This study primarily aimed to identify prognostic factors for patients with recurrent/metastatic tongue squamous cell carcinoma (R/M TSCC) undergoing re-resection and to preliminarily explore the value of baseline metabolic parameters in predicting pathological response after neoadjuvant therapy (NAT). In the primary analyses, we analyzed 114 patients with R/M TSCC who underwent direct re-resection or re-resection after NAT between 2017 and 2024. Clinical, pathological, and PET/CT parameters were collected. Lasso-Cox regression was performed to identify factors influencing disease-free survival (DFS) and overall survival (OS), with internal validation via bootstrapping with 1000 resamples. Sensitivity analysis was performed to test the robustness of the main findings by restricting the analysis to the 100 patients who underwent elective neck dissection (a subgroup of the 114 patients). Patients undergoing re-resection after NAT were grouped by pathological response (pCR/MPR vs. non-MPR) for comparison. Median follow-up was 43.0 months (110 were evaluable), with 53 deaths and 46 remaining recurrence-free. Initial pathological N status and differentiation at recurrence were prognostic factors for both DFS and OS, with HRs of 2.29 (95

OBJECTIVES:Patients with recurrent tongue squamous cell carcinoma (RTSCC) receiving nonsurgical treatment have a poor prognosis. This study aims to identify independent factors associated with survival in these patients and to evaluate the effects of treatment response on survival outcomes. METHODS:Patients with RTSCC who received nonsurgical treatment at Hunan Cancer Hospital between January 2017 and July 2024 were retrospectively enrolled. Pretreatment metabolic parameters derived from 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were measured, including the maximum, mean, and peak standardized uptake values corrected for lean body mass (SULmax, SULmean, and SULpeak), the lesion-to-mediastinal blood-pool SULmean ratio (SULR), whole-body total metabolic tumor volume (MTV), and whole-body total lesion glycolysis (TLG). Baseline clinical characteristics, pathological features from the initial surgery, and treatment modalities after recurrence were also collected. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), or the immune Response Evaluation Criteria in Solid Tumors (iRECIST), and patients were classified into response and nonresponse groups. Progression-free survival (PFS) and overall survival (OS) were followed. Univariate and multivariate Cox regression analyses were performed to identify independent factors associated with PFS and OS. Two sensitivity analyses, restricted to patients scanned using the same scanner model and to those who underwent whole-body scanning, respectively, were conducted to assess the robustness of the primary findings. Model performance was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, and calibration curves. Time-dependent Cox regression and landmark analyses were used to assess the effects of treatment response on survival. RESULTS:A total of 93 patients with RTSCC were included. The follow-up duration ranged from 2 to 81 months, with a median of 38 months. Disease progression occurred in 72 patients, and 66 patients died. PFS ranged from 1 to 81 months, with a median of 4 months, whereas OS ranged from 2 to 81 months, with a median of 11 months. In the primary analysis, radiotherapy after recurrence was an independent protective factor for PFS (HR=0.461, 95% CI 0.233 to 0.912, P=0.026). This association remained significant in the sensitivity analysis restricted to patients scanned using the same scanner model (P=0.032), but was not significant in the analysis restricted to patients who underwent whole-body scanning (P=0.159). The corrected C-index of the PFS prediction model was 0.609, indicating limited predictive performance for 3- and 6-month PFS. In the analysis of OS, the natural logarithm of MTV [ln(MTV); HR=1.299, 95% CI 1.092 to 1.546, P=0.003] and radiotherapy after recurrence (HR=0.377, 95% CI 0.180 to 0.790, P=0.010) were independent predictors of OS. Both sensitivity analyses supported the robustness of these findings. The corrected C-index of the OS prediction model was 0.663, indicating moderate discrimination for 1- and 2-year OS. Time-dependent Cox regression analysis showed that treatment response was not significantly associated with PFS (HR=0.618, 95% CI 0.327 to 1.167, P=0.138; C-index=0.517), whereas treatment response had a significant protective effect on OS (HR=0.340, 95% CI 0.196 to 0.590, P<0.001; C-index=0.620). The 2-month landmark analysis showed that both PFS and OS were significantly longer in the response group than in the nonresponse group (both P<0.001). CONCLUSIONS:Whole-body total MTV and radiotherapy after recurrence have potential prognostic value for OS in patients with RTSCC receiving nonsurgical treatment. The protective association between radiotherapy after recurrence and PFS requires further validation. Patients who achieved a treatment response had better OS than those who did not respond.

