The incidence of prostate cancer continues to rise worldwide. While conventional static PET/CT provides semi-quantitative metrics, total-body PET/CT enables voxel-level dynamic imaging and parametric imaging, demonstrating great potential for clinical applications in prostate cancer. Therefore, this review synthesizes the technical principles of dynamic PSMA total-body PET/CT and its emerging clinical applications in prostate cancer, providing a novel clinical insight for individualized patient management. We performed a state-of-the-art narrative review of dynamic PSMA total-body PET/CT in prostate cancer, searching the PubMed database up to March 2026. Our analysis focused on the methodology of PSMA kinetic modeling and parametric reconstruction, alongside their clinical applications across clinical staging, treatment response monitoring, and individualized radioligand therapy dosimetry in prostate cancer. Dynamic PSMA total-body PET/CT advances molecular imaging from semi-quantitation to absolute quantification through non-invasive image-derived input function extraction and kinetic modeling. Clinically, this absolute quantification effectively suppresses background activity, improving diagnostic accuracy in prostate cancer staging and recurrence. Furthermore, dynamic imaging offers novel insights for early treatment response assessment and provides a quantitative basis for dosimetric evaluation in individualized radioligand therapy. To address prolonged acquisition times, deep learning and modified kinetic models have compressed scan durations into clinically acceptable windows, improving tolerability and mitigating motion artifacts. Dynamic PSMA total-body PET/CT bridges kinetic modeling with precision oncology, representing a technological evolution from conventional semi-quantitation to absolute quantification. Despite its early clinical promise, the technology’s widespread translation depends on rigorous prospective validation across different clinical scenarios. Ultimately, routine clinical adoption of dynamic total-body PSMA PET/CT requires resolving its current technical constraints and definitively proving its added value over standard static PET/CT in patient management.
To evaluate the diagnostic accuracy of total-body 18 F-FDG PET/MRI compared with contrast-enhanced CT in detecting distant metastases in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (pCRT). This retrospective study included patients with LARC treated with pCRT between 2016 and 2019. Both contrast-enhanced CT and 18 F-FDG PET/MRI were performed within 6–8 weeks after completion of pCRT. Two independent expert teams assessed the presence of hepatic, pulmonary, lymph node, and other distant metastases. Histopathology and/or radiological follow-up served as the reference standard. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and AUC were compared between the two modalities. Metastases were confirmed in 17/51 patients (33.3
Clinical trials in Nuclear Medicine (NM) increasingly rely on complex radiopharmaceutical protocols and multidisciplinary workflows, yet the role of the Study Coordinator (SC), central to regulatory compliance, data quality, and operational efficiency, remains insufficiently mapped in Italy. A national cross-sectional survey was distributed to Italian NM Units with documented research activity. Twenty-two centers responded, providing information on SC presence, responsibilities, contractual conditions, and perceived impact on clinical research performance. SC resources were unevenly distributed: only 10 of 22 centers (45.5
Dual-phase amyloid positron emission tomography (PET) combines early-phase perfusion assessment with late-phase amyloid deposition evaluation, but the optimal timing for early-phase acquisition remains debated. This study aimed to compare semiquantitative and qualitative image metrics between 5-minute and 10-minute early-phase acquisitions using a within-patient, within-acquisition design. Nine patients underwent dual-phase [¹⁸F]-flutemetamol PET/CT with list-mode acquisition, allowing retrospective reconstruction of both timeframes from the same dataset. Semiquantitative analysis included regional absolute standardised uptake value mean (SUVmean), cerebellar-normalised standardised uptake value ratio (SUVr), and Z-scores calculated from cerebellar-normalised SUVr values using a fluorodeoxyglucose normative database as reference, across 6 clinically relevant brain regions analysed bilaterally. Image quality assessment included signal-to-noise ratio (SNR) and coefficient of variation (CV). In borderline cases, two independent nuclear medicine readers performed a blinded qualitative concordance evaluation. SUVmean was higher at 10 min (+ 3–5
