Radiopharmaceuticals are combinations of two main components including a pharmaceutical ingredient that targets specific moieties, and radionuclide, which acts through spontaneous degradation to create diagnostic or therapeutic effects, as well as both effects simultaneously known as theranostics. By combining diagnostic and therapeutic methods, radiotheranostics play an important role in reducing patient radiation dosages, increasing treatment effectiveness, controlling side effects, improving patient outcomes, and reducing overall treatment costs. Despite the diagnostic and therapeutic roles, radiopharmaceuticals are beneficial for assessing prognosis, disease progression, and the possibility of recurrences, treatment planning strategies, and assessing response to treatment. The most incredible role of radiopharmacy is establishing new radiopharmaceuticals with the aim of better targeting functions and enhanced tolerability for imaging and treatment purposes in a clinic. These approaches are supported by nuclear medicine non-invasive procedures. It is crucial for radiopharmaceuticals that drug delivery occurs in a highly selective and sensitive manner to minimize the potential radiation risk to non-targeted organs of patients. This report will provide an overview of basic pharmacological patterns related to clinical radiopharmaceuticals for diagnosis and therapy, including the latest radiotheranostic tracers, key concerns within the field, and future trends and prospects. Additionally, the available and useful radiopharmaceuticals are categorized into separate tables based on their specific characteristics. Presenting information in table format enhances organization and makes the data more understandable and accessible for users. This structured approach allows users to quickly locate relevant information, compare different radiopharmaceuticals, and grasp essential details at a glance. By utilizing tables, we ensure that critical information is not only easy to read but also effectively highlights the unique attributes of each radiopharmaceutical, ultimately improving the decision-making process for healthcare professionals.

Introduction:Accurate staging is paramount for the effective management of medullary thyroid carcinoma (MTC). Imaging cancer-associated fibroblasts utilizing Gallium-68-labeled fibroblast activation protein inhibitors (FAPI) presents a novel approach for molecular imaging across various cancers, including MTC. This study aimed to compare the diagnostic accuracy of FAP-targeted imaging (68Ga-RTX-1363S, abbreviated as 68Ga-FAPI) with the established imaging standard, 18F-DOPA, for the detection of metastases in patients with MTC. Methods:This retrospective study compared 18F-DOPA- and 68Ga-FAPI PET/CT imaging using per-patient and per-lesion analyses in patients with recurrent MTC. Imaging findings were correlated with morphological imaging (CT/MRI/sonography) or histopathology as gold standard. Quantitative assessment included a comparison of standardized uptake values (SUVs) and tumor-to-background ratios (TBRs). Results:Nine patients (mean age 55 years, range 34-80 years) with 62 lesions were included. Compared to 18F-DOPA, 68Ga-FAPI showed significantly higher lesion detection rates for lymph node metastases (true-positive [TP] rate: 100% [8/8] vs. 50% [4/8]; TBR: 10.9 vs. 6.9), lung metastases (TP rate: 85.7% [12/14] vs. 42.9% [6/14]; TBR: 6.1 vs. 3.6), and liver metastases (TP rate: 100% [22/22] vs. 23% [5/22]; TBR: 24.1 vs. 2.7). Conclusion:In direct comparison, 68Ga-FAPI detected a higher number of metastases with higher TBR values. 68Ga-FAPI PET/CT holds promise for improving staging in MTC. However, these findings necessitate confirmation in a larger, prospective study.

Melanoma is a form of skin cancer with a poor prognosis, especially when diagnosis and treatment are delayed. Detecting metastasis is a significant challenge, with [18F]FDG PET/CT scans offering both advantages and limitations. Given the high affinity of α-MSH analogs for melanoma tumors, we aimed to clinically assess the [68Ga]Ga-α-MSH PET/CT scan for the first time in Iran. This preliminary descriptive-analytical study was conducted from 2023 to 2024 on 10 patients with biopsy-confirmed melanoma. Each patient underwent whole-body scans with both [68Ga]Ga-α-MSH PET/CT and [18F]FDG PET/CT. Lesions detected in each scan were described and compared, with standardized uptake ratios calculated as lesion SUVmax normalized to liver SUVmean. A total of 10 melanoma patients were evaluated (mean age 55 ± 12 years, 60

Early and accurate diagnosis of infectious processes can significantly enhance the effectiveness of therapeutic interventions. [99mTc]Tc-HMPAO-labeled white blood cell (WBC) SPECT/CT is a well-established imaging tool for this purpose. This pictorial review illustrates the clinical utility of [99mTc]Tc-HMPAO-WBC SPECT/CT in patients with suspected infections through case-based examples. Ten patients (5 women, 5 men; median age 57 years, range 32–84) with suspected infection based on clinical symptoms and/or elevated inflammatory markers underwent [99mTc]Tc-HMPAO-WBC SPECT/CT between January 2023 and December 2024 at IKHC nuclear medicine center, Tehran, Iran. Of the 10 patients undergoing [99mTc]Tc-HMPAO-WBC SPECT/CT, 4 showed radiotracer uptake indicating infection that was confirmed by clinical and/or microbiological evidence. The remaining 6 patients including 2 cases with suspected osteomyelitis (OM) and 4 cases with non-OM conditions (avascular necrosis, fever of unknown origin and fungal ear infection) revealed no radiotracer uptake and lacked sufficient clinical or laboratory evidence in support of infection.

During the last decade, diagnosis and therapy of prostate cancer have been accomplished with clear evidence of enhanced survival. Improved diagnostic capabilities, particularly radiolabeled PSMA PET/CT approaches benefit from reduced unnecessary biopsies and more accuracy. The advantage of visualization of the abnormalities prior to therapeutic procedures is clarifying these locations specifically in order to targeting therapy applying the theranostic principle. Targeted therapy with high efficacy and minimal damage has emerged as very promising advancement in nuclear medicine. Recently, radiolabeled PSMA-617 and other derivatives have shown considerable improvements in the management of advanced-stage PSMA–positive mCRPC. This manuscript attempts to summarize the most recent advancements in the diagnosis and treatment of prostate cancer in nuclear medicine.

Copper radioisotopes including copper-60/61/62, and -64 exhibit a wide range of decay characteristics, making them appropriate choices for diagnostic/therapeutic (theranostic) applications in nuclear medicine. One notable feature of copper is the feasible coordination chemistry, which makes radiolabeling of a wide range of chemical structures including antibodies, proteins, peptides, and other biologically relevant small molecules possible. This chapter will summarize common radiopharmaceuticals of copper-64 and their radiation dosimetry in order to highlight recent improvements of positron emission tomography diagnostics.

Immunotherapy has emerged as a very considerable and potent therapeutic method in which immune inhibitors have gained a lot of attention in the curative field of various cancers. Under certain circumstances, when radiotherapy is accompanied by immunotherapy, the efficacy of the therapeutic procedure increases. Irradiated tumor cells follow a pathway called immunogenic cell death, which targets tumor associated antigens. The application of radiolabeled antibodies under the concept of "radioimmunotherapy" (RIT) makes the synergistic targeted therapeutic effect possible. Since antibodies themselves are cytotoxic, they can kill the cells that not only bind but are within the path length of their radiation emissions. RIT can be categorized as a substantial progress in nuclear medicine. The main concept of RIT includes targeting specified tumor-expressing antibodies. The mentioned purpose is achievable by formulation of radiolabeled antibodies, which could be injected intravenously or directly into the tumor, as well as compartmentally into a body cavity such as the peritoneum, pleura, or intrathecal space. RIT has demonstrated very optimistic therapeutic outcomes in radioresistant solid tumors. Wide ranges of efforts are accomplished in order to improve clinical trial accomplishments. In this review, we intend to summarize the performed studies on RIT and their importance in medicine.

This work discusses the role of Nuclear Medicine for women's health, the role of women in the development of this emerging field and the various issues which arise from both. It emphasizes the importance of young women and their competing needs due to factors like pregnancy and work-related challenges. The objectives of this overview include improving imaging techniques, preserving fertility during cancer treatment, diagnosing pelvic and uterine conditions, developing radiopharmaceuticals for women's health, protecting female employees in Nuclear Medicine, and considering the role of artificial intelligence.

Inflammation comprises a heterogeneous category of disease with multiple clinical conditions and basically includes infection, acute inflammation, and chronic inflammation. One of the concerns for clinicians is the differentiation between tumor tissue and an inflammation site which significantly influences the treatment decisions. Recent progresses in nuclear medicine through the introducing of novel radiopharmaceuticals based on SPECT and PET, have been very promising in improvement of the specific differentiation between these two pathologies. In this review, the nuclear medicine approaches for the diagnosis of infection/inflammation, the differentiation between infection and inflammation, as well as the exclusion of tumor tissue, will be discussed.

Dementia (the most common cause of Alzheimer's disease) is defined as a chronic or progressive syndrome with disturbance of multiple cortical functions, the most important of them including memory, learning capacity, comprehension, orientation, calculation, language, and judgement. These cognitive impairments affect the quality of life, behavior, and social relations. Techniques of nuclear medicine provide feasible ways to record the intracellular alterations of disease and deficiencies. In these non-invasive manners, the hippocampal-neocortical disconnection may partly explain the hypo-metabolism incident found in Alzheimer's disease. Based on this fact, the study of all these mechanisms of action is conceivable and achievable by radiopharmaceuticals. This review is aimed at the presentation of radiopharmaceuticals that are developed for the detection of Alzheimer's disease in preclinical and clinical trials.

Breast cancer is still one of the substantial malignancies with high mortalities which early and accurate diagnosis is very decisive in providing long survival. Nuclear medicine lately introduced a novel way for evaluation of breast cancer in early and advanced stages. This method is based on sentinel lymph node scintigraphy which is more preferable over axillary lymphadenectomy, since it results in less postoperative morbidity. For this aim radiocolloids have superlative impress for detection of metastatic lymph nodes. In this short review we will try to introduce radiopharmaceuticals which play an important role in clinical application of BC lymphoscintigraphy.

