Positron Emission Tomography/Computed Tomography (PET/CT) imaging has emerged as an important tool with growing potential in the diagnosis, staging, and monitoring of pancreatic cancer, though its clinical implementation varies across different healthcare systems. This study aims to analyze the global research landscape and emerging trends in PET/CT for pancreatic cancer through a comprehensive bibliometric analysis. A bibliometric analysis was conducted using the Web of Science Core Collection to gather literature. The bibliometric tools VOSviewer, CiteSpace, and the R package “bibliometrix” were employed to visualize collaboration networks, keyword co-occurrences, and emerging research trends. The analysis identified 381 publications on PET/CT in pancreatic cancer. The annual number of publications exhibited an overall increasing trend with a 13.56

Purpose: To develop a fully automated deep learning system, AutoLugano, for end-to-end lymphoma classification by performing lesion segmentation, anatomical localization, and automated Lugano staging from baseline FDG-PET/CT scans. Methods: The AutoLugano system processes baseline FDG-PET/CT scans through three sequential modules:(1) Anatomy-Informed Lesion Segmentation, a 3D nnU-Net model, trained on multi-channel inputs, performs automated lesion detection (2) Atlas-based Anatomical Localization, which leverages the TotalSegmentator toolkit to map segmented lesions to 21 predefined lymph node regions using deterministic anatomical rules; and (3) Automated Lugano Staging, where the spatial distribution of involved regions is translated into Lugano stages and therapeutic groups (Limited vs. Advanced Stage).The system was trained on the public autoPET dataset (n=1,007) and externally validated on an independent cohort of 67 patients. Performance was assessed using accuracy, sensitivity, specificity, F1-scorefor regional involvement detection and staging agreement. Results: On the external validation set, the proposed model demonstrated robust performance, achieving an overall accuracy of 88.31%, sensitivity of 74.47%, Specificity of 94.21% and an F1-score of 80.80% for regional involvement detection,outperforming baseline models. Most notably, for the critical clinical task of therapeutic stratification (Limited vs. Advanced Stage), the system achieved a high accuracy of 85.07%, with a specificity of 90.48% and a sensitivity of 82.61%.Conclusion: AutoLugano represents the first fully automated, end-to-end pipeline that translates a single baseline FDG-PET/CT scan into a complete Lugano stage. This study demonstrates its strong potential to assist in initial staging, treatment stratification, and supporting clinical decision-making.

This study explored the gain value of fractionated administration of 177Lu-PSMA-617 in treating prostate cancer. 20

Due to the COVID‐19 pandemic, a series of sequelae, such as fatigue, tachypnea, and ageusia, appeared in long COVID patients, but the pathological basis was still uncertain. The targeted radiopharmaceuticals were of potential to systemically and dynamically trace the pathological changes. For the key ACE2 protein in the virus‐host interaction, 68Ga‐cyc‐DX600 was developed on the basis of DX600 as a PET tracer of ACE2 fluctuation and maintained the ability in differentiating ACE and ACE2. In the temporary infection model inhaled with the radio‐traceable pseudovirus in the upper respiratory tract of male humanized ACE2 (hACE2) mice, organ‐specific ACE2 dysfunction in acute period and the following ACE2 recovery in a relatively long period was visualized and quantified by ACE2 PET, revealing a complex pattern of virus concentration‐dependent degree and time period‐dependent tendency of ACE2 recovery, mainly a sudden decrease of apparent ACE2 in the heart, liver, kidneys, lungs, and so on, but the liver was of a quick functional compensation on ACE2 expression after a temporary decrease. ACE2 expression of most organs has recovered to a normal level at 15 days post inhalation, with brain and genitals still of a decreased SUVACE2; meanwhile, kidneys were of an increased SUVACE2. These findings on ACE2 PET were further verified by western blot. When compared with high‐resolution computed tomography on structural changes and FDG PET on glycometabolism, ACE2 PET was superior in an earlier diagnostic window during infection and more comprehensive understanding of functional dysfunction post‐infection. In the respective ACE2 PET/CT and ACE2 PET/MR scans of a volunteer, the repeatability of SUVACE2 and the ACE2 specificity were further confirmed. In conclusion, 68Ga‐cyc‐DX600 was developed as an ACE2‐specific tracer, and the corresponding ACE2 PET revealed the dynamic patterns of functional ACE2 recovery and provided a reference and approach to explore the ACE2‐related pathological basis of sequelae in long COVID.

