Hier finden Sie die aktuellsten Publikationen aus dem Gebiet der Nuklearmedizin in Österreich. Zusätzlich sind die Publikationen aus den Teilbereichen der PET, SPECT sowie nuklearmedizinischen Therapien unserer Kollegen in Österreich gesondert hervorgehoben.
Rezente Publikationen in Österreich
Performance evaluation of the Biograph Trinion EP2 PET/CT system according to NEMA NU2-2018
Rausch I, Schmidt F, Hoffmann M and Peloschek P
Performance evaluation of the Biograph Trinion EP2 PET/CT system according to NEMA NU2-2018
Rausch I, Schmidt F, Hoffmann M and Peloschek P
This study evaluates the performance of the Siemens Biograph Trinion EP2 whole-body PET/CT system according to the NEMA NU2-2018 standard.
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
The management of treatment-refractory meningioma in patients with previous surgical resection and radiation therapy remains challenging due to the lack of effective systemic treatment options. Therefore, novel therapeutic applications, such as peptide receptor radionuclide therapy (PRRT) targeting somatostatin receptors, may offer a promising therapeutic strategy. We aimed to assess the lesion-based tumour-absorbed dose and efficacy of PRRT with [Y]Y-DOTATOC in patients with treatment-refractory meningioma.
Evaluation of Signal Enhancement Techniques for Motion Correction for High Temporal Resolution Functional PET
Falb P, Reed MB, Klug S, Murgaš M, Godbersen GM, Schmidt C, Nics L, Hacker M, Lanzenberger R and Hahn A
Evaluation of Signal Enhancement Techniques for Motion Correction for High Temporal Resolution Functional PET
Falb P, Reed MB, Klug S, Murgaš M, Godbersen GM, Schmidt C, Nics L, Hacker M, Lanzenberger R and Hahn A
Functional Positron Emission Tomography (fPET) data offers novel insights into brain energy demands and molecular connectivity. Recent advances in improving temporal resolutions for this imaging technique have opened up new research possibilities. However, lower signal-to-noise ratios (SNR) inherent to short PET frames bring into question whether current realignment approaches still provide appropriate motion correction or whether additional processing steps might be required to improve correction outcomes. Thus, we aimed to evaluate the effectiveness of a standard motion correction procedure in conjunction with different SNR enhancement methods and explore potential improvements for high temporal resolution fPET with 3s dynamic frames. We investigated three techniques aimed at improving the SNR to facilitate more accurate realignment of fPET images, in comparison to conventional motion correction without any prior modifications. The methods include a deep learning technique based on the application of a conditional generative adversarial network, an exponentially weighted sliding window average and an established filtering method for denoising dynamic imaging data. Performance was compared and evaluated by correlating rigid motion parameters between approaches and with simultaneously acquired fMRI data, and by assessing magnitudes of task-induced activation. Our results indicate that none of the methods substantially improve mitigation of motion artefacts. Given the increased computational effort of the techniques, we propose that the standard motion correction procedure without prior signal modification is adequate for processing high temporal resolution fPET data of a healthy study population, exhibiting commonly observed amounts of movement. Nevertheless, future development of targeted strategies to enhance motion correction may further advance this imaging technique and applications thereof.
Response Evaluation Criteria in Bone Metastases: Performance and Association of Response Classifications with Survival Outcomes
Xu T, Yu X, Chen F, Wang W, Cheng K, Liu Y, Wang Y, Peng D, Huang Z, Zhang C, Qiu L, Liu Z, Mou L, Lei L, Qi C, Zhang J, Li B, Xie L, Dai T, Chen D, Li X and Chen Y
Response Evaluation Criteria in Bone Metastases: Performance and Association of Response Classifications with Survival Outcomes
Xu T, Yu X, Chen F, Wang W, Cheng K, Liu Y, Wang Y, Peng D, Huang Z, Zhang C, Qiu L, Liu Z, Mou L, Lei L, Qi C, Zhang J, Li B, Xie L, Dai T, Chen D, Li X and Chen Y
Background Current bone metastasis evaluation relies on fragmented anatomic or metabolic criteria, often yielding discordant classifications. Purpose To develop Response Evaluation Criteria in Bone Metastases (termed RECIBM) and evaluate its performance against the University of Texas MD Anderson Cancer Center, PET Response Criteria in Solid Tumors (PERCIST), and European Organisation for Research and Treatment of Cancer (EORTC) criteria. Materials and Methods This retrospective study was conducted between October 2017 and September 2023. RECIBM was established based on multidisciplinary consensus and assessed on real-world patient data, with treatment responses evaluated using RECIBM, MD Anderson, PERCIST, and EORTC criteria. The paired subgroup comprised patients evaluable by all four criteria; the remaining patients underwent technetium 99m methylene diphosphonate bone scintigraphy only and were evaluable using the MD Anderson criteria and RECIBM. Agreement was quantified using the Cohen κ value, and prognostic performance for overall survival and bone progression-free survival was assessed using the Harrell C-index and multivariable Cox regression. Results Eighty-four patients (median age, 59.0 years [IQR, 52.0-68.3 years]; 59 male) were included. RECIBM-defined response classifications demonstrated high agreement with those of existing criteria (κ = 0.80-0.98; all < .001) and reclassified 19% of patients (16 of 84). In the paired subgroup, RECIBM showed the highest C-index for overall survival (0.807 vs 0.771-0.782; = .10-.14) and bone progression-free survival (0.849 vs 0.799-0.833; raw = .03-.26; adjusted = .088-.256), with no evidence of differences after adjustment. Subgroup analyses showed consistent performance across different imaging modalities and tumor types ( for interaction = .39 and .051, respectively). In multivariable analysis, RECIBM-defined response was associated with overall survival (hazard ratio, 0.07 [95% CI: 0.03, 0.19]; < .001) and bone progression-free survival (hazard ratio, 0.03 [95% CI: 0.01, 0.08]; < .001). Conclusion RECIBM-defined response classifications showed high agreement with established criteria, reclassified 19% of patients, and were associated with overall survival and bone progression-free survival. © RSNA, 2026 See also the editorial by Mohammadi and Guermazi in this issue.
