LAFOV PET presents an excellent sensitivity, offering the ability of high-quality extra short images. We assess through a case report the additional value of performing 68GA-PSMA-11 PET/CT dynamic acquisitions on an LAFOV PET system to improve discrimination between pathological uptakes, such as lymph nodes, from urinary physiological uptake. We performed a single-bed 4-minute list-mode acquisition, reconstructed in 4 frames of 1 minute, providing a dynamic visualization of 68GA-PSMA-11 urinary ureteral excretion over time. This additional reconstruction is easy to implement in clinical practice, requiring no additional acquisition time or radiological exposure.

PurposeCutaneous melanoma (CM) incidence is rising, and despite advances in immune checkpoint inhibitors (ICI), many metastatic patients do not respond or develop resistance. This study aimed to evaluate the prognostic value of a pre-treatment FDG-PET/CT-based radiomic model (MEL-RAD) for predicting 1-year progression-free survival (1y-PFS) in metastatic CM patients treated with first-line ICI.MethodsWe retrospectively included 154 metastatic CM patients from two centers who underwent pre-treatment FDG-PET/CT before ICI initiation. Patients were split into a development cohort (n=95) and an independent testing cohort (n=59). Radiomic features were extracted and harmonized to reduce inter-cohort variability. A two-step feature selection identified three key wavelet-transformed texture features used to build the MEL-RAD predictive model. The model’s performance was assessed by receiver operating characteristic (ROC) analysis, sensitivity, specificity, and predictive values. Survival analyses (progression-free (PFS) and overall survival (OS)) were performed with Cox regression and Kaplan-Meier methods.ResultsIn the development cohort, MEL-RAD achieved an AUC of 0.74 (p<0.0001) for predicting 1y-PFS. Using a 55% probability threshold, sensitivity was 93.8%, specificity 31.9%, with positive and negative predictive values of 58.4% and 83.4%, respectively. Patients with MEL-RAD >55% had significantly worse PFS (HR = 2.73, p=0.0009) and OS (HR = 3.20, p=0.0003). These results were externally validated: in the testing cohort, MEL-RAD positivity remained significantly associated with poorer PFS (HR = 2.73, p=0.047), and showed non-significant for OS.ConclusionThe MEL-RAD radiomic model based on pre-treatment FDG-PET/CT offers a non-invasive biomarker to stratify metastatic CM patients treated with immunotherapy.

BackgroundRevolution of chemo-immunotherapy (CT-IO) in the first-line treatment of metastatic non-small-cell lung cancers (NSCLC) without actionable genomic alterations (AGAs) has dramatically improved prognosis, providing long response in a subset of patients. Due to the highly heterogeneous nature of the disease, most of patients do not show long term benefit. Long axial field of view positron emission tomography (LAFOV-PET) scanner is a new emerging system allowing dynamic whole-body imaging with higher sensitivity, representing unique opportunity for oncological applications. The aim of this study is to determine whether 18F-fluorodeoxyglucose positron emission (18F-FDG) LAFOV-PET derived parameters might have prognostic and predictive potential for CT-IO outcomes in NSCLC.MethodsPROFIL-1 (NCT06738680) is a multicentre, prospective single-arm biomarker pilot study investigating the prognostic and predictive potential of multiparametric 18F-FDG LAFOV-PET for first-line CT-IO efficacy in advanced NSCLC, with a planned enrolment of 120 patients at 2 French sites. Adult patients with treatment-naïve advanced non-squamous or squamous NSCLC without AGAs and eligible for first-line CT-IO will be recruited for PROFIL-1. Patients will undergo baseline LAFOV-PET before treatment (optional second dynamic LAFOV-PET after CT-IO induction). The primary objective is to evaluate the prognostic and predictive potential of a whole-body multiparametric analysis (radiomics and dynamics) derived from LAFOV-PET for first-line CT-IO efficacy, using the rate of disease progression or death at one year as the primary endpoint, assessed by investigators according to RECIST v1.1 criteria. Secondary endpoints included correlations between imaging parameters and clinico-pathological characteristics, comparison between direct Patlak and indirect Patlak reconstruction methods to determine dynamic parameters such as Ki (the net influx rate) and distribution volume (DV), number of detected tumor lesions and signal-to-noise ratio (vs. SAFOV-like imaging), objective response rate, overall survival and safety. The study opened for enrolment in January 2025. Duration of inclusions: 2 years.Clinical trial informationNCT06738680.