Conventional 99mTc-methylene diphosphonate (99mTc-MDP) bone scintigraphy reflects osteoblastic activity but lacks tumor specificity, which may result in false-positive findings and overstaging in high-risk prostate cancer. Prostate-specific membrane antigen (PSMA)-targeted imaging enables tumor-specific detection; however, its incremental clinical value relative to conventional 99mTc-MDP bone scintigraphy remains uncertain, particularly in settings where bone scintigraphy remains the primary skeletal staging modality. We prospectively evaluated the diagnostic performance and potential impact on skeletal metastatic classification of 99mTc-PSMA compared with 99mTc-MDP bone scintigraphy in treatment-naïve patients with unfavorable intermediate-, high-, and very high-risk prostate cancer. Sixty-eight newly diagnosed patients, stratified by NCCN risk criteria, underwent both 99mTc-PSMA and 99mTc-MDP scintigraphy. Skeletal metastatic status was determined using longitudinal clinical and imaging follow-up as a composite reference standard. Patient-level agreement, diagnostic performance, and lesion-level positive predictive value were assessed. Skeletal metastases were confirmed in 33 of 68 patients (48.5
Post-therapy assessment of paraskeletal plasmacytoma (PM) in multiple myeloma (MM) relies on lesion persistence and/or size changes on whole-body low-dose CT (WBLDCT). To evaluate the prognostic value of WBLDCT and 18F-FDG-PET/CT (PET/CT) before and after therapy in newly diagnosed MM patients with PM, and a small subgroup with solitary plasmacytoma (PSO), aiming to refine future imaging response criteria. We retrospectively reviewed PET/CT and WBLDCT images of 42 patients (39 MM, 3 PSO) undergoing first-line therapy from October 27, 2016, to June 12, 2021. Imaging including criteria were a positive PET/CT scan at baseline and a subsequent negative PET/CT scan prior to starting maintenance. Negative PET/CT was defined applying Deauville criteria for focal, PM, and bone marrow uptake, with complete metabolic response defined as uptake below liver background (Deauville scores < 4). PET parameters (IMPeTUs criteria), CT morphological/technical features, and baseline laboratory data were assessed using univariate and multivariate analyses for their impact on clinical outcomes. Pre-maintenance SUVmax of the PM lesions predicted adverse progression-free survival (PFS) and Deauville Score 3 identified patients with significantly worse PFS (median 27 months vs. not reached; HR = 3.45, p = 0.05) and showed a trend toward inferior overall survival (OS) (52 months vs. not reached; HR = 2.99, p = 0.16), remaining an independent prognostic factor. In transplanted patients (n = 32), PM Deauville Score 3 predicted inferior PFS (median 27 vs. 74 months, p = 0.015) and OS (39 months vs. not reached, p = 0.03). CT had limited prognostic value, except for pre-maintenance transverse diameter (PFS: HR = 1.86, p = 0.02) and absence of cortical bone regeneration. Pre-maintenance PM Deauville Score 3 has been shown to be representative of adverse outcomes, highlighting the added prognostic value of 18F-FDG-PET/CT over WBLDCT alone, and the possibility of refining future PET monitoring in this patient population.
To investigate the relationship between serum fibroblast growth factor-23 (FGF23) and [^18F]FDG PET/CT metabolic parameters in fibrous dysplasia (FD), and to describe the performance of FDG PET/CT across the FD/McCune–Albright spectrum, including low-uptake lesions. In this single-centre retrospective cohort study, consecutive adult patients with FD who underwent [^18F]FDG PET/CT and had an available serum FGF23 measurement within the same clinical work-up were included. The index lesion (highest uptake) was analysed per patient. Semi-automated VOIs were generated on a GE Advantage workstation using a fixed percentage-of-SUVmax isocontour. SUVmax and SUVmean were recorded for the index lesion; contralateral bone, blood pool, and liver SUVmax were also collected. Lesion-to-blood-pool and lesion-to-liver SUVmax ratios were calculated as reproducible reference-normalized uptake indices. MTV and TLG were computed when VOI delineation was feasible. Associations between FGF23 and PET metrics were assessed using Pearson correlation (pairwise complete observations), with additional sensitivity analyses for skewed distributions. Forty patients were included (female 65.0
Sentinel lymph node biopsy (SLNB) represents the current standard procedure for regional nodal staging in patients with clinically localized cutaneous melanoma. This AIMN practical guide provides an updated overview of the role of nuclear medicine in the sentinel lymph node procedure, integrating recommendations from major international guidelines and current clinical practice. The document describes indications, contraindications, radiopharmaceuticals, and technical aspects of lymphoscintigraphy, including radiotracer administration, imaging protocols, and interpretation criteria. Particular attention is devoted to the contribution of hybrid imaging techniques, especially SPECT/CT, which improve sentinel node detection and anatomical localization, thereby facilitating surgical planning. The guide also addresses intraoperative radioguided detection using handheld gamma probes, as well as relevant radiation safety considerations. By standardizing preoperative mapping and promoting multidisciplinary collaboration between nuclear medicine physicians and surgeons, these recommendations aim to optimize diagnostic accuracy and enhance the clinical management of melanoma patients undergoing SLNB.