The European Association for Neuro-oncology (EANO) Consensus Statement on Radiation Necrosis
Duerinck J, Van Den Bent M, Brandal P, Minniti G, Galldiks N, Franceschi E, Geurts M, Berghoff AS, Renovanz M, Brandsma D, Snijders TJ, Weller M, Short SC, Platten M, Le Rhun E, Preusser M, Schweizer L, Albert NL, Furtner J and Razis E
The European Association for Neuro-oncology (EANO) Consensus Statement on Radiation Necrosis
Duerinck J, Van Den Bent M, Brandal P, Minniti G, Galldiks N, Franceschi E, Geurts M, Berghoff AS, Renovanz M, Brandsma D, Snijders TJ, Weller M, Short SC, Platten M, Le Rhun E, Preusser M, Schweizer L, Albert NL, Furtner J and Razis E
Radiation necrosis (RN) complicates neuro-oncological care, mimicking tumor recurrence and lacking high-level evidence for standardized management.
Sequential [C]Acetate and [F]FDG PET/CT Assessment of Systemic Chronic Active Epstein-Barr Virus Disease: An Exploratory Retrospective Study
Wakui M, Yanai S, Tsuchiya J, Yamamoto M, Yamada H, Yokoyama K, Taura S, Anzai T, Arai A and Tateishi U
Sequential [C]Acetate and [F]FDG PET/CT Assessment of Systemic Chronic Active Epstein-Barr Virus Disease: An Exploratory Retrospective Study
Wakui M, Yanai S, Tsuchiya J, Yamamoto M, Yamada H, Yokoyama K, Taura S, Anzai T, Arai A and Tateishi U
Systemic chronic active Epstein-Barr virus disease (sCAEBV) is a rare and potentially fatal disorder characterized by inflammatory manifestations and organ infiltration by EBV-infected T- or NK-cells. Although [F]FDG PET/CT has limited utility for assessing the disease activity of sCAEBV, [C]acetate PET/CT has not previously been evaluated in this setting. We therefore conducted this exploratory retrospective study to assess the utility of sequentially performed [C]acetate and [F]FDG PET/CT in sCAEBV. Five patients diagnosed with sCAEBV according to the criteria of the Research Group on Measures against Intractable Diseases, Ministry of Health, Labour and Welfare of Japan (consistent with the 2017 WHO classification) and assessed between July 2017 and December 2018 were included; patients younger than 20 years were excluded. Each patient underwent both [C]acetate and 2-deoxy-2-[F]fluoro-D-glucose ([F]FDG) positron emission tomography/computed tomography (PET/CT) on the same day. The maximum and mean standardized uptake values (SUVmax and SUVmean) of the liver and spleen and the liver-to-spleen ratio (LSR) were correlated with laboratory parameters, including alanine aminotransferase (ALT) and lactate dehydrogenase (LDH), using Spearman's rank correlation coefficient. The LSR was compared between active and inactive cases using the Mann-Whitney U test. Twenty-one lymph node regions were assessed in each patient, and the SUVmax of detected lesions was measured. The detection rate of lymph node lesions between the two tracers was compared using McNemar's test, and the SUVmax of lymph node lesions was compared between the two tracers and between active and inactive cases using the Mann-Whitney U test. All statistical analyses were performed using R version 4.5.3 (R Foundation for Statistical Computing, Vienna, Austria), and a -value < 0.05 was considered statistically significant. Five patients (three men and two women; mean age 31.8 years, range 21-39 years) were included. [C]acetate PET/CT showed significant negative correlations between spleen SUV and liver enzymes (AST, ALT, and LDH), and significant positive correlations between the LSR and all five liver enzymes tested (AST, ALT, LDH, γGTP, and ALP) (Spearman's rank correlation coefficient; < 0.05 for all). No significant correlations were observed with [F]FDG PET/CT. The LSR on [C]acetate PET/CT was numerically higher in active cases than in inactive cases, though this difference was not statistically significant (0.88 ± 0.02 vs. 0.61 ± 0.02; = 0.20, Mann-Whitney U test). Lymph node lesion detectability did not differ significantly between the two tracers (16 vs. 12 regions; = 0.13, McNemar's test). In this pilot study, [C]acetate PET/CT spleen SUV showed significant negative correlations with liver enzymes (AST, ALT, and LDH), and the LSR showed significant positive correlations with all measured liver enzymes, suggesting that [C]acetate PET/CT reflects both hepatic and splenic involvement in sCAEBV. [C]acetate PET/CT may therefore serve as a novel imaging biomarker for assessing disease activity in sCAEBV, warranting further investigation in larger cohorts.