Cutaneous melanoma (CM) is an aggressive malignancy with rising incidence. Immune checkpoint blockades (ICBs), particularly anti–PD-1 therapies, have improved survival in metastatic CM. However, many patients show primary resistance or develop progression after initial benefit. Early identification of patients likely to benefit remains a clinical challenge. Total Metabolic Tumor Volume (TMTV) and the maximum distance between two lesions (Dmax), derived from baseline [18F]FDG-PET/CT, have shown prognostic relevance in other cancers. This study evaluates their prognostic value in metastatic CM. This retrospective study included 143 patients with metastatic CM treated with ICBs (2016–2023) across two centers. Tumor lesions were segmented using PERCIST procedure on baseline (PET0) and early follow-up (PET1, 9–12 weeks post-treatment) [18F]FDG-PET/CT. TMTV, Dmax, and their changes (ΔTMTV, ΔDmax) were calculated. Associations with progression-free survival (PFS) and overall survival (OS) were assessed, including in multivariable analyses. Elevated Dmax (above median) at PET0 was independently linked to poorer PFS (HR = 1.67; 95

Background and purpose:To compare the performance of anatomic and functional dosimetric parameters based on Gallium-68 lung perfusion positron emission tomography and computed tomographic imaging (PET/CT) imaging to predict the risk of symptomatic long-term radiation-induced lung toxicity (RILT) in patients with lung tumors treated with stereotactic body radiation therapy (SBRT). Materials and methods:We have performed a prospective study in patients treated with SBRT. Mean dose (MD) and volumes receiving xGy were calculated in five lung volumes: the conventional anatomical volume (AV) delineated on CT images, three lung functional volumes defined on lung perfusion PET imaging (FV50%, FV70%, FV90%, i.e. the minimal volume containing 50 %, 70 % and 90 % of the total activity within the AV), and a low functional volume (LFV = AV-FV90%). The primary endpoint of this analysis was grade ≥2 long-term RILT at 12 months as assessed with NCI CTCAE v.5. The predictive value of anatomical and functional dose volume parameters was evaluated by comparing patients with and without long-term RILT. Results:Out of the 59 patients included, 50 were still alive at 12 months and 9 (18 %) had grade ≥2 long-term RILT. The MD and the VxGy in the AV and LFV were not statistically different in patients with and without long-term RILT (p > 0.05). All functional parameters in FV50% and FV70% were significantly higher in long-term RILT patients (p < 0.05). Discussion:The predictive value of PET perfusion-based functional parameters outperforms the standard CT-based dose-volume parameters for the risk of grade ≥2 long-term RILT.

BACKGROUND:New factors predicting response in patients with a PD-L1 tumor proportion score (TPS) ≥ 50% for locally advanced or metastatic non-small cell lung cancer (NSCLC) are needed to better select first-line therapy. Based on the literature, we previously developed a radiomic model predicting the KEAP1/NFE2L2 mutational status. METHOD:This was a retrospective monocenter study including 94 consecutive patients with advanced or metastatic PD-L1 ≥ 50% NSCLC, treated with pembrolizumab, who underwent a pre-therapeutic FDG-PET/CT and were followed up for 1 year. Seventy-seven patients who did not progress within the first 60 days of treatment were analyzed. Each primary lesion was segmented by 2 physicians on PET and CT scans. Radiomic features were calculated using MIM software on both PET and CT imaging. A previously developed KEAP1/NFE2L2 radiomic prediction model (called MUTPET) was applied to this cohort using the initial FDG-PET/CT. The primary endpoint was the validation of the MUTPET model as a predictive factor of PFS via the non-invasive prediction of KEAP1/NEF2L2 mutation. RESULTS:The main characteristics of this cohort were: median age of 67.0 years [range, 48.0-84.0], sex ratio M/F = 60/17, 74.0% of patients with a histopathology of adenocarcinoma and 85.0% with a stage IV disease. The median follow-up was 20.0 months [range, 15.3-23.9]. Fifty-six (72.2%) patients experienced a disease progression with a median PFS of 11.8 months (CI95% 8.6-15.8) among which 51 (66.2%) died. In univariable analysis, MUTPET model was statistically significant as a predictive factor of improved PFS (HR = 0.51, CI95% 0.30-0.91, p = 0.02) whereas it was not statistically significant regarding OS (HR = 0.61, CI95% 0.34-1.11, p = 0.10). In multivariable analysis, the MUTPET model was associated with a HR of 0.6 (CI95% 0.34-1.06, p = 0.08). Combining the MUTPET prediction, the histology subtype and the existence of liver metastases, a multimodal nomogram was able to predict PFS (chi-test of 39.43, p < 0.0001). CONCLUSION:In PD-L1 TPS ≥ 50% NSCLC patients treated with pembrolizumab, our results suggest an improved PFS in patients predicted to be KEAP1/NFE2L2 mutated.