PET imaging of neuroendocrine tumours (NET) is well established for staging and therapy follow-up. The short half-life, increasing costs, and regulatory issues significantly limit the availability of approved imaging agents, such as [68Ga]Ga-DOTA-TATE. Al[18F]F-NOTA-Octreotide provides a similar biodistribution and tumour uptake, can be produced on a large scale and may improve access to precision imaging. Here we prospectively compared the clinical utility of [68Ga]Ga-DOTA-TATE and Al[18F]F-NOTA-Octreotide in the Latin-American population. Our results showed that in patients with stage IV NETs [68Ga]Ga-DOTA-TATE presents higher physiological uptake than Al[18F]F-NOTA-Octreotide in the liver, hypophysis, salivary glands, adrenal glands (all p < 0.001), pancreatic uncinated process, kidneys, and small intestine (all p < 0.05). Nevertheless, despite the lower background uptake of Al[18F]F-NOTA-Octreotide, comparative analysis of tumour-to-liver (TLR) and tumour-to-spleen (TSR) showed no statistically significant difference for lesions in the liver, bone, lymph nodes, and other tissues. Only three discordant lesions in highly-metastases livers were detected by [68Ga]Ga-DOTA-TATE but not by Al[18F]F-NOTA-Octreotide and only one discordant lesion was detected by Al[18F]F-NOTA-Octreotide but not by [68Ga]Ga-DOTA-TATE. Non-inferiority analysis showed that Al[18F]F-NOTA-Octreotide is comparable to [68Ga]Ga-DOTA-TATE. Hence, our results demonstrate that Al[18F]F-NOTA-Octreotide provided excellent image quality, visualized NET lesions with high sensitivity and represents a highly promising, clinical alternative to [68Ga]Ga-DOTA-TATE.

Nuclear medicine is defined as the diagnosis and the treatment of disease using radiolabeled compounds known as radiopharmaceuticals. Single-photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computer tomography (PET/CT) based radiopharmaceuticals have proven reliable in diagnostic imaging in nuclear medicine and cancer treatment. One of the most critical cancers that also relies on an early diagnosis is gynecological cancer. Given that approximately 25% of all cancers in developing countries are a subset of gynecological cancer, investigating this cancer subtype is of significant clinical worth, particularly in light of its high rate of mortality. With accurate identification of high grade distant abdominal endometrial cancer as well as extra abdominal metastases, 18F-Fluorodeoxyglucose ([18F]FDG) PET/CT imaging is considered a valuable step forward in the investigation of gynecological cancer. Considering these factors, [18F]FDG PET/CT imaging can assist in making management of patient therapy more feasible. In this literature review, we will provide a short overview of the role of nuclear medicine in the diagnosis of obstetric and gynecological cancers.

The tumor microenvironment (TME) play critical roles in tumor survival, progression, and metastasis and can be considered potential targets for molecular imaging of cancer. The targeting agents for imaging of TME components (e.g., fibroblasts, mesenchymal stromal cells, immune cells, extracellular matrix, blood vessels) provide a promising strategy to target these biomarkers for the early diagnosis of cancers. Moreover, various cancer types have similar tumor immune microenvironment (TIME) features that targeting those biomarkers and offer clinically translatable molecular imaging of cancers. In this review, we categorize and summarize the components in TME which have been targeted for molecular imaging. Moreover, this review updated the recent progress in targeted imaging of TIME biological molecules by various modalities for the early detection of cancer.

The implication of 'theranostic' refers to targeting an identical receptor for diagnostic and therapeutic purposes, by the same radioligand, simultaneously or separately. In regard to extensive efforts, many considerable theranostic tracers have been developed in recent years. Emerging evidence strongly demonstrates the tendency of nuclear medicine towards therapies based on a diagnosis. This review is focused on the examples of targeted radiopharmaceuticals for the imaging and therapy of breast cancer.

Gallium-68 was applied for positron emission tomography (PET) imaging already in the early beginnings of PET imaging. Today, with the introduction of PSMA-targeting tracers (e.g. PSMA-11, PSMA-617, and PSMA-I&T), the number of clinical applications of 68Ga-radiopharmaceuticals for diagnostic imaging has grown considerably. This development was initiated and supported already in the mid-2000s by the commercial availability of 68Ge/68Ga generators designed for clinical usage. This progression was accompanied by the development of several purification methods to generator eluate as well as sophisticated 68Ga-radiopharmaceuticals. Due to the 68Ga-rush, the need for implementation of gallium-68 (depending on production route) and its certain tracers into the pharmacopeia increased. Based on the specifications given by the pharmacopeia, interest focused on the development of automated synthesis systems, 99mTc-analog kits with regard to patient as well as operator safety.

Radiometal-based theranostics or theragnostics, first used in the early 2000s, is the combined application of diagnostic and therapeutic agents that target the same molecule, and represents a considerable advancement in nuclear medicine. One of the promising fields related to theranostics is radioligand therapy. For instance, the concepts of targeting the prostate-specific membrane antigen (PSMA) for imaging and therapy in prostate cancer, or somatostatin receptor targeted imaging and therapy in neuroendocrine tumors (NETs) are part of the field of theranostics. Combining targeted imaging and therapy can improve prognostication, therapeutic decision-making, and monitoring of the therapy.