FAPI PET-guided tumor volume delineation for radiotherapy planning: A comprehensive review across solid tumors
Sadeghpour S, Aghaee A, Doostparast A, Rezaei N, Divband G, Raeisi N, Roeder F, Jung T, Pirich C, Soltani S, Sadeghi R and Beheshti M
FAPI PET-guided tumor volume delineation for radiotherapy planning: A comprehensive review across solid tumors
Sadeghpour S, Aghaee A, Doostparast A, Rezaei N, Divband G, Raeisi N, Roeder F, Jung T, Pirich C, Soltani S, Sadeghi R and Beheshti M
Accurate gross tumor volume (GTV) delineation remains a critical yet error-prone step in radiotherapy (RT) planning. Conventional imaging and [¹⁸F]FDG PET/CT are limited by poor tumor-to-background contrast and non-specific inflammatory uptake. F/Ga-labeled fibroblast activation protein inhibitor (FAPI) PET, which targets cancer-associated fibroblasts (CAFs) within the tumor microenvironment, offers a biologically distinct and potentially superior alternative. This review summarizes the current evidence across multiple solid tumors, highlighting its potential to improve gross tumor volume delineation, refine staging, and reduce interobserver variability compared with conventional imaging and [¹⁸F]FDG PET. Although FAPI PET frequently altered target volumes and RT planning, the available evidence is limited by small, predominantly retrospective studies and the absence of histopathological validation or long-term clinical outcomes. At present, FAPI PET should be considered a complementary imaging tool with particular value in selected clinical settings. Prospective multicenter studies are needed to establish standardized segmentation methods and determine whether improved target delineation translates into better patient outcomes.
External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection
Schmidt CJ, Gaertner FC, Kreppel B, Essler M, Luetkens JA, Attenberger U, Anspach M, Ohlmann CH, Bernhardt M, Kristiansen G, Hauser S, Ellinger J, Ritter M and Krausewitz P
External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection
Schmidt CJ, Gaertner FC, Kreppel B, Essler M, Luetkens JA, Attenberger U, Anspach M, Ohlmann CH, Bernhardt M, Kristiansen G, Hauser S, Ellinger J, Ritter M and Krausewitz P
This study aimed to externally validate the P-Score, a composite scoring system combining PI-RADS and PRIMARY score, for its diagnostic accuracy in detecting clinically significant (ISUP ≥ 2) and higher-grade (ISUP ≥ 3) prostate cancer (PCa).
Adipose triglyceride lipase driven lipolysis as a targetable metabolic vulnerability in prostate cancer with intrinsic metabolic inflexibility
Tiefenbacher A, Gudenus M, Valcanover D, Neudert B, Sheibani-Tezerji R, Mendrina T, Kalla J, Pajed L, Draganić K, Haitel A, Haase A, Hartenbach M, Rasul S, Berger W, Breinbauer R, Grabner G, Schweiger M, Compérat E and Egger G
Adipose triglyceride lipase driven lipolysis as a targetable metabolic vulnerability in prostate cancer with intrinsic metabolic inflexibility
Tiefenbacher A, Gudenus M, Valcanover D, Neudert B, Sheibani-Tezerji R, Mendrina T, Kalla J, Pajed L, Draganić K, Haitel A, Haase A, Hartenbach M, Rasul S, Berger W, Breinbauer R, Grabner G, Schweiger M, Compérat E and Egger G
Despite the widespread clinical use of prostate-specific membrane antigen (PSMA)-targeted imaging and therapy in prostate cancer, the biological functions underlying PSMA-associated tumour aggressiveness remain incompletely understood.
Longitudinal [F]FDG PET/MR Assessment of Arterial Inflammation in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy
Xue S, Hu C, Li L, Einspieler H, Kiss A, Podesser BK, Bergler-Klein J, Hacker M, Li X, Zhou X and Liu J
Longitudinal [F]FDG PET/MR Assessment of Arterial Inflammation in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy
Xue S, Hu C, Li L, Einspieler H, Kiss A, Podesser BK, Bergler-Klein J, Hacker M, Li X, Zhou X and Liu J
Androgen deprivation therapy (ADT) improves outcomes in advanced prostate cancer but is associated with increased cardiovascular morbidity and mortality. Arterial inflammation, measurable by [F]FDG positron emission tomography, may represent an intermediate pathway linking ADT to cardiovascular risk. We quantified intraindividual changes in arterial inflammation on [F]FDG positron emission tomography/magnetic resonance across ADT exposure, characterized their temporal trajectory, and explored associated clinical factors.
Teilbereich PET
Performance evaluation of the Biograph Trinion EP2 PET/CT system according to NEMA NU2-2018
Rausch I, Schmidt F, Hoffmann M and Peloschek P
Performance evaluation of the Biograph Trinion EP2 PET/CT system according to NEMA NU2-2018
Rausch I, Schmidt F, Hoffmann M and Peloschek P
This study evaluates the performance of the Siemens Biograph Trinion EP2 whole-body PET/CT system according to the NEMA NU2-2018 standard.