Abstract Angiotensin converting enzyme 2 (ACE2) played a critical role in regulating renin‐angiotensin‐aldosterone system (RAAS). In this research, 68Ga‐cyc‐DX600 was synthesized as PET tracer of ACE2 imaging. ACE2 positron emission tomography/magnetic resonance (PET/MR) was preliminary administered on twelve healthy volunteers, and the images were normalized and registered to establish the standard model of ACE2 PET. In diseased conditions, 68Ga‐cyc‐DX600 PET and 18F‐FDG PET were compared for COVID‐19 (one in acute phase and three in post‐COVID), anemia (n = 1) and malignancies (n = 2) to evaluate the diagnostic efficiency. 68Ga‐cyc‐DX600 PET was of a definite ACE2 dependence. For the tracer uptake of ACE2 PET/MR of female and male, differences existed in salivary glands, upper respiratory tract and kidneys, meanwhile, age, and body mass index (BMI) were also the confounding factors. RAAS‐related tissue and organs were of the relatively higher tracer uptake, such as SUVmean of cardiac chamber (3.786 ± 1.495), liver (5.342 ± 2.267), spleen (4.465 ± 2.508), and kidney (4.906 ± 1.619 for female and 8.431 ± 5.179 for male). For COVID‐19, ACE2 PET revealed ACE2 fluctuations, particularly in the susceptible organs, including liver, spleen and testis. In the case of anemia, the activated local RAS in the bone marrow was of diffuse high tracer uptake. ACE2 PET of malignancies added supplementary information to FDG PET. 68Ga‐cyc‐DX600‐based ACE2 PET models were established for visually monitoring of whole‐body ACE2 expression. The feasibility of ACE2 PET in supervising disease was primarily proved in COVID‐19, anemia and malignancies as providing a comprehensive view on the disease process and functional recovery.

68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT has been widely used in the diagnosis of prostate cancer (PCa); however, the urine lead shielding resulting from the urinary metabolism of tracers may obstruct the detection of surrounding metastasis. In this research, the additive value of super early scanning in diagnosing primary lesions and metastasis in the pelvic cavity was evaluated. Firstly, the differentiation efficiency of 68Ga-PSMA-11 PET scanned at 3 min post-injection (min P.I.) was measured in PSMA-positive (22rv1 cells) and PSMA-negative (PC3 cells) model mice. Secondly, 106 patients were scanned at 3 min P.I. for the pelvic cavity and then scanned as a standard protocol at 45 min P.I. In the results, the differential diagnosis of PSMA expression was completely reflected as early as 3 min P.I. for mice models. For patients, when correlated with the Gleason score, the quantitative results of the super early scan displayed a comparable correlation coefficient with the routine scan. The target to bladder ratios increased from 1.44 ± 2.40 at 45 min to 10.10 ± 19.10 at 3 min (p < 0.001) for the primary lesions, and it increased from 0.99 ± 1.88 to 9.27 ± 23.03 for metastasis. Meanwhile, the target to background ratios increased from 2.21 ± 2.44 at 3 min to 19.13 ± 23.93 at 45 min (p < 0.001) for the primary lesions, and it increased from 1.68 ± 2.71 to 12.04 ± 18.73 (p < 0.001) for metastasis. In conclusion, super early scanning of 68Ga-PSMA-11 PET/CT added referable information for metastasis detection in order to avoid disturbing tracer activity in the urinary system.

To investigate 18F-FDG PET/CT feature of pancreatic adenosquamous carcinoma (PASC) in contrast with conventional pancreatic ductal adenocarcinoma (PDAC), and its correlation with pathological findings. Patients with PASC or PDAC confirmed by surgical pathology, who underwent FDG PET/CT scanning before surgical resection, were retrospectively studied. PASC group and conventional PDAC group included 13 and 104 patients, respectively. Delayed phase of PET/CT scanning was performed in 12 patients with PASC and 99 with PDAC. Maximum standardized value (SUVmax) was measured, and the mean retention index (RI) was calculated by ([PET120min SUVmax]–[PET 60min SUVmax]) ÷ PET 60min SUVmax × 100%. On PET/CT, all lesions of PASC group showed intense FDG uptake, and the SUVmax were significantly higher than the lesions of conventional PDAC group both on the early [10.43 ± 5.10 (4.37–24.00) vs. 7.31 ± 3.86 (1.93–21.08), P = 0.011] and delayed phase [13.29 ± 6.04 (5.72–28.16) vs. 8.84 ± 5.14 (1.92–27.58), P = 0.005]. On the delayed phase, all lesions of PASC group had increased SUVmax with positive RI value (27.04% ± 8.87%, 7.14–39.27%). For conventional PDAC group, 81 lesions had increased SUVmax with positive RI value (27.25% ± 19.10%, 1.09–104.49%), while eighteen (18.18%) lesions of PDAC group had slightly decreased SUVmax, and their RI value were negative (− 11.35% ± 13.50%, − 43.17 to − 0.14%). The proliferative index (Ki-67) of lesions of PASC group was positively correlated with both the early (P = 0.034, r = 0.671) and delayed SUVmax (P = 0.019, r = 0.721). The RI value of lesions with adjacent organ invasion in PASC group was significantly higher than those without invasion (33.25% ± 4.92% vs. 20.83% ± 7.49%, P = 0.007). PASC has more intense FDG uptake than conventional PDAC both on early and delayed phase. RI value of PASC was positive. Negative RI value may be helpful for differentiating PDAC from PASC. SUVmax and RI value may be helpful for prediction of its malignancy and invasion.

1390 Objectives To investigate the relationship between 18F-FDG PET/CT imaging characteristics and circulating cell free tumor specific DNA copies , and to explore its’ potential clinical values. Methods The VX2 tumor rabbit animal models were established by transplanting VX2 tumor fragment into leg muscles(n=6) . Two weeks post transplant, tumor size and glucose metabolic parameters were observed by 18F-FDG PET/CT scan. The Shope virus DNA in tumor tissues and plasma was quantified by a fluorescent quantitative real-timepolymerase chain reaction (PCR) method as the tumor specific circulating cell free DNA. The copies of circulating Shope virus DNA and FDG PET finding were compared. Results Before tumor transplantation, no viral DNA was examined in peripheral blood, 14 days after transplantation circulating Shope virus specific DNA fragments could be examined. Concentration of Shope virus DNA in tumor tissue (mean (4.9±1.9)×10^6 copies/l) was significantly higher than that in the plasma (mean (1.3±0.9)×10^3 copies/l). There is a positive relationship between circulating Shope DNA level and 18F-FDG-PET/CT maximum standard uptake value, but no significant association was observed between plasma Shope virus DNA level and VX2 tumor size. Conclusions Plasma circulating cell free Shope viral DNA may be a tumor-marker of VX2 tumor animal model, and the quantitive of circulating cell free tumor specific DNA may be related to FDG PET imaging. Tumor specific circulating cfDNA is proposed as an novel early detectable bio-marker as well as an inexpensive, noninvasive assay to cancer management.

580 Objectives To improve the quantification and visualization in oncology whole-body FDG PET-CT. Methods Eleven patients with clinical diagnosed liver caner or liver metastasis were selected to have dynamic whole-body FDG PET-CT. All PET-CT scans were performed on a Siemens Biograph TruePoint mCT scanner. About 60-min 11-pass dynamic whole-body scan via multi-bed (1 min/bed, 5 beds/pass, and all passes in same direction from foot to head) were started immediately after FDG injection. Conventional clinical 10-min whole-body FDG PET scan was performed after 60-min dynamic PET scan for comparison. For voxelwise quantification of whole-body FDG PET, a Patlak plot based spatial constraint parametric imaging approach was evaluated by computer simulation for optimization. A population-based plasma input function with calibrated by the maximum value of aorta activity at the first pass was used for the Patlak plot. A 3D Gaussion filter with 18-mm FWHM was used for spatial constraint. The FDG uptake rate constant Ki images from the Patlak plot was compared to the SUV images from clinical scan. Results Computer simulation showed that the Ki images generated by an optimal spatial constraint have consistent lower noise levels, negligible bias and loss in spatial resolution. Consistent FDG kinetics in liver, liver cancer, and liver metastasis were observed through all patients: lower in the first pass, and higher in last pass relative to normal liver FDG activity. The different kinetics between normal liver tissue and malignant lesions resulted in an increased contrast in the Ki images as compared to SUV images. The low noise level of patient Ki images was appropriate for clinical diagnosis in both visualization and quantification. Conclusions The dynamic scanning with parametric imaging improved quantification and visualization of whole-body FDG PET-CT. The clinical value of the method is under investigation.

282 Objectives The purpose of this study was to evaluate the ability of FDG-PET to predict the early response of VX2 tumor to radiotherapy in VX2 tumor rabbit model. Methods The VX2 tumor bearing animal models were established by transplanting VX2 tumor fragment into leg muscles. All the rabbits were divided into control group (n=7), radiation response group (n=12) and resistance group(n=7), based on the changes of tumor volume. FDG-PET studies were performed before and after completion of radiotherapy, and tumor glucose metabolic parameters (Standard Uptake Value, Metabolic Tumor Volume, Total Lesion Glycolysis) were calculated. Based on histopathological analysis of the specimens obtained after PET scan, the ratios of tumor cell necrosis, inflammation and Ki67 positive staining were calculated. Results Seven days after radiotherapy, There was no difference in the ΔMTV value among the response group and the resistance group. However, there were significant difference in ΔSUVmax and ΔTLG value between the response and resistance groups, and the ΔTLG showed great difference among the three groups. Pathological analysis confirmed that there are a large number of necrotic foci and inflammatory cells in response group, and Ki67-positive rate significantly reduced. TLG and tumor necrosis rate was correlated significantly. Conclusions ΔTLG may have the potential to predict early response to induction radiotherapy in VX2 tumor rabbit model, and it can play some important role in tumor therapy planning and follow-up.

Pulmonary embolism derived from the right atrial myxoma is a rare event and can be difficult to recognize. A chest x-ray image from a 48-year-old woman with shortness of breath revealed multiple pulmonary nodules, which suggested lung metastases. An FDG PET/CT was performed for further evaluation. The images showed that the lung nodules had variable but mild FDG activity in general. There was 1 additional large FDG activity in the right atrium. The subsequent studies demonstrated that the patient experienced pulmonary embolism derived from the right atrial myxoma.