67.09% of physicians considered nuclear medicine essential for optimal patient management, and 88.92% expressed a desire for its inclusion in general medical education. Physicians practicing in Benin demonstrated insufficient knowledge of nuclear medicine, primarily due to the limited routine practice of this specialty. However, their perception was favorable, supported by the imminent launch of a new nuclear medicine department at the International Hospital Center of Calavi in Benin. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Objective. - The aim of this study is to investigate whether it is possible to predict the response to neoadjuvant therapy (NAT) in axillary lymph node metastasis of breast cancer patients using parameters from 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans, and to evaluate the correlation of post-NAT PET/CT findings with axillary histopathology results. Materials and methods. - Breast cancer patients with axillary lymph node involvement, who underwent staging and post-NAT PET/CT, followed by surgery or histopathological evaluation, were included. Metabolic and volumetric 18F-FDG PET/CT parameters were analyzed to determine their predictive value for NAT response. Receiver operating characteristic (ROC) curves and Chi-square tests were used for statistical evaluation. Results. - Forty-three breast cancer patients were included in the study. Statistically significant differences were observed between the axillary pathology-negative and positive patient groups for the following variables: post-NAT SUVmax (primary and axilla), DSUVmax% (primary and axilla), the largest lymph node diameter on staging PET/CT, and the change in diameter of the same lymph node post-NAT. In the post-NAT axillary lymph node visual evaluation, the sensitivity, specificity, the positive predictive value (PPV), and the negative predictive value (NPV) for detecting metastatic axillary lymph nodes on PET/CT, based on pathology results, were calculated as 81.8%, 66.7%, 72%, and 77.7%, respectively. When a 92.38% threshold value was determined for DSUVmax% (axilla), they were 90.9%, 42.9%, 62.5%, and 81.8%, respectively. Conclusion. - Metabolic parameters obtained from 18F-FDG PET/CT can contribute to predicting the treatment response for axillary metastases. 18F-FDG PET/CT provides insights into the necessity of sentinel lymph node biopsy (SLNB) and axillary dissection. However, due to 18F-FDG PET/CT's inability to achieve sufficient sensitivity and specificity, it is unlikely to replace SLNB. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Brain metastasis in prostate cancer is a rare entity with a poor prognosis. Early detection of brain metastasis might improve patient management and prognosis. 68-Gallium prostate-specific membrane antigen (68Ga-PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) is a unique imaging modality for prostate cancer patients with higher accuracy and soft tissue resolution, which provides excellent identification of soft tissue metastases. We have presented two prostate adenocarcinoma patients with unexpected brain metastases demonstrated by 68Ga-PSMA PET/MRI. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Hyperthyroidism is a pathological condition marked by an excess of thyroid hormones in the bloodstream. The most common observed etiology is Graves' disease. In order to establish the epidemiological profile of this disease in the Algerian west and evaluate its treatment in nuclear medicine, we conducted a retrospective, cross-sectional study from January 2014 to December 2023 at the University Hospital Establishment of Oran, including 180 folders of patients suffering from hyperthyroidism. We report a high prevalence of Graves' disease (98.33%) with a notable female predominance of 72.88%. A peak incidence is noted across all genders between the ages of 31 and 50. In Algeria, radiotherapy with iodine 131 is generally indicated as a second line after antithyroid drugs treatment. In our study, one hundred and sixty-five patients have received radioactive activities administered empirically (extremes: 8-28 mCi). An activity below 15 mCi was administered to 67.27% of patients, between 15 mCi and 20 mCi to 30.3% of patients, and only 2.42% received an activity exceeding 20 mCi. A single dose was administered in 98.18% of cases, while only three patients (1.82%) received a second. Finally, the RAI therapy was successful in 85.83% of cases over a follow-up period ranged between 1 and 9 months. These observed results are promising and encourage healthcare professionals to consider the radiotherapy as an early treatment of Graves' disease. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Limping in children is a common and polymorphic symptom that can reveal a wide spectrum of underlying conditions, from benign mechanical disorders to severe infectious, inflammatory, or tumoral diseases. Bone scintigraphy plays a key role in the diagnostic workup, especially when a systemic or infectious cause is suspected. Through a series of illustrative clinical cases, this article highlights unusual causes of limping identified by bone scintigraphy, including oncological (metastatic neuroblastoma, acute leukemia), infectious (appendicitis, spondylodiscitis, sacroiliitis), inflammatory (osteochondrosis, SAPHO syndrome), and traumatic (tendinopathies) conditions. We emphasize the importance of systematically evaluating both soft tissue and delayed phases of scintigraphy, as certain extra-skeletal abnormalities may be the first signs of serious underlying diseases. (c) 2025 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Bone sarcomas, including osteosarcomas (OS) and Ewing sarcomas (ES), are rare but aggressive tumors requiring specialized care. Among the available imaging techniques, FDG PET-CT (PET FDG) has taken a significant role in this oncological field in recent years. It has been established for the initial staging due to its high sensitivity for detecting extrapulmonary metastases, particularly for detecting bone and bone marrow involvement. The use of PET FDG is also developing for the evaluation of therapeutic response to neoadjuvant chemotherapy and systemic treatments in patients with advanced metastatic disease. PET FDG offers better availability and fewer acquisition constraints compared to whole-body MRI, which is important for managing a pediatric population. Furthermore, the latest technological advances will improve radiation protection for these young patients. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
In the context of child abuse, post-traumatic bone lesions are the most commonly observed after cutaneous lesions. Therefore, imaging has an important role to play in diagnosis, especially among the youngest children. Several imaging modalities are now available. While standard radiographs are essential and remain the first-line test, bone scintigraphy is useful for detecting certain recent infra-radiological lesions and types of fractures. Some fractures are more common in the setting of non-accidental trauma, but there is no single pathognomonic lesion. It is the association of multiple fractures associated with the absence of a concordant lesion mechanism that can lead to the diagnosis. The presence of fractures of different ages is an important, but unfortunately, inconsistent diagnostic factor. Bone scans alone do not allow accurate lesion dating. Prompt and multidisciplinary management, high quality imaging and accurate interpretation are essential to the diagnosis of child abuse. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