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
The management of treatment-refractory meningioma in patients with previous surgical resection and radiation therapy remains challenging due to the lack of effective systemic treatment options. Therefore, novel therapeutic applications, such as peptide receptor radionuclide therapy (PRRT) targeting somatostatin receptors, may offer a promising therapeutic strategy. We aimed to assess the lesion-based tumour-absorbed dose and efficacy of PRRT with [Y]Y-DOTATOC in patients with treatment-refractory meningioma.
Evaluation of Signal Enhancement Techniques for Motion Correction for High Temporal Resolution Functional PET
Falb P, Reed MB, Klug S, Murgaš M, Godbersen GM, Schmidt C, Nics L, Hacker M, Lanzenberger R and Hahn A
Evaluation of Signal Enhancement Techniques for Motion Correction for High Temporal Resolution Functional PET
Falb P, Reed MB, Klug S, Murgaš M, Godbersen GM, Schmidt C, Nics L, Hacker M, Lanzenberger R and Hahn A
Functional Positron Emission Tomography (fPET) data offers novel insights into brain energy demands and molecular connectivity. Recent advances in improving temporal resolutions for this imaging technique have opened up new research possibilities. However, lower signal-to-noise ratios (SNR) inherent to short PET frames bring into question whether current realignment approaches still provide appropriate motion correction or whether additional processing steps might be required to improve correction outcomes. Thus, we aimed to evaluate the effectiveness of a standard motion correction procedure in conjunction with different SNR enhancement methods and explore potential improvements for high temporal resolution fPET with 3s dynamic frames. We investigated three techniques aimed at improving the SNR to facilitate more accurate realignment of fPET images, in comparison to conventional motion correction without any prior modifications. The methods include a deep learning technique based on the application of a conditional generative adversarial network, an exponentially weighted sliding window average and an established filtering method for denoising dynamic imaging data. Performance was compared and evaluated by correlating rigid motion parameters between approaches and with simultaneously acquired fMRI data, and by assessing magnitudes of task-induced activation. Our results indicate that none of the methods substantially improve mitigation of motion artefacts. Given the increased computational effort of the techniques, we propose that the standard motion correction procedure without prior signal modification is adequate for processing high temporal resolution fPET data of a healthy study population, exhibiting commonly observed amounts of movement. Nevertheless, future development of targeted strategies to enhance motion correction may further advance this imaging technique and applications thereof.
Response Evaluation Criteria in Bone Metastases: Performance and Association of Response Classifications with Survival Outcomes
Xu T, Yu X, Chen F, Wang W, Cheng K, Liu Y, Wang Y, Peng D, Huang Z, Zhang C, Qiu L, Liu Z, Mou L, Lei L, Qi C, Zhang J, Li B, Xie L, Dai T, Chen D, Li X and Chen Y
Response Evaluation Criteria in Bone Metastases: Performance and Association of Response Classifications with Survival Outcomes
Xu T, Yu X, Chen F, Wang W, Cheng K, Liu Y, Wang Y, Peng D, Huang Z, Zhang C, Qiu L, Liu Z, Mou L, Lei L, Qi C, Zhang J, Li B, Xie L, Dai T, Chen D, Li X and Chen Y
Background Current bone metastasis evaluation relies on fragmented anatomic or metabolic criteria, often yielding discordant classifications. Purpose To develop Response Evaluation Criteria in Bone Metastases (termed RECIBM) and evaluate its performance against the University of Texas MD Anderson Cancer Center, PET Response Criteria in Solid Tumors (PERCIST), and European Organisation for Research and Treatment of Cancer (EORTC) criteria. Materials and Methods This retrospective study was conducted between October 2017 and September 2023. RECIBM was established based on multidisciplinary consensus and assessed on real-world patient data, with treatment responses evaluated using RECIBM, MD Anderson, PERCIST, and EORTC criteria. The paired subgroup comprised patients evaluable by all four criteria; the remaining patients underwent technetium 99m methylene diphosphonate bone scintigraphy only and were evaluable using the MD Anderson criteria and RECIBM. Agreement was quantified using the Cohen κ value, and prognostic performance for overall survival and bone progression-free survival was assessed using the Harrell C-index and multivariable Cox regression. Results Eighty-four patients (median age, 59.0 years [IQR, 52.0-68.3 years]; 59 male) were included. RECIBM-defined response classifications demonstrated high agreement with those of existing criteria (κ = 0.80-0.98; all < .001) and reclassified 19% of patients (16 of 84). In the paired subgroup, RECIBM showed the highest C-index for overall survival (0.807 vs 0.771-0.782; = .10-.14) and bone progression-free survival (0.849 vs 0.799-0.833; raw = .03-.26; adjusted = .088-.256), with no evidence of differences after adjustment. Subgroup analyses showed consistent performance across different imaging modalities and tumor types ( for interaction = .39 and .051, respectively). In multivariable analysis, RECIBM-defined response was associated with overall survival (hazard ratio, 0.07 [95% CI: 0.03, 0.19]; < .001) and bone progression-free survival (hazard ratio, 0.03 [95% CI: 0.01, 0.08]; < .001). Conclusion RECIBM-defined response classifications showed high agreement with established criteria, reclassified 19% of patients, and were associated with overall survival and bone progression-free survival. © RSNA, 2026 See also the editorial by Mohammadi and Guermazi in this issue.