We present a publicly available multimodal dataset for head and neck cancer research, comprising 1123 annotated Positron Emission Tomography/Computed Tomography (PET/CT) studies from patients with histologically confirmed disease, acquired from 10 international medical centers. All studies contain co-registered PET/CT scans with varying acquisition protocols, reflecting real-world clinical diversity from a long-term, multi-institution retrospective collection. Primary gross tumor volumes (GTVp) and involved lymph nodes (GTVn) were manually segmented by experienced radiation oncologists and radiologists following established guidelines. We provide anonymized NifTi files, expert-annotated segmentation masks, comprehensive clinical metadata, and radiotherapy dose distributions for a patient subset. The metadata include TNM staging, HPV status, demographics, long-term follow-up outcomes, survival times, censoring indicators, and treatment information. To demonstrate its utility, we benchmark three key clinical tasks: automated tumor segmentation, recurrence-free survival prediction, and HPV status classification, using state-of-the-art deep learning models like UNet, SegResNet, and multimodal prognostic frameworks.

The PEGASUS trial was the first study to evaluate and demonstrate the benefits of 68Ga-perfusion PET/CT in the lung stereotactic body radiotherapy (SBRT) planning process in preserving functional lung volumes while respecting target volume coverage and doses to other organs at risk. Here we report the prespecified exploratory endpoint of SBRT on health-related quality of life (HRQoL). In this single-center prospective study, we recruited patients planned to be treated in our radiotherapy department with SBRT for primary or secondary lung tumors. Patient-reported outcomes were assessed at the first visit, 1 month, 3 months and every 3 months until 12 months after SBRT using the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 items (QLQ-C30), the EORTC Quality of Life Questionnaire Lung Cancer 13 items (QLQ-LC13), and the European Quality of Life 5 Dimensions-5 Level (EQ-5D-5 L) questionnaire. The key exploratory HRQoL endpoints (analyzed for all patients who completed at least QLQ-C30 at least one time point after SBRT) were baseline-to-early change (between 1 month and 3 month) and baseline-to-late change (between 6 month and 12 month) in the QLQ-C30 global health status (GHS)/quality-of-life (QoL) score and in the deterioration of the dyspnea (patient-reported lung toxicity). Explorative analysis of the impact of baseline HRQoL, patient- and SBRT-related characteristics, including PET perfusion-based functional parameters, on the change in HRQoL from baseline was analyzed using univariate analysis. Of the 60 patients included, 39 were analyzable as early-onset and 22 as late-onset. Thirteen (33