Purpose:To evaluate the diagnostic performance of [18F]AlF-NOTA-FAPI-04 PET/CT in detecting primary and metastatic lesions in biliary tract cancer (BTC) and to compare it with contrast-enhanced (CE) MRI. Materials and methods:A total of 46 patients with suspected BTC were enrolled, all of whom underwent [18F]AlF-NOTA-FAPI-04 PET/CT and abdominal CE-MRI examinations. Histopathological findings, typical imaging features, follow-up imaging, and comprehensive clinical assessments were used as reference standards. McNemar's test was used to compare diagnostic performance; tracer uptake between paired samples was analyzed with the Wilcoxon signed-rank test or paired t-test. Results:In total, 46 participants (mean age 61.5 ± 9.91 years) were evaluated. In the patient-based comparison, [18F]AlF-NOTA-FAPI-04 PET/CT and CE-MRI demonstrated comparable sensitivity in detecting primary tumors (42/44 [95%] vs. 44/44 [100%], p = 0.480), lymph node metastases (20/21 [95%] vs. 18/21 [86%], p = 0.480), and distant metastases (12/12 [100%] vs. 9/12 [75%], p = 0.064). However, in detecting lymph node metastases, [18F]AlF-NOTA-FAPI-04 PET/CT achieved higher specificity (25/25 [100%] vs. 19/25 [76%], p = 0.041) and accuracy (45/46 [98%] vs. 37/46 [80%], p = 0.013) than CE-MRI. Conclusion:The findings of this study demonstrate that [18F]AlF-NOTA-FAPI-04 PET/CT and abdominal CE-MRI exhibit comparable sensitivity in detecting primary lesions and metastases in BTC. However, [18F]AlF-NOTA-FAPI-04 PET/CT demonstrated superior specificity and accuracy in lymph node detection and effectively overcame the limitations of abdominal CE-MRI in evaluating distant metastases across the whole body.

OBJECTIVE:This study aimed to evaluate the prognostic value of [¹⁸F]ALF-NOTA-FAPI-04 PET/CT-derived parameters, including the maximum standardized uptake value (SUVmax), FAPI-avid tumor volume (FTV), and total lesion FAP expression (TLF), in patients with recurrent gastric cancer undergoing combined chemoimmunotherapy. We sought to establish a noninvasive imaging biomarker framework to optimize patient stratification and therapeutic decision-making. MATERIALS AND METHODS:This retrospective cohort study analyzed 51 patients with recurrent gastric cancer who received programmed cell death protein 1 (PD-1) inhibitors combined with chemotherapy after gastrectomy. All patients underwent [¹⁸F]ALF-NOTA-FAPI-04 PET/CT within 14 days of chemoimmunotherapy. Semi-quantitative parameters (SUVmax, FTV, and TLF) were derived using semi-automated tumor segmentation. The primary endpoint of this study was the assessment of the clinical efficacy of chemoimmunotherapy, categorized as a durable or nondurable clinical benefit. The secondary endpoints included progression-free survival (PFS) and overall survival (OS). In a subgroup of 16 patients who underwent sequential [¹⁸F]FDG PET/CT within seven days of [¹⁸F]ALF-NOTA-FAPI-04 PET/CT, tracer uptake values were compared between the two PET/CT examinations. RESULTS:51 patients were included. The median PFS and OS were 7 and 10 months, respectively. Durable clinical benefit (DCB) was observed in 30 patients and showed significantly lower SUVmax, FTV, and TLF values than non-DCB. TLF demonstrated the highest diagnostic accuracy for DCB (area under the receiver operating characteristic curve [AUC] = 0.80). Multivariable analysis identified TLF ≥ 188.88 SUVbw·cm³ as an independent factor associated with PFS (hazard ratio [HR] = 7.29, P = 0.001) and FTV ≥ 44.17 cm³ as an independent factor associated with OS (HR = 5.16, P = 0.010). In the subgroup analysis of 16 patients, semi-quantitative analysis demonstrated consistently higher values of [¹⁸F]ALF-NOTA-FAPI-04-derived parameters than [¹⁸F]FDG-derived parameters (all P < 0.001). CONCLUSION:[¹⁸F]ALF-NOTA-FAPI-04 PET/CT may be a useful imaging tool for predicting clinical outcomes in patients with recurrent gastric cancer undergoing treatment with PD-1 inhibitors and chemotherapy.

RATIONALE AND OBJECTIVES:In this study, we aimed to compared the performance of [18F]FAPI-04 and [18F]fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET/CT) in the evaluation of peritoneal carcinomatosis. MATERIALS AND METHODS:71 patients with suspected peritoneal malignancies were enrolled in our study. All the participants underwent both [18F]FAPI-04 and [18F]FDG PET/CT imaging within 7 days. The detection rates, diagnostic accuracies, semiquantitative parameters of the tracers, peritoneal cancer index (PCI) scores, and tumor markers were evaluated and compared. RESULTS:Among the 71 patients, 40 patients were diagnosed with peritoneal carcinomatosis, and 31 were true-negative patients. The sensitivity and accuracy of [18F]FAPI-04 PET/CT were higher than those of [18F]FDG PET/CT (sensitivity: 92.50% vs. 72.50%, p=0.003; accuracy: 91.55% vs. 80.28%, p<0.001), particularly in patients with gastric cancer. The SUVmax, tumor-to-liver background ratio (TBR-L), tumor-to-descending aorta ratio (TBR-A), and PCI score were significantly higher for [18F]FAPI-04 PET/CT than [18F]FDG PET/CT (all p<0.05). In the [18F]FAPI-04 PET/CT group, the PCI score, TBR-L, TBR-A, TBR-M and SUVmax were higher in the high level group than the low level group (all p<0.05). The carbohydrate antigen 125 (CA 125) levels were strongly correlated with the PCI of both [18F]FAPI-04 and [18F]FDG PET/CT. CONCLUSION:[18F]FAPI-04 PET/CT outperformed [18F]FDG PET/CT in the evaluation of peritoneal carcinomatosis, particularly in patients with gastric cancer. Furthermore, [18F]FAPI-04 PET/CT may be used for the assessment of peritoneal carcinomatosis in patients, especially FAPI-PCI.

PurposeThis study compared the diagnostic performance, semi-quantitative capability, and staging accuracy of [18F]AlF-NOTA-FAPI-04 and [18F]FDG PET/CT in detecting lymph node metastases.MethodsThis single-center retrospective study included 41 patients with suspected lymph node metastases who received both [18F]FDG and [18F]AlF-NOTA-FAPI-04 PET/CT. The study compared metastatic lymph node detection, semi-quantitative values, and N staging accuracy. Subgroup analyses were performed for lymph nodes with short-axis diameters (SADs) ≥10 and <10 mm.ResultsA total of 41 patients with 126 nodes were included. [18F]AlF-NOTA-FAPI-04 outperformed [18F]FDG in the detection of metastatic lymph nodes, achieving higher accuracy in both patient-based (92.7% vs. 70.7%, p = 0.004) and node-based analyses (91.3% vs. 60.3%, p < 0.001). In semi-quantitative analysis, the maximum standardized uptake value and target-to-background ratio of [18F]AlF-NOTA-FAPI-04 were higher than those of [18F]FDG in metastatic lymph nodes (all p < 0.001). Both tracers distinguished metastatic from benign nodes with SAD ≥ 10 mm (p < 0.05). [18F]AlF-NOTA-FAPI-04 PET/CT could distinguish between benign and metastatic lymph nodes with SAD < 10 mm (p < 0.001), whereas [18F]FDG PET/CT could not (p > 0.05). [18F]AlF-NOTA-FAPI-04 also provided more accurate N staging assessments (87.8% vs. 65.9%, p = 0.006). [18F]AlF-NOTA-FAPI-04 PET/CT enabled the correct diagnosis of more lymph nodes, leading to a change in the therapeutic regimen for eight patients (19.5%).Conclusion[18F]AlF-NOTA-FAPI-04 PET/CT demonstrated superior diagnostic performance, semi-quantitative capability, and N staging accuracy compared to [18F]FDG PET/CT, particularly for small metastatic lymph nodes (SAD < 10 mm), offering enhanced guidance for tumor staging.

Non-Hodgkin lymphoma of the rib is extremely rare. Herein, we report a case of solitary primary rib lymphoma in a 55-year-old man. 18 F-FDG PET/CT revealed a hypermetabolic lesion in the right seventh rib. The subsequent histology and immunohistochemistry of the rib lesion confirmed the diagnosis of highly aggressive B-cell non-Hodgkin lymphoma.

Fibroblast activation protein (FAP)-targeted PET/CT has emerged as a promising tool for visualizing tumor stroma. This study aimed to validate the diagnostic efficacy of [18F]AlF-NOTA-FAPI-04 PET/CT in detecting subclinical metastases in recurrent differentiated thyroid cancer (DTC), with direct comparison to [18F]FDG PET/CT. Twenty-three DTC participants with biochemical recurrence (suppressed thyroglobulin [Tg] ≥ 1 ng/mL or Tg antibodies [Tg-Ab] > 115 IU/mL) underwent [18F]AlF-NOTA-FAPI-04 PET/CT, including 16 who underwent paired [18F]FDG scans. Lesion classification followed histopathology or 15.5-month clinical follow-up (median, 8–32 months). [18F]AlF-NOTA-FAPI-04 PET/CT demonstrated significantly higher lesion-level sensitivity (75

ObjectiveTo explore the value of 18F-fluordeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) semi-quantitative parameters of primary tumor combined with squamous cell carcinoma antigen (SCC-Ag) in predicting lymph node metastasis (LNM) of cervical cancer (FIGO 2018 stage I-II).Materials and MethodsA total of 65 patients with stage I-II cervical cancer underwent 18F-FDG PET/CT were included in our study. Comparing the primary tumor 18F-FDG PET/CT semi-quantitative parameters and SCC-Ag between the LNM group and the non-LNM group. Logistic regression and receiver operating characteristic (ROC) were used to analyze the value of 18F-FDG PET/CT metabolic parameters and SCC-Ag in predicting LNM.ResultsThere were 14 and 51 patients were classified as having LNM and NLNM. The semi-quantitative parameters, including the maximum standardized uptake value (SUVmax), the mean standardized uptake value (SUVmean), the peak standardized uptake value (SUVpeak), the total lesion glycolysis (TLG), the metabolic tumor volume (MTV) of the tumor and SCC-Ag were all significantly higher in LNM than in NLNM (SUVmax, 16.07 ± 7.81 vs 11.19 ± 4.73, SUVmean, 9.16 ± 3.48 vs 6.29 ± 2.52, SUVpeak, 12.70 ± 5.26 vs 7.65 ± 3.26, MTV, 22.77 ± 12.36 vs 7.09 ± 5.21, TLG, 211.01 ± 154.25 vs 43.38 ± 36.17, SCC-Ag, 5.39 ± 4.56 vs 2.13 ± 2.50, all p<0.01). Logistic regression analysis showed that TLG was an independent predictor of LNM in stage I-II cervical cancer (OR 1.032, 95% CI 1.013–1.052, p<0.01). Moreover, the predictive value of TLG combined with SUVpeak and SCC-Ag increased and the area under the curve increased compared SUVpeak and SCC-Ag.Conclusion18F-FDG PET/CT semi-quantitative parameters and SCC-Ag have promise for assessing LNM in stage I-II cervical cancer. TLG of primary tumor provides independent and increasing values in predicting LNM in stage I-II cervical cancer.

PurposeThis study aimed to compare the efficacy of [18F]AlF-NOTA-FAPI-04 PET/CT with that of [18F]FDG PET/CT for detecting postoperative recurrence in patients with gastric cancer.MethodsThis single-center retrospective clinical study was performed at Hunan Cancer Hospital between December 2020 and June 2022. The participants underwent both [18F]AlF-NOTA-FAPI-04 and [18F]FDG within 14 days. Histopathologic examination, morphological imaging, and/or follow-up imaging were used as a reference for the final diagnosis. We recorded the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of [18F]AlF-NOTA-FAPI-04 and [18F]FDG PET/CT for detecting local recurrence, lymph node metastasis and distant metastasis. The SUVmax and background ratio (TBR) of local recurrence and metastases between [18F]FDG and [18F]AlF-NOTA-FAPI-04 PET/CT were compared using paired-sample t tests.ResultsForty-seven patients (27 males, aged 25–68 years) with gastric cancer after curative resection (27 with adenocarcinoma, 17 with signet ring cell carcinoma and 4 with mucinous adenocarcinoma) were included in the study. [18F]AlF-NOTA-FAPI-04 accumulation was significantly greater than that of [18F]FDG in terms of local recurrence (SUVmax, 11.65 vs 3.48, p< 0.0001; TBR, 12.93 vs 2.94, p< 0.0001), lymph node metastasis (SUVmax, 13.45 vs 3.05, p=0.003875; TBR, 12.43 vs 2.21, p=0.001661), and distant metastasis (SUVmax, 11.89 vs 2.96, p < 0.0001; TBR, 13.32 vs 2.32, p< 0.0001). Despite no statistical comparison was made with [18F]FDG, [18F]AlF-NOTA-FAPI-04 imaging exhibited high levels of sensitivity, specificity, PPV, NPV, and accuracy for detecting postoperative local recurrence, lymph node metastasis, and distant metastasis in patients with gastric cancer.Conclusion[18F]AlF-NOTA-FAPI-04 has demonstrated potential for more accurate tumor re-evaluation in GC, thus enhancing treatment decision-making.

•Fluorine 18 fibroblast activation protein inhibitor PET/CT imaging was performed for multisystemic tuberculosis.•Fibrosis in granulomas may lead to increased fluorine 18 fibroblast activation protein inhibitor activity in multisystemic tuberculosis.

ABSTRACT:Ewing sarcoma (ES), which is described as diffuse endothelioma of the bone, is divided into osseous and extraosseous ES mostly affecting children and adolescents. In addition, ES of the peritoneum is rare. We present a case of a 46-year-old man with ES of the peritoneum in whom FDG PET/CT showed high radiotracer activity in the primary tumor.

To determine the diagnostic performance of PET–CT in differentiating benign and malignant adrenal lesions when evaluating PET parameters individually as well as in combination with CT parameters, using histopathology as the reference standard.