The European Association for Neuro-oncology (EANO) Consensus Statement on Radiation Necrosis
Duerinck J, Van Den Bent M, Brandal P, Minniti G, Galldiks N, Franceschi E, Geurts M, Berghoff AS, Renovanz M, Brandsma D, Snijders TJ, Weller M, Short SC, Platten M, Le Rhun E, Preusser M, Schweizer L, Albert NL, Furtner J and Razis E
The European Association for Neuro-oncology (EANO) Consensus Statement on Radiation Necrosis
Duerinck J, Van Den Bent M, Brandal P, Minniti G, Galldiks N, Franceschi E, Geurts M, Berghoff AS, Renovanz M, Brandsma D, Snijders TJ, Weller M, Short SC, Platten M, Le Rhun E, Preusser M, Schweizer L, Albert NL, Furtner J and Razis E
Radiation necrosis (RN) complicates neuro-oncological care, mimicking tumor recurrence and lacking high-level evidence for standardized management.
Sequential [C]Acetate and [F]FDG PET/CT Assessment of Systemic Chronic Active Epstein-Barr Virus Disease: An Exploratory Retrospective Study
Wakui M, Yanai S, Tsuchiya J, Yamamoto M, Yamada H, Yokoyama K, Taura S, Anzai T, Arai A and Tateishi U
Sequential [C]Acetate and [F]FDG PET/CT Assessment of Systemic Chronic Active Epstein-Barr Virus Disease: An Exploratory Retrospective Study
Wakui M, Yanai S, Tsuchiya J, Yamamoto M, Yamada H, Yokoyama K, Taura S, Anzai T, Arai A and Tateishi U
Systemic chronic active Epstein-Barr virus disease (sCAEBV) is a rare and potentially fatal disorder characterized by inflammatory manifestations and organ infiltration by EBV-infected T- or NK-cells. Although [F]FDG PET/CT has limited utility for assessing the disease activity of sCAEBV, [C]acetate PET/CT has not previously been evaluated in this setting. We therefore conducted this exploratory retrospective study to assess the utility of sequentially performed [C]acetate and [F]FDG PET/CT in sCAEBV. Five patients diagnosed with sCAEBV according to the criteria of the Research Group on Measures against Intractable Diseases, Ministry of Health, Labour and Welfare of Japan (consistent with the 2017 WHO classification) and assessed between July 2017 and December 2018 were included; patients younger than 20 years were excluded. Each patient underwent both [C]acetate and 2-deoxy-2-[F]fluoro-D-glucose ([F]FDG) positron emission tomography/computed tomography (PET/CT) on the same day. The maximum and mean standardized uptake values (SUVmax and SUVmean) of the liver and spleen and the liver-to-spleen ratio (LSR) were correlated with laboratory parameters, including alanine aminotransferase (ALT) and lactate dehydrogenase (LDH), using Spearman's rank correlation coefficient. The LSR was compared between active and inactive cases using the Mann-Whitney U test. Twenty-one lymph node regions were assessed in each patient, and the SUVmax of detected lesions was measured. The detection rate of lymph node lesions between the two tracers was compared using McNemar's test, and the SUVmax of lymph node lesions was compared between the two tracers and between active and inactive cases using the Mann-Whitney U test. All statistical analyses were performed using R version 4.5.3 (R Foundation for Statistical Computing, Vienna, Austria), and a -value < 0.05 was considered statistically significant. Five patients (three men and two women; mean age 31.8 years, range 21-39 years) were included. [C]acetate PET/CT showed significant negative correlations between spleen SUV and liver enzymes (AST, ALT, and LDH), and significant positive correlations between the LSR and all five liver enzymes tested (AST, ALT, LDH, γGTP, and ALP) (Spearman's rank correlation coefficient; < 0.05 for all). No significant correlations were observed with [F]FDG PET/CT. The LSR on [C]acetate PET/CT was numerically higher in active cases than in inactive cases, though this difference was not statistically significant (0.88 ± 0.02 vs. 0.61 ± 0.02; = 0.20, Mann-Whitney U test). Lymph node lesion detectability did not differ significantly between the two tracers (16 vs. 12 regions; = 0.13, McNemar's test). In this pilot study, [C]acetate PET/CT spleen SUV showed significant negative correlations with liver enzymes (AST, ALT, and LDH), and the LSR showed significant positive correlations with all measured liver enzymes, suggesting that [C]acetate PET/CT reflects both hepatic and splenic involvement in sCAEBV. [C]acetate PET/CT may therefore serve as a novel imaging biomarker for assessing disease activity in sCAEBV, warranting further investigation in larger cohorts.