123I-ioflupane Single Photon Emission Computed Tomography with Computed Tomography (SPECT-CT) imaging is widely used to assess dopaminergic denervation in parkinsonian syndromes, such as Parkinson’s disease and atypical variants. Standard imaging generally uses low-energy high-resolution (LEHR) parallel-hole collimators, which require long acquisition times and minimal source-to-detector distance to optimize spatial resolution. Recently, the Smart-Zoom High-Resolution and eXtended magnification volume (SZ-HRX) solution was designed specifically for neurological applications. It incorporates multifocal collimators and a dedicated reconstruction algorithm, promising a reduction in acquisition duration, and an improvement in patient comfort by allowing detectors to be positioned further away from the head. The aim of this study is to investigate the performance of SZ-HRX system compared to LEHR collimators. A striatal phantom with 5 compartments (putamens, caudates, and background) was filled with different concentrations of 123I-ioflupane to simulate various clinical situations. Tomographic acquisitions were performed on each LEHR and SZ-HRX system. The summation of dynamically acquired projections allowed testing different acquisition durations with the SZ-HRX collimator. Sensitivity and Spatial resolution were assessed and compared. The data were reconstructed according to EANM recommendations. Contrast-to-noise ratio (CNR), striatum-to-background ratio (SBR), coefficient of variation (CV), and normalized asymmetry index (NAI) were calculated for both systems and compared to the LEHR acquisition. To estimate the shortest SZ-HRX acquisition duration, a linear regression of all quantitative results were calculated between the two systems. SZ-HRX collimation had superior performance characteristics than LEHR, with relative changes in CNR, CV, and SBR of + 99

PET has become an indispensable tool in medical imaging, providing critical insight into disease prognosis and treatment response. This review article aims to examine the multifaceted role of PET quantification by (1) providing an overview of the routinely used quantitative metrics and their limitations; (2) reporting how these metrics are being tested in clinical research to improve prognosis, highlighting both their potential benefits and the most promising applications; (3) defining current therapeutic assessment criteria in hemato-oncology with adaptations to innovative treatments and novel tracers; and (4) exploring advanced quantification techniques to harness large-scale data for more accurate prognostic modeling.

New factors predicting response in patients with a PD-L1 tumor proportion score (TPS) ≥ 50

This study focuses on modeling a population-based input function (PBIF) in dynamic ⁶⁸Ga-DOTATOC PET/CT exams, with the aim of developing clinically adoptable protocols. The PBIF is derived from an image-derived input function (IDIF), ensuring a non-invasive and standardized approach to tracer kinetic modeling. Patients with well-differentiated neuroendocrine tumors were included from the GAPETNET clinical trial (n = 37), divided into a PBIF modeling group (n = 20) and an independent validation group (n = 17). Dynamic whole-body (dWB) PET/CT imaging was performed using a Vision 600 PET/CT system. A population-based input function (PBIF) was modeled using the Feng approach and scaled to individual patient-specific IDIFs over two different time windows (sPBIF3 − 7: 25–55 min, sPBIF5 − 7: 40–55 min). The scaled PBIF was normalized to IDIF data from 6 to 55 min post-injection. A full individual patient-specific IDIF using data from 0 to 70 min post-injectionwas used as the reference for AUC and Ki comparisons. IDIFs and scaled PBIFs were compared by assessing the area under the curve (AUC) and radiotracer influx rate (Ki). Linear correlation and Bland-Altman analyses were conducted for AUC and Ki comparisons. Additionally, Mann-Whitney tests were performed to compare Ki values obtained with IDIF and sPBIF in both tumoral lesions and physiological organs. The lowest mean relative AUC bias was observed with sPBIF3 − 7, calculated to be 2.7 ± 7.9

A current limitation to the use of lung PET/CT is the absence of a tool that reliably and reproducibly quantifies the intensity of tracer uptake. We aim to develop a quantitative approach for lung perfusion PET/CT imaging. Sixty patients who underwent [68Ga]Ga-MAA PET/CT scans before (M0) and 3 months (M3) after completion of radiotherapy were analyzed. The anatomical lung volume (ALV) was delineated on the CT scan. CT and PET images were co-registered, and the ALV was transferred onto the PET images. The measured activity concentration (kBq/L) in each voxel was converted in three metrics: SUV based on normalizing the measured activity to the patient’s weight (kg) and the injected dose (kBq); SUVp by normalizing to the ALV (L) and the injected dose (kBq); pulmonary uptake value (PUV) by normalizing to the ALV (L) and the total activity measured in the ALV (kBq). The mean SUV, SUVp and PUV values within the ALV were measured. The mean (SD) SUV in the ALV was 9.90 (5.24) with an inconsistently wide range of values from 0.11 to 22.52. The correlation coefficient between the patient’s weight and the ALV was 0.14. The mean (SD) SUVp in the ALV was 0.54 (0.09). The mean (SD) percentage of [68Ga]Ga-MAA lung retention was 58.2

Nous avons étudié la faisabilité d'un protocole raccourci d'acquisition dynamique corps entier en TEP (CE-dynTEP) au 68Ga-DOTATOC à l'aide d'une fonction d'entrée dérivée d'une population (PBIF) chez des patients porteurs de tumeurs neuroendocrines (TNE), en le comparant à un protocole basé sur une fonction d'entrée dérivée de l'image (IDIF) nécessitant une acquisition de plus d'une heure. Il s'agit d'une étude ancillaire de l'essai GAPETNET visant à explorer le rôle pronostique de la CE-dynTEP au 68Ga-DOTATOC (Biograph Vision 600, Siemens©) chez des patients présentant une TNE. Les IDIFs ont été obtenues après délinéation automatique d'une ROI sphérique au sein du ventricule gauche. La PBIF a été obtenue à partir de 20 IDIFs synchronisées et moyennées auxquelles a été appliqué le modèle de Feng. La PBIF a été normalisée aux aires sous la courbes (AUC) des IDIFs de 17 patients indépendants sur deux intervalles de temps (t3-7 et t5-7 selon les pass CE) pour reconstruire 2 séries d'images Patlak (T3* et T5* pour 20–55 et 40–55 min post-injection, respectivement). L'évaluation de la fidélité de la PBIF normalisée à celles des IDIFs correspondantes a été réalisée en comparant le biais ± écart-type par test de Bland-Altman et le coefficient de détermination (R2) des AUC. Les mêmes opérations ont été effectuées pour l'analyse comparative des valeurs moyennes (KiMOY) et maximales (KiMAX). Une comparaison des moyennes de Ki tumoraux et physiologiques a été effectuée par test de Mann-Whitney. Les AUC des PBIFs normalisées ont montré des résultats proches de celles des IDIFs correspondantes, avec un biais minimum calculé sur les intervalles t3-7 et t5-7 à 2,7 ± 7,9 % (R2 = 0,97) et 7,35 ± 8,58 % (R2 = 0,95). L'analyse comparative des Ki avec les PBIFs a montré des biais acceptables par rapport à celles des IDIFs (< 10 %, R2 > 0,94). Les biais relatifs les plus faibles pour les Ki tumoraux ont été observés pour la reconstruction Patlak PBIF T5* (KiMOY = −0,33 ± 4,34 % et KiMAX = −0,41 ± 4,95 %). Les biais relatifs les plus faibles pour les Ki physiologiques ont également été observés pour la reconstruction Patlak PBIF T5* (< 1,7 % pour KiMOY et KiMAX). Aucune différence significative n'a été retrouvée dans les comparaisons de valeurs moyennes de Ki (p < 0,05). Notre étude a démontré la faisabilité de l'utilisation d'une PBIF afin d'estimer des valeurs de Ki à partir d'un protocole raccourci d'acquisition CE-dynTEP au 68Ga-DOTATOC.

Le « Hot Clot » artefact (HCa) pulmonaire en TEP est un phénomène mal expliqué, correspondant à la présence d'un foyer de fixation focal de FDG sans traduction anatomique TDM, et ne correspondant pas à une lésion pathologique après ré-évaluation morphologique et/ou métabolique. Il serait en lien avec un micro-embole secondaire à des lésions de l'endothélium vasculaire au cours de l'injection (littérature basée sur des cas cliniques). Décrire les caractéristiques du HCa en TEP/TDM FDG et rechercher des facteurs de risque (FDR). Tous les examens TEP/TDM FDG réalisés entre juin 2021 et 2023 au CHU de Brest ont été rétrospectivement relus pour rechercher un HCa. À chaque patient concerné (cas) a été associé 2 patients pré-/post-analysés (témoins). Différentes caractéristiques standards (nombre de foyer, latéralité, lobe) et métaboliques (SUVmax, SUVmean, MTV, TLG) ont été analysées. Des FDR liés à la préparation/administration du FDG (no de lot, opérateur, site d'injection, activité, délai inj/acq, extravasation ou accrochage vasculaire), au patient (sexe, âge, BMI) et son histoire vasculaire (ATCD EP/TVP, traitement anticoagulant, antiplaquettaire) ou son statut pathologique général (cancer actif) et pulmonaire (tabagisme actif, BPCO) ont été recherchés. Les différences cas-témoins entre variables ont été réalisées avec un test de Chi2 (qualitative) ou de Student (quantitative). Sur 22 671 examens TEP/TDM FDG réalisés en 2 ans, 212 patients (0,94 %) ont présenté un HCa. Le foyer était unique, double ou triple dans, respectivement, 207 cas (97,6 %), 4 cas (1,9 %) et 1 cas (0,5 %) et se situait dans le poumon droit dans 111 cas (51,2 %) (59 LS, 17 LM et 35 LI) et gauche dans 106 cas (48,8 %) (67 LS et 39 LI). Les valeurs moyennes ± SD de SUVmax, SUVmean, MTV et TLG étaient, respectivement, de 11,3 ± 16,4 ; 5,1 ± 5,0 ; 0,3 ± 0,3 mL et 1,5 ± 2,1 g. Seule la présence d'un accrochage vasculaire, défini sur l'image par une fixation hétérogène intense sur au moins 5 cm en amont du site injecté, présentait une différence significative entre les groupes cas et témoins (138/212 = 65,1 % versus 182/431 = 42,2 %, p < 0,001). Cette étude cas-témoins est la première évaluant la prévalence (≈ 1 %) en TEP/TDM FDG du « Hot Clot » artefact, fixation focale TEP+/TDM− sans localisation préférentielle, quasi exclusivement unique et de faible volume (< 1 mL). La présence d'un accrochage vasculaire est un FDR confirmant l'hypothèse d'un lien avec un traumatisme à l'injection.

Objectif Évaluer l’association entre le métabolisme thyroïdien en TEP-TDM au 18F-FDG (18FDG-TEP-TDM) et la survie des patients traités par anticorps-antiPD1 pour un CBNPC. Methodes Étude de cohorte rétrospective incluant du 20/07/2015 au 30/11/2021 les patients atteints d’un CBNPC stade IIIB-IV, traités par Pembrolizumab ou Nivolumab, ayant bénéficié d’une 18FDG-TEP-TDM pré-thérapeutique (TEP0) et après la 1ère cure d’immunothérapie (TEP1). Les paramètres métaboliques et volumétriques thyroïdiens (SUVmax, SUVmean, volume thyroïdien(VT), TLG=VT*SUVmean), les rapports de captations thyroïdiennes/captations physiolgoiques (Thyroïd-to-Blood-Ratio (TBR) et Thyroïd-to-Liver-Ratio (TLR) et les différentiels paramétriques ΔTEP1-TEP0 étaient mesurés. Les critères de jugement principaux étaients la survie globale (SG) et la survie sans progression (SSP). Résultats Quatre vingt cinq patients étaient inclus (âge médian=65 ans, 77,6 % d’hommes, 75,3 % stade IV, 70,2 % traités par Pembrolizumab). Dans la population totale, la SG médiane était de 20,1 mois (IC95 % 14,6 ;27,2) et la SSP médiane de 6,2mois (IC95 % 4 ;12,5). Les patients présentant un SUVmax≥2,8 au TEP0 avaient une meilleure SG médiane de 27,2 mois (IC95 % 19,7 ;NC) versus 15,7 mois (IC95 % 12,1 ;23,1), (p=0,03). Les patients ayant un TBRmean≥0,7 au TEP0 avaient une meilleure SSP de 15,2 mois (IC95 % 4,7 ;60,9) versus 5,2 mois (IC95 % 3,8 ;6,4), (p=0,006). En analyse multivariée, le TBRmean≥0,7 restait un facteur prédictif indépendant associé à la SG et SSP. Il n’a pas été retrouvé de lien significatif entre la SG, la SSP et les paramètres TEP1 ni les différentiels ΔTEP1-TEP0. Conclusion Cette étude suggère que la captation thyroïdienne pré-thérapeutique du 18F-FDG est associée à une meilleure SG et SSP des patients traités par anticorps-antiPD1 pour un CBNPC.