Coregistration CT in PET/CT and SPECT/CT is a transmissive imaging technique performed immediately before the emission study with the patient in the same position, eliminating temporal mismatches typical of software-based image fusion. Its primary purposes are attenuation correction through a densitometric map and anatomical localization of PET or SPECT abnormalities. Although coregistration CT can improve the specificity of nuclear medicine findings, it is not a full diagnostic CT because it is acquired with lower tube current, free breathing, and without contrast, limiting its ability to detect small or subtle lesions. With the widespread adoption of hybrid scanners, incidental morphological findings on coregistration CT have become increasingly common. These findings—whether or not they have a PET/SPECT correlate—are unrelated to the clinical indication but may represent clinically relevant or potentially progressive conditions. Unlike radiology, where structured models such as the ACR’s actionable incidental findings system guide management, no formal guidelines exist for handling incidental CT findings in PET/SPECT. Nuclear Medicine physicians, despite not being radiologists, should recognize CT abnormalities that may pose clinical risk and communicate them to the appropriate specialists as “findings of possible pathological significance,” without providing definitive diagnostic interpretation. This atlas supports such recognition by illustrating key CT patterns associated with patient risk.
This explorative head-to-head comparison investigated correlations between imaging biomarkers of malignancy in soft tissue sarcomas (STS) using Long-Axial-Field-of-View (LAFOV) FDG PET-CT versus diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI). A retrospective FDG PET-CT database search (December 2021–November 2025) identified 22 STS patients with comparable MRI acquired within three months. Seven patients were excluded for absent MRI or non-specific FDG uptake, leaving 15 patients with 53 FDG-avid lesions. VOI-based SUV, ADC values, and contrast enhanced signal intensity were measured and analyzed via a Spearman rank correlation. Moderate inverse correlation existed between SUVmax and mean/minimal ADC values (ρ = -0.35 to -0.47, p < 0.05). Strong correlations were found between FDG uptake and arterial phase signal intensity (ρ = 0.57), with moderate correlations in venous phase (ρ = 0.45), but negligible correlation in equilibrium phase. Diffusion-restricted tumors demonstrated strong negative correlations between ADC and arterial enhancement (ρ = -0.5 to -0.81) with moderate correlations in the venous phase (ρ = -0.33 to -0.53) and no relevant correlation to the equilibrium phase. This head-to-head comparison indicates that FDG PET-CT, DWI, and DCE-MRI parameters behave synergistically in STS characterization. Diffusion-restricted, FDG-avid tumors demonstrated a characteristic pattern: strongest arterial phase enhancement, decreasing correlation in venous phase, and negligible correlation in equilibrium phase. Complementary multimodal assessment combining these parameters may enhance diagnostic accuracy and guide treatment planning in STS. In particular, due to heterogeneity of STS, larger prospective studies are needed to confirm these observations. Question: Heterogeneity in soft tissue sarcomas (STS) poses a challenge in diagnostics. We investigated common characteristics for malignancy in a head-to-head MRI and FDG PET-CT comparison. Findings: Diffusion-restricted, FDG-avid tumors demonstrated a characteristic pattern: strong arterial phase enhancement, decreasing correlation in venous phase, and negligible correlation in equilibrium phase. Clinical Relevance Statement: Complementary multimodal assessment combining these parameters of metabolic activity, cellular density and vascular behavior may enhance diagnostic accuracy and guide treatment planning in STS.
Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) may provide prognostic information in patients with non-small cell lung cancer (NSCLC) receiving immunotherapy. We investigated the predictive value of spleen and bone marrow metabolic parameters on 18F-FDG PET/CT for response to nivolumab, progression-free survival (PFS), and overall survival (OS) in stage IV NSCLC. Selected metabolic parameters of the spleen (such as baseline/post-treatment total spleen glycolysis [TSG]) and bone marrow (baseline and post-treatment standardized uptake values [SUVs]) were retrospectively evaluated on baseline and post-treatment PET/CT scans in 61 patients. The effects of all parameters on PFS and OS were examined. Baseline spleen and bone marrow metabolic parameters did not differ significantly between responders and non-responders to nivolumab. The median OS was longer for patients with lower post-treatment TSG (27.0 vs. 19.6 months, p = 0.036) and baseline spleen volume (26.9 vs. 18.2 months, p = 0.022). The median OS was longer in patients whose post-treatment bone marrow SUVmean (25.3 vs. 15.7 months, p = 0.007) and spleen-to-liver SUVmax ratio (SLR_SUVmax) were lower than their baseline values (25.1 vs. 18.3 months, p = 0.043). Baseline spleen volume was the only independent predictor of PFS (hazard ratio [HR] = 1.02, p = 0.039). Age (≥ 70 years) (HR = 1.08, p = 0.019), baseline neutrophil-to-lymphocyte ratio (HR = 1.42, p = 0.012), and post-treatment decreases in bone marrow SUVmean (HR = 0.12, p = 0.001) and SLR_SUVmax (HR = 0.16, p = 0.042) from baseline were independent predictors of OS. Splenic glucose metabolism, baseline spleen volume, and bone marrow glucose metabolism were associated with survival after nivolumab in patients with metastatic NSCLC. Baseline spleen volume was the only independent predictor of PFS. Age, baseline neutrophil-to-lymphocyte ratio, and decreased bone marrow SUVmean and SLR_SUVmax after nivolumab were identified as independent predictors of OS.
This study aimed to evaluate the utility of Total Lesion Somatostatin Receptor expression (TLS), a volumetric imaging biomarker integrating tumour burden and tumour somatostatin receptor density, for early response assessment and progression-free survival (PFS) prediction in patients with neuroendocrine neoplasms (NENs) undergoing peptide receptor radionuclide therapy (PRRT). We retrospectively evaluated the baseline and post-therapy [68Ga] Ga-DOTATATE PET/CT scans of 49 patients. TLS was calculated for every target lesion. The therapeutic response defined by TLS was compared with RECIST 1.1 and PERCIST criteria. The prognostic significance of baseline parameters, including Ki-67 index, hemograms, liver and renal function tests and metabolic parameters derived from imaging was analysed using Cox regression. At a median follow-up of 32.6 months, TLS-based response assessment demonstrated superior PFS stratification compared to RECIST 1.1 and PERCIST. Notably, TLS reclassified 76
Neuroblastoma (NBL) is the most common extracranial solid malignancy in children and remains one of the main causes of pediatric cancer deaths. Its marked biological and clinical heterogeneity, reflected by a broad histological spectrum of peripheral neuroblastic tumours and diverse genomic alterations, underpins highly variable outcomes. Current risk stratification according to the International Neuroblastoma Risk Group (INRG) integrates age, stage based on image-defined risk factors, histology, MYCN status, segmental chromosomal aberrations and ploidy to classify patients into very low-, low-, intermediate- and high-risk categories, thereby guiding treatment intensity. In this context, nuclear medicine plays a pivotal role across the disease course. This paper provides practical recommendations for the standardised performance and interpretation of [¹²³I]mIBG SPECT/CT, [¹⁸F]FDG PET/CT, [¹⁸F]F-DOPA PET/CT and [⁶⁸Ga]Ga-DOTA-peptide PET/CT in children with NBL, including procedural prerequisites, pediatric radiopharmaceutical dosing, acquisition protocols and response assessment. [¹²³I]mIBG scintigraphy remains the reference technique for staging, restaging and response evaluation, with semiquantitative skeletal scoring systems (Curie and SIOPEN) incorporated into the revised International Neuroblastoma Response Criteria. [¹⁸F]FDG PET/CT is recommended as a complementary tool, particularly in mIBG-non-avid or discordant disease, and provides additional prognostic information through metabolic parameters. [¹⁸F]F-DOPA PET/CT is emerging as the most sensitive alternative to mIBG for initial staging, response assessment and detection of relapse, while [⁶⁸Ga]Ga-DOTA-peptide imaging offers theranostic implications in somatostatin receptor-expressing tumours. Finally, novel PET tracers such as [¹⁸F]mFBG and [¹²⁴I]mIBG may further refine disease characterisation and dosimetry, supporting increasingly individualised management of pediatric neuroblastoma.
The aim of this study was to evaluate the detection performance of zero-echo time (ZTE) and T1-weighted (T1W) MRI sequences for pulmonary nodules (PNs), and to determine the clinical significance of undetectable PNs on ZTE MRI in oncologic 18F-FDG PET/MRI examinations. Patients who underwent 18F-FDG PET/MRI including ZTE and T1W MRI sequences for oncological indications, and who had a concurrent 18F-FDG PET/CT or a thoracic CT within one month were included in the study. Patients with at least one 18F-FDG-positive PN were included in the 18F-FDG-positive nodule-based analysis. Patients with at least one 18F-FDG-negative PN on CT and without any 18F-FDG-positive PNs were included in the 18F-FDG-negative nodule-based analysis. The total number of PNs and their sizes on CT, the presence and sizes of PNs on MRI sequences were recorded. The CT images were accepted as the reference. Detection rates among sequences were compared using Cochran’s Q and McNemar tests. 175 18F-FDG-positive PNs from 103 patients and 68 18F-FDG-negative PNs from 51 patients were included. The detection rates of T1W water (T1_W), in-phase (T1_IP), and out-of-phase (T1_OP), and ZTE MRI for 18F-FDG-positive PNs were 36.6
Lutetium-177 bound with prostate-specific membrane antigen-617 ([177Lu]Lu-PSMA-617) is the first radioligand therapy (RLT) approved and reimbursed in Italy for the treatment of patients affected by PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) that have progressed after ≥1 androgen receptor-targeted agent (ARTA) and after chemotherapy with docetaxel and cabazitaxel. Furthermore, patients pretreated with docetaxel and ≥1 ARTA may receive [177Lu]Lu-PSMA-617 if they are unfit for cabazitaxel. Due to the lack of Italian real-world data about the management of [177Lu]Lu-PSMA-617 in mCRPC, we performed a consensus conference to provide clinicians with guidance on best practices. A group of Sicilian nuclear medicine physicians, medical and radiation oncologists, experts on prostate cancer, used a round-robin variant of the focus group method to generate a series of consensus statements that may be helpful for the management of patients treated with [177Lu]Lu-PSMA-617 for mCRPC. In the absence of unsolved disagreement, a consensus was obtained for various areas of controversy and clinical questions in six major topics regarding [177Lu]Lu-PSMA-617 RLT: (1) indication; (2) patient’s selection; (3) administration; (4) radiation protection; (5) follow-up; (6) patients’ access. Experts’ considerations are of particular importance in one of the largest Italian regions, where 180 patients would potentially receive [177Lu]Lu-PSMA-617 per year. It is hoped that clinicians treating patients with [177Lu]Lu-PSMA-617 in daily practice will find this sharing of expert opinion of value.
[¹⁸F]FDOPA PET/CT is a functional imaging modality that exploits the preserved ability of several neuroendocrine tumors to uptake, decarboxylate, and store amino acid precursors. Its oncologic role has expanded substantially, particularly for neuroendocrine neoplasms, pheochromocytoma/paraganglioma, and medullary thyroid carcinoma. Standardized technical and clinical guidance is necessary to optimize its diagnostic performance and ensure appropriate clinical use. This work summarizes current evidence and expert recommendations regarding patient preparation, acquisition protocols, image interpretation, indications, contraindications, radiation exposure, and reporting for [¹⁸F]FDOPA PET/CT or PET/MR in adult oncologic applications. Relevant literature, international guidelines, and clinical studies were reviewed to formulate practical procedural recommendations. To date, [¹⁸F]FDOPA PET demonstrates high diagnostic accuracy in selected neuroendocrine malignancies, particularly pheochromocytoma/paraganglioma, well-differentiated gastroenteropancreatic neuroendocrine tumors and recurrent medullary thyroid carcinoma with elevated calcitonin levels. Proper patient preparation, including short fasting and attention to physiological biodistribution, is essential. Acquisition typically occurs about 60 min after radiotracer injection, with protocol adaptations for specific indications. The modality provides high target-to-background contrast but may be affected by physiological uptake, excretory activity, genetic factors, and technical artifacts. Radiation exposure is moderate and primarily related to urinary excretion of the radiotracer. In conclusion, [¹⁸F]FDOPA PET/CT is a highly sensitive and clinically impactful imaging technique for selected oncologic indications. Adherence to standardized technical procedures and careful interpretation of physiological variants are crucial to maximizing diagnostic accuracy and clinical utility. These recommendations aim to support harmonized use of [¹⁸F]FDOPA PET imaging in routine oncologic practice.
The global incidence of hepatocellular carcinoma remains high, and early diagnosis is key to improving patient prognosis. This article reviews the technical characteristics, diagnostic value, and limitations of commonly used radiotracers in the diagnosis of hepatocellular carcinoma, with the aim of providing guidance for the development of personalized treatment plans in clinical practice. Radionuclide molecular imaging effectively addresses the shortcomings of conventional imaging in detecting early-stage microlesions and distinguishing tumor subtypes. The combined use of dual tracers and novel tracers also shows promising prospects, and various radionuclide imaging techniques can provide more precise diagnostic evidence for hepatocellular carcinoma. In the future, it will be necessary to accelerate the research and development of new radionuclides and targeted molecules to further promote the integrated development of nuclear medicine diagnosis and therapy.
We aimed to assess therapy response and prognosis of pediatric patients with Burkitt lymphoma (BL) using [18F] Fluorodeoxyglucose positron emission tomography/computed tomography [18F] FDG PET/CT metabolic indices, including whole body metabolic tumor volume (wbMTV), whole body total lesion glycolysis (wbTLG), mean standardized uptake value (SUVmean) and maximum standardized uptake value (SUVmax). We analyzed 98 pediatric patients with Burkitt lymphoma who underwent [¹⁸F] FDG PET/CT at baseline and after completion of therapy. Quantitative metabolic parameters, including the hottest lesion SUVmax (SUVmax-HL), hottest lesion SUVmean (SUVmean-HL), whole-body metabolic tumor volume (wbMTV), and whole-body total lesion glycolysis (wbTLG), were evaluated. Patients were followed for up to three years. Univariate Cox regression analyses were used to identify PET/CT parameters and clinical factors associated with event-free and overall survival. EFS and OS were defined as the time from chemotherapy initiation to the first event or death, respectively, or last follow-up. Optimal cut-offs were determined using ROC curve analysis, and survival differences were analyzed by Kaplan–Meier and log-rank tests. wbMTV and wbTLG differed significantly between therapy response groups (p < 0.001 and p = 0.002, respectively), whereas hottest lesion SUVmax and SUVmean showed no significant differences. In univariate analysis, wbMTV and wbTLG were associated with event-free survival (EFS) (p = 0.002 and p = 0.008, respectively). Among clinical variables, CNS involvement (p = 0.048) and bulky disease (p = 0.015) were also linked to poorer EFS, while other PET/CT and clinical parameters were not. No PET/CT or clinical variables were significantly related to overall survival (OS). Therapy response was significantly associated with baseline wbMTV and wbTLG. In addition, these PET/CT parameters, along with CNS involvement and bulky disease, were linked to poorer event-free survival, indicating possible prognostic relevance. No variables significantly influenced overall survival. Given the small number of events, validation in larger prospective studies, including multivariate analyses, is warranted.