FAPI PET-guided tumor volume delineation for radiotherapy planning: A comprehensive review across solid tumors
Sadeghpour S, Aghaee A, Doostparast A, Rezaei N, Divband G, Raeisi N, Roeder F, Jung T, Pirich C, Soltani S, Sadeghi R and Beheshti M
FAPI PET-guided tumor volume delineation for radiotherapy planning: A comprehensive review across solid tumors
Sadeghpour S, Aghaee A, Doostparast A, Rezaei N, Divband G, Raeisi N, Roeder F, Jung T, Pirich C, Soltani S, Sadeghi R and Beheshti M
Accurate gross tumor volume (GTV) delineation remains a critical yet error-prone step in radiotherapy (RT) planning. Conventional imaging and [¹⁸F]FDG PET/CT are limited by poor tumor-to-background contrast and non-specific inflammatory uptake. F/Ga-labeled fibroblast activation protein inhibitor (FAPI) PET, which targets cancer-associated fibroblasts (CAFs) within the tumor microenvironment, offers a biologically distinct and potentially superior alternative. This review summarizes the current evidence across multiple solid tumors, highlighting its potential to improve gross tumor volume delineation, refine staging, and reduce interobserver variability compared with conventional imaging and [¹⁸F]FDG PET. Although FAPI PET frequently altered target volumes and RT planning, the available evidence is limited by small, predominantly retrospective studies and the absence of histopathological validation or long-term clinical outcomes. At present, FAPI PET should be considered a complementary imaging tool with particular value in selected clinical settings. Prospective multicenter studies are needed to establish standardized segmentation methods and determine whether improved target delineation translates into better patient outcomes.
External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection
Schmidt CJ, Gaertner FC, Kreppel B, Essler M, Luetkens JA, Attenberger U, Anspach M, Ohlmann CH, Bernhardt M, Kristiansen G, Hauser S, Ellinger J, Ritter M and Krausewitz P
External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection
Schmidt CJ, Gaertner FC, Kreppel B, Essler M, Luetkens JA, Attenberger U, Anspach M, Ohlmann CH, Bernhardt M, Kristiansen G, Hauser S, Ellinger J, Ritter M and Krausewitz P
This study aimed to externally validate the P-Score, a composite scoring system combining PI-RADS and PRIMARY score, for its diagnostic accuracy in detecting clinically significant (ISUP ≥ 2) and higher-grade (ISUP ≥ 3) prostate cancer (PCa).
Adipose triglyceride lipase driven lipolysis as a targetable metabolic vulnerability in prostate cancer with intrinsic metabolic inflexibility
Tiefenbacher A, Gudenus M, Valcanover D, Neudert B, Sheibani-Tezerji R, Mendrina T, Kalla J, Pajed L, Draganić K, Haitel A, Haase A, Hartenbach M, Rasul S, Berger W, Breinbauer R, Grabner G, Schweiger M, Compérat E and Egger G
Adipose triglyceride lipase driven lipolysis as a targetable metabolic vulnerability in prostate cancer with intrinsic metabolic inflexibility
Tiefenbacher A, Gudenus M, Valcanover D, Neudert B, Sheibani-Tezerji R, Mendrina T, Kalla J, Pajed L, Draganić K, Haitel A, Haase A, Hartenbach M, Rasul S, Berger W, Breinbauer R, Grabner G, Schweiger M, Compérat E and Egger G
Despite the widespread clinical use of prostate-specific membrane antigen (PSMA)-targeted imaging and therapy in prostate cancer, the biological functions underlying PSMA-associated tumour aggressiveness remain incompletely understood.
Longitudinal [F]FDG PET/MR Assessment of Arterial Inflammation in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy
Xue S, Hu C, Li L, Einspieler H, Kiss A, Podesser BK, Bergler-Klein J, Hacker M, Li X, Zhou X and Liu J
Longitudinal [F]FDG PET/MR Assessment of Arterial Inflammation in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy
Xue S, Hu C, Li L, Einspieler H, Kiss A, Podesser BK, Bergler-Klein J, Hacker M, Li X, Zhou X and Liu J
Androgen deprivation therapy (ADT) improves outcomes in advanced prostate cancer but is associated with increased cardiovascular morbidity and mortality. Arterial inflammation, measurable by [F]FDG positron emission tomography, may represent an intermediate pathway linking ADT to cardiovascular risk. We quantified intraindividual changes in arterial inflammation on [F]FDG positron emission tomography/magnetic resonance across ADT exposure, characterized their temporal trajectory, and explored associated clinical factors.
Teilbereich SPECT
Quantitative Tc-PYP SPECT/CT at 90 minutes improves diagnostic stratification in transthyretin cardiac amyloidosis
Nazerani-Zemann T, Stanzel S, Weitzer F, Kuenzer T, Stangl VM and Bucerius J
Quantitative Tc-PYP SPECT/CT at 90 minutes improves diagnostic stratification in transthyretin cardiac amyloidosis
Nazerani-Zemann T, Stanzel S, Weitzer F, Kuenzer T, Stangl VM and Bucerius J
Scintigraphy using Tc-labeled bone-seeking tracers is a cornerstone in the non-invasive diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). However, planar imaging alone, particularly in patients with Perugini score 1, often lacks diagnostic specificity. This study evaluates the incremental diagnostic value of quantitative SPECT/CT at 90 min post-injection (p.i.) when added to standard planar imaging at 60 and 180 min.