Over the past decade, several strategies have revolutionized the clinical management of patients with cutaneous melanoma (CM), including immunotherapy and targeted tyrosine kinase inhibitor (TKI)-based therapies. Indeed, immune checkpoint inhibitors (ICIs), alone or in combination, represent the standard of care for patients with advanced disease without an actionable mutation. Notably BRAF combined with MEK inhibitors represent the therapeutic standard for disease disclosing BRAF mutation. At the same time, FDG PET/CT has become part of the routine staging and evaluation of patients with cutaneous melanoma. There is growing interest in using FDG PET/CT measurements to predict response to ICI therapy and/or target therapy. While semiquantitative values such as standardized uptake value (SUV) are limited for predicting outcome, new measures including tumor metabolic volume, total lesion glycolysis and radiomics seem promising as potential imaging biomarkers for nuclear medicine. The aim of this review, prepared by an interdisciplinary group of experts, is to take stock of the current literature on radiomics approaches that could improve outcomes in CM.

La TEP/TDM au 18FDG, couramment utilisée pour le bilan pré- et post-thérapeutique des cancers bronchopulmonaires non à petites cellules (CBNPC), peut détecter précocement les dysthyroïdies immunoinduites et pourrait être un facteur prédictif de la survie des patients traités par anticorps (Ac) antiPD1. Évaluation de la corrélation entre la survie globale (SG), la survie sans progression (SSP) et le métabolisme thyroïdien chez des patients traités par Ac-antiPD1 pour un CBNPC. Cette étude de cohorte rétrospective a inclus du 20/07/2015 au 30/11/2021 les patients atteints d'un CBNPC de stade IIIB/IV confirmé histologiquement, traités par Pembrolizumab ou Nivolumab et ayant reçu une TEP/TDM au 18FDG (Biograph mCT, Siemens) pré-thérapeutique (TEP0) et après la 1re cure d'immunothérapie (TEP1). Sur chaque examen, le volume thyroïdien a été manuellement segmenté sur les images TDM, permettant d'obtenir le volume anatomique thyroïdien (VT) appliqué à l'imagerie TEP. Les paramètres métaboliques et volumétriques thyroïdiens (SUVmax, SUVmean, VT, TLG = VT*SUVmean), les rapports de fixation thyroïdienne sur les fixations physiologiques (Thyroid to Blood Ratio (TBR) et Thyroid to Liver Ratio (TLR)) étaient mesurés. Les différentiels paramétriques entre TEP1 et TEP0 étaient également calculés. Les critères de jugement principaux étaient la SG et la SSP. Au total, 85 patients ont été inclus (âge médian 65 ans, 77,6 % d'hommes, 75,3 % stade IV, 70,2 % traités par Pembrolizumab, 63,5 % en 1ère ligne thérapeutique). Dans la population totale, la SG médiane étaient de 20,1 mois (IC95 % : 14,6 ; 27,2) et la SSP médiane de 6,2 mois (IC95 % : 4 ; 12,5). Les patients présentant un SUVmax thyroïdien ≥ 2,8 en TEP0 avaient une meilleure SG médiane de 27,2 mois (IC95 % : 19,7 ; NC) versus 15,7 mois (IC95 % : 12,1 ; 23,1), (p = 0,03). Les patients ayant un TBRmean thyroïdien ≥ 0,7 en TEP0 avaient une meilleure SSP de 15,2 mois (IC95 % : 4,7 ; 60,9) versus 5,2 mois (IC95 % : 3,8 ; 6,4), (p = 0,006). En analyse multivariée, le TBRmean thyroïdien ≥ 0,7 restait un facteur prédictif indépendant associé à la SG/SSP. Il n'a pas été retrouvé de lien significatif entre les paramètres de la TEP1 et la SG/SSP des patients. Cette étude suggère que la captation pré-thérapeutique du 18FDG par le parenchyme thyroïdien est associée à une meilleure SG et SSP des patients traités par Ac-antiPD1 pour un CBNPC, ce qui mérite d'être exploré dans de futures études prospectives.