Lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 4 or greater on multiparametric MRI (mpMRI) indicate a high likelihood of prostate cancer (PCa), and guidelines recommend a targeted biopsy. We aimed to compare the diagnostic performance of robotic arm-assisted [68Ga]Ga-PSMA-11 PET/CT-guided prostate biopsy (PGPB) with mpMRI-directed cognitive-fusion transrectal ultrasound-guided biopsy (MCFB) in biopsy-naïve men with clinical findings suggestive of PCa. Methods: This prospective, single-center, randomized clinical trial (NCT05137561) enrolled biopsy-naïve men age 50-90 y with elevated levels of prostate-specific antigen (≥4 ng/mL) and abnormal digital rectal examination findings. All participants underwent mpMRI, and those with a PI-RADS score of 4 or greater were randomized into 2 arms. In arm 1, participants underwent PGPB for a [68Ga]Ga-PSMA-avid lesion, and participants in arm 2 underwent MCFB. Participants in arm 1 with PET-negative findings subsequently underwent MCFB, and participants with negative biopsy results underwent PET and PGPB. The primary outcome was the detection of PCa. Secondary outcomes included complication rates and participant-reported pain. Result: Of the 267 participants enrolled, 81.3% (217) had lesions with a PI-RADS score of 4 or greater and were randomized to either PGPB (n = 112) or MCFB (n = 105). PCa was detected in 97.1% of participants (101/104) in arm 1 and 81.0% (85/105) in arm 2 (P < 0.05). PGPB showed higher diagnostic accuracy for PI-RADS 5 lesions (100% vs. 95.1%, P = 0.09). Major complications were observed in arm 2 only (n = 5). Arm 1 had significantly fewer complications (10.8% vs. 51.4%, P < 0.01), a lower median visual analog scale score for pain (3 vs. 5), and shorter procedure times. The core positivity rate was higher in arm 1 (60% ± 20%), despite obtaining fewer cores. Conclusion: [68Ga]Ga-PSMA-11 PGPB demonstrated higher diagnostic performance, fewer complications, and better tolerability compared with MCFB. This approach enables integrated diagnosis and staging, offering a promising alternative for efficient, safe, and accurate evaluation of prostate cancer.

Fever of unknown origin (FUO) is a prolonged fever with unknown etiology after an extensive outpatient or inpatient workup. 18F-Flurodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT) has shown a higher diagnostic yield than CT. This study assesses the diagnostic yield of 18F-FDG PET/CT-guided targeted biopsy in FUO. This single-centre retrospective study included FUO patients who underwent 18F-FDG PET/CT-guided biopsy. A distinct focal area of FDG-uptake above the surrounding background within the organ of interest was considered PET-positive and targeted using automated robotic arm–assisted PET/CT-guided biopsy systems. Procedure-related complications were recorded, and histopathological examination was taken as the reference standard. Diagnostic yield and other PET-based parameters were calculated. Data from 165 FUO patients [median age 47 years (IQR, 30–60)] who underwent 18F-FDG PET/CT-guided biopsy between 2017 and June 2025 were analysed. 64 (39

OBJECTIVES:Bone marrow involvement (BMI) upstages lymphoma and influences prognosis and treatment. Conventional bone marrow trephine biopsy (BMTB) may miss patchy or extrapelvic disease. This study compared the diagnostic performance of automated-robotic-arm (ARA)-assisted 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT)-guided bone marrow biopsy with BMTB in treatment-naive lymphoma. METHODS:In this prospective single-centre study, 169 treatment-naive lymphoma patients underwent baseline 18 F-FDG PET/CT and bilateral posterior iliac crest BMTB. Among these, 44 patients with focal FDG-avid marrow lesions (unifocal or multifocal) underwent ARA-assisted PET/CT-guided bone marrow biopsy. Histopathological findings from PET/CT-guided biopsy and BMTB were used to establish the final diagnosis of BMI. Diagnostic performance parameters were calculated with 95% confidence intervals (CIs) using Wilson score method. Comparisons were performed using Fisher's exact test. RESULTS:Of the 44 patients with focal FDG-avid marrow lesions, 40 had lymphomatous BMI on final diagnosis. PET/CT-guided biopsy yielded 37 true positives, four true negatives, and three false-negatives, with no false-positive. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 92.5% (95% CI: 80.1-97.4%), 100% (95% CI: 51.0-100.0%), 100% (95% CI: 90.6-100.0%), 57.1% (95% CI: 25.0-84.2%), and 93.2% (95% CI: 81.8-97.7%), respectively. Conventional BMTB demonstrated significantly lower sensitivity (52.5%) and accuracy (56.8%) ( P  < 0.001). CONCLUSION:ARA-assisted PET/CT-guided metabolic bone marrow biopsy demonstrates superior sensitivity and accuracy than conventional iliac crest trephine biopsy. It improves detection of lymphomatous BMI, boosts diagnostic confidence and reduces over-staging risk. It may play a selective problem-solving tool for focal FDG-avid marrow lesions.

5095 Background: De-novo high-volume metastatic hormone-sensitive prostate cancer (mHSPC) presents a therapeutic challenge with a dismal five-year survival rate. Till recently, androgen deprivation therapy (ADT) with docetaxel had been the standard-of-care for such patients. Nevertheless, a substantial proportion of patients continue to harbour residual disease after completion of docetaxel. 177 Lu-PSMA-617 has shown positive survival outcomes in the metastatic castrate-resistant setting. Here, we intended to evaluate the role of upfront 177 Lu-PSMA-617 as consolidation therapy for residual disease following docetaxel in de-novo high-volume mHSPC patients. Methods: This was an investigator-initiated randomized, parallel-group, open-label, phase 2 trial. Patients with de-novo high-volume mHSPC who were initiated on ADT plus docetaxel (75 mg/m 2 /cycle x 6) and had residual non-progressive disease after completion of six cycles of docetaxel (defined as serum PSA >0.2 ng/mL with PSMA-positive disease on 68 Ga-PSMA-11 PET/CT) were randomized in 1:1 ratio to the experimental arm ( 177 Lu-PSMA-617, 7.4 GBq/cycle x 2, 6 weeks apart with continued ADT) or control arm (continued ADT only). The primary end-point was the proportion of patients achieving a serum PSA of ≤0.2 ng/mL at 6 months from randomization. Major secondary end-points included radiographic progression-free survival (rPFS), PSA-PFS, and treatment-emergent adverse events (TEAEs). A total sample size of 78 patients was estimated to be recruited assuming a 30% improvement in the primary end-point in the experimental arm with two-sided alpha of 5% and power of 80%. Results: The trial was terminated early due to poor accrual COVID-19 pandemic and following the change in standard of care from doublet to triplet therapy incorporating an androgen-receptor pathway inhibitor along with ADT plus docetaxel. Thirty high-volume mHSPC patients (15 in each arm) were recruited between January 2021 and May 2024. The primary end-point was achieved in 9/15 (60%) patients in the experimental arm versus 2/15 (13.3%) patients in the control arm (risk ratio: 4.5, 95% CI: 1.2-17.4, p=0.008). The median rPFS was 18 months in the experimental arm versus 9 months in the control arm, while the median PSA-PFS were 15 months and 9 months, respectively. No major grade 3/4 TEAEs were seen in the experimental arm. Conclusions: In de-novo high-volume mHSPC patients treated with docetaxel and having residual disease, 177 Lu-PSMA-617 consolidation therapy demonstrated remarkable efficacy in terms of biochemical response. Larger phase 3 trials are needed to definitively establish its survival benefits. Clinical trial information: CTRI/2021/01/030267 .

Prostate-specific membrane antigen (PSMA) PET/CT imaging has revolutionized the management of prostate cancer. Increased PSMA expression is also reported in many benign pathologies and can lead to diagnostic pitfalls if not carefully considered. The knowledge of these conditions is crucial in clinical decision-making in prostate cancer. Here, we highlight a case of liver amoebic abscesses interpreted as necrotic hepatic metastases on ultrasonography showing PSMA expression in periphery of the early hepatic amoebic lesions.

Myocardial perfusion imaging is susceptible to imaging artifacts that may limit its clinical utility. One approach to differentiate true perfusion defects from artifacts involves examining the presence of perfusion abnormalities that align with the typical anatomy of coronary vessels. However, this approach may not be applicable in patients having coronary anomalies. We report a patient with dual LAD exhibiting isolated ischemia of the anteroseptal wall on MPI, resembling artifact typically observed in patients with LBBB. The present case highlights the importance of familiarity with variations in coronary anatomy, like dual LAD, to avoid misinterpretation of atypical perfusion defects observed in MPI.

Abstract Prostate-specific membrane antigen PET imaging has revolutionized the role of prostate cancer diagnosis and management, with very high sensitivity and specificity. To prevent misdiagnosis and for accurate therapy planning, prostate-specific membrane antigen (PSMA) uptake in nonprostatic diseases needs to be recognized correctly. Besides the physiological PSMA expression, 68Ga-PSMA-11 uptake has been mentioned in multiple oncological and nononcological lesions. The present case report exhibits 68Ga-PSMA-11 uptake in fibroadenoma in a male accessory breast in the right axillary region.

Differentiated thyroid carcinoma (DTC) metastasizing to the adrenal glands is very infrequent. We present three cases of DTC with adrenal metastasis in their follow-up, in which two were from follicular thyroid carcinoma and one from papillary thyroid carcinoma along with review of literature to emphasize the role of cross-sectional and correlative imaging in DTC with adrenal metastasis.

Nocardiosis, an opportunistic infection occurs in immunodeficient population commonly in organ transplant recipients. Patients with risk factors likely chronic corticosteroids and immunosuppressants consumption usually have a higher tendency for disseminated infections with formation of deep abscesses at various sites in the body. Functional imaging with PET, being a whole body imaging offers information about the various sites of disease, thereby assisting the treatment planning, treatment response and also to identify the sites of biopsy. 68Ga FAPI PET serves this purpose as previous studies in various other infections have shown activated fibroblasts with increased FAP expression at the infective foci.

RBC scintigraphy has shown to be a sensitive imaging technique for detecting gastrointestinal bleed. There may be a time interval between the initiation of bleed and appearance of symptoms. This study can help in localizing the site of active bleed; though, false positive results may be seen. A patient of chronic liver disease presented with dark stools and falling hemoglobin who after initial management, showed focal tracer uptake in the pelvis on 99mTc-labelled RBC scintigraphy planar imaging suggesting gastrointestinal bleed. However, SPECT/CT accurately localized the tracer activity in a previously undiagnosed urinary bladder hernia in the inguinal canal and scrotum.

PURPOSE:A monoclonal antibody, trastuzumab, is used for immunotherapy for HER2-expressing breast cancers. Large-sized antibodies demonstrate hepatobiliary clearance and slower pharmacokinetics. A trastuzumab fragment (Fab; 45 kDa) has been generated for theranostic use. PATIENTS AND METHODS:Fab was generated by papain digestion. Trastuzumab and Fab have been radiolabelled with 177 Lu after being conjugated with a bifunctional chelating. The affinity and target specificity were studied in vitro. The first-in-human study was performed. RESULTS:The bifunctional chelating agent conjugation of 1-2 molecules with trastuzumab and Fab was detected at the molar ratio 1:10 in bicarbonate buffer (0.5 M, pH 8) at 37°-40°C. However, 2-3 molecules of bifunctional chelating agent were conjugated when DMSO in PBS (0.1 M, pH 7) was used as a conjugation buffer at a molar ratio of 1:10. The radiolabelling yield of DOTA-conjugated Fab and trastuzumab at pH 5, 45°C to 50°C, with incubation time 2.5-3 hours was 80% and 41.67%, respectively. However, with DOTAGA-conjugated trastuzumab and Fab, the maximum radiolabelling yield at pH 5.5, 37°C, and at 2.5-3 hours was 80.83% and 83%, respectively. The calculated K d of DOTAGA Fab and trastuzumab with HER2-positive SKBR3 cells was 6.85 ± 0.24 × 10 -8 M and 1.71 ± 0.10 × 10 -8 M, respectively. DOTAGA-Fab and trastuzumab showed better radiolabelling yield at mild reaction conditions.177 Lu-DOTAGA-Fab demonstrated higher lesion uptake and lower liver retention as compared with 177 Lu-DOTAGA-trastuzumab. However, 177 Lu-DOTAGA-Fab as compared with 177 Lu-DOTAGA-trastuzumab showed a relatively early washout (5 days) from the lesion. CONCLUSIONS:177 Lu-DOTAGA-Fab and trastuzumab are suitable for targeting the HER2 receptors.

ABSTRACT:Metastatic or recurrent adrenocortical carcinoma is a potentially lethal malignancy, presenting significant challenges in disease management owing to absence of effective systemic treatments. Significantly diminished survival rates necessitate rapid identification of specific molecules for the development of targeted therapeutics. Fibroblast activation protein (FAP)-expressing cancer-associated fibroblasts have been a major breakthrough causing a paradigm shift in targeted theranostics focusing on the tumor microenvironment. The effectiveness of various FAP inhibitors (FAPis) and FAP targeting peptide has been extensively documented in diverse clinical investigations. We have evaluated 3 molecules, that is, DOTA.SA.FAPi (SA.FAPi), FAPi46, and FAP2286, as potential theranostic probes for adrenocortical carcinoma.