Longitudinal serum uric acid levels are not associated with dopamine transporter binding in progressive supranuclear palsy
Buchinger D, Aleksic T, Brücke C, Berger-Sieczkowski E, Nakuz T, Traub-Weidinger T and Milenkovic I
Longitudinal serum uric acid levels are not associated with dopamine transporter binding in progressive supranuclear palsy
Buchinger D, Aleksic T, Brücke C, Berger-Sieczkowski E, Nakuz T, Traub-Weidinger T and Milenkovic I
Progressive supranuclear palsy (PSP) causes rapid motor decline and severe dopaminergic dysfunction. While uric acid (UA) may act as a neuroprotective antioxidant in some neurodegenerative disorders (like Parkinson’s disease), its role in PSP remains unclear. This study evaluated the relationship between serum UA levels, measured cross-sectionally and longitudinally, and striatal dopamine transporter binding in PSP. A total of 33 PSP patients with repeated pre-[I]FP-CIT SPECT UA measurements, along with 30 healthy control individuals and 30 patients with Alzheimer’s disease (AD), were retrospectively analyzed. Group and sex effects were analyzed with tests and ANOVA. Effects of mean UA and longitudinal UA trajectories on FP-CIT SPECT binding in PSP were modeled using linear mixed-effects models and regressed against binding in four regions (caudate and putamen), separated into more-affected and less-affected side for both sexes. A Bayesian two-stage measurement-error model provided sensitivity analysis. UA was significantly lower in PSP (4.98 mg/dl) and AD (4.69 mg/dl) compared to healthy controls (5.71 mg/dL; = 0.001). Sex had a significant effect on UA ((1, 89) = 9.38, = 0.003, partial η = 0.10), however, this effect was significant only in PSP (< 0.001). Within PSP, UA–[I]FP-CIT SPECT correlations were weak and nonsignificant, and neither UA intercept nor slope predicted [I]FP-CIT SPECT binding (all > 0.7). Bayesian estimates corroborated the absence of a credible relationship. In the present cohort, serum UA is reduced in PSP, primarily in females, but neither mean levels nor longitudinal changes are related to striatal [I]FP-CIT SPECT binding, suggesting no clear association with dopaminergic degeneration in PSP, without precluding a potential role of uric acid at other disease stages.
Correlation of global and regional quantitative 99m Tc-3,3-diphosphono-1,2 propanodicarboxylicacid single-photon emission computed tomography with echocardiography in patients with suspected transthyretin-related cardiomyopathy
Caobelli F, Popescu CE, Gözlügöl N, Rominger A, Zangeneh FA, Munsch LH, Ciocca N, Stortecky S, Dobner S, Hundertmark M and Gräni C
Correlation of global and regional quantitative 99m Tc-3,3-diphosphono-1,2 propanodicarboxylicacid single-photon emission computed tomography with echocardiography in patients with suspected transthyretin-related cardiomyopathy
Caobelli F, Popescu CE, Gözlügöl N, Rominger A, Zangeneh FA, Munsch LH, Ciocca N, Stortecky S, Dobner S, Hundertmark M and Gräni C
Quantitative single-photon emission computed tomography (SPECT) with 99m Tc-3,3-diphosphono-1,2 propanodicarboxylicacid ([ 99m Tc]Tc-DPD) is a cornerstone in the noninvasive diagnostic workup of amyloid transthyretin-related cardiomyopathy (ATTR-CM). As diagnosis is often suspected after transthoracic echocardiography (TTE), this study aims to explore the correlations between global and regional quantitative [ 99m Tc]Tc-DPD SPECT results and TTE findings in patients with suspected ATTR-CM.
Sentinel Node Biopsy in the Neck Management of cN0 Sinonasal Squamous Cell Carcinoma: A Multicenter Pilot Trial on Safety and Feasibility
Doescher J, von Witzleben A, Eberhardt N, Sauter C, Mlynarcik C, Peiper A, Treutlein E, Schuler PJ, Sommer F, Laban S, Beer AJ, Zenk J and Hoffmann TK
Sentinel Node Biopsy in the Neck Management of cN0 Sinonasal Squamous Cell Carcinoma: A Multicenter Pilot Trial on Safety and Feasibility
Doescher J, von Witzleben A, Eberhardt N, Sauter C, Mlynarcik C, Peiper A, Treutlein E, Schuler PJ, Sommer F, Laban S, Beer AJ, Zenk J and Hoffmann TK
To date, there are no clear recommendations for the treatment of a clinically inconspicuous neck (cN0) in sinonasal squamous cell carcinoma. Elective neck dissection or neck irradiation appears too aggressive given the relatively low occult metastasis rates. However, the development of neck lymph node metastases is significantly associated with worse survival, therefore patients at relevant risk need to be identified. The aim of this trial was to evaluate feasibility and safety of sentinel node biopsy for sinonasal squamous cell carcinoma.
Early timepoint Tc-DPD whole body scintigraphy and quantitative SPECT/CT imaging for diagnosis of cardiac ATTR amyloidosis
Settelmeier S, Kessler L, Hammersen N, Papathanasiou M, Rischpler C, Carpinteiro A, Oubari S, Michel L, Vogel J, Wollenweber T, Ning J, Hacker M, Spielvogel CP, Varasteh Z, Fendler WP, Barbato F, Costa PF, Leyser S, Rassaf T, Herrmann K, Telli T and Kersting D
Early timepoint Tc-DPD whole body scintigraphy and quantitative SPECT/CT imaging for diagnosis of cardiac ATTR amyloidosis
Settelmeier S, Kessler L, Hammersen N, Papathanasiou M, Rischpler C, Carpinteiro A, Oubari S, Michel L, Vogel J, Wollenweber T, Ning J, Hacker M, Spielvogel CP, Varasteh Z, Fendler WP, Barbato F, Costa PF, Leyser S, Rassaf T, Herrmann K, Telli T and Kersting D
Cardiac transthyretin amyloidosis (ATTR-CM) is a progressive myocardial disease ultimately leading to heart failure. Standard diagnostic workup includes Tc-DPD scintigraphy performed after 2.5-3 h. The purpose of this study is to compare early (1 h after injection) to late imaging of Tc-DPD scintigraphy and SPECT for the detection of ATTR-CM. Early imaging could improve patient comfort and examination efficiency.
Outcome-driven dosimetry optimization for [Lu]Lu-PSMA-617 radiopharmaceutical therapy: proof of concept on single time point dosimetry optimization
Hu J, Seifert R, Gomes CV, Chen Y, Liu Y, Jutidamrongphan W, Amon M, Wang J, Xue S, Rominger A, Afshar-Ormieh A and Shi K
Outcome-driven dosimetry optimization for [Lu]Lu-PSMA-617 radiopharmaceutical therapy: proof of concept on single time point dosimetry optimization
Hu J, Seifert R, Gomes CV, Chen Y, Liu Y, Jutidamrongphan W, Amon M, Wang J, Xue S, Rominger A, Afshar-Ormieh A and Shi K
Internal dosimetry in radiopharmaceutical therapy (RPT) traditionally prioritizes methodological optimization driven by physical dose accuracy. However, even recommended multiple-time-point (MTP) dosimetry remains subject to uncertainties related to limited sampling schedules, pharmacokinetic, and curve-fitting modeling assumptions. In patients with metastatic castration-resistant prostate cancer (mCRPC) treated with [Lu]Lu-PSMA-617 RPT, we explored an outcome-driven dosimetry optimization strategy by comparing MTP and single-time-point (STP) dosimetry, and identifying optimal time-points (TPs) for Hänscheid approximation based on therapy outcomes.
SPECT and PET myocardial perfusion imaging in Austria, Germany, and Switzerland results of the 2nd joint survey 2024
Lindner O, Bucerius J, Derlin T, Burchert W and Buechel RR
SPECT and PET myocardial perfusion imaging in Austria, Germany, and Switzerland results of the 2nd joint survey 2024
Lindner O, Bucerius J, Derlin T, Burchert W and Buechel RR
PURPOSE: We herein present the results of the second survey on SPECT and PET myocardial perfusion imaging (MPI) in Austria, Germany, and Switzerland in 2024. METHODS: A questionnaire was sent to facilities practicing nuclear medicine. RESULTS: Data from 12 Austrian (10,689 SPECT), 198 German (128,707 SPECT), and 16 Swiss departments (11,593 MPI (2,911 SPECT; 8,682 PET)) were analysed. In Austria and Germany, the PET MPI numbers were negligible and not considered. In Austria 50%, in Germany 69%, and in Switzerland 69% of the facilities reported stable or increasing numbers of examinations compared to the 2021 survey. Ambulatory care cardiologists represented the major referral group (46-71%). Most stress tests were performed pharmacologically (57-96%). In SPECT imaging, the one-day protocol was predominant in Switzerland (77%), while the two-day protocol was used in Austria (41%) and Germany (49%). The primary camera systems used were hybrid SPECT-CT systems in Austria (75%) and Switzerland (100%), and SPECT cameras (without CT) in Germany (56%). Attenuation correction was regularly performed in Switzerland (100%), followed by Austria (74%), and Germany (35%). Both gated SPECT and perfusion scoring were frequently applied (gated SPECT 82-99%; perfusion scoring 82-88%). CONCLUSIONS: This second joint survey for 2024 confirms positive trends in MPI imaging in all three countries, albeit with differences. The results document a high level of guideline conformity. The situation in Switzerland is exceptional due to the widespread use of PET-MPI. Switzerland also leads in terms of camera equipment and attenuation correction followed by Austria and Germany.
Radioembolization Practice in North America Versus Europe: Results from a Global Survey
Keane G, Lam MGEH, Braat AJAT, Bruijnen RCG, Kaufmann N, de Jong HWAM, Salem R and Smits MLJ
Radioembolization Practice in North America Versus Europe: Results from a Global Survey
Keane G, Lam MGEH, Braat AJAT, Bruijnen RCG, Kaufmann N, de Jong HWAM, Salem R and Smits MLJ
The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) conducted an international survey on the real-life application of transarterial radioembolization (TARE). This sub-analysis of the complete survey evaluates intercontinental disparities in TARE practices.
Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging
Einstein AJ, Williams MC, Weir-McCall JR, Shaw LJ, Karthikeyan G, Better N, Vitola JV, Cerci RJ, Dorbala S, Bouyoucef SE, Choi AD, Pontone G, Ozkan E, Yang LD, Bremner L, Castillo M, Cohen YA, Malkovskiy E, Ayoola I, Veduta A, Yurystovskyi D, Pynda Y, Pascual TNB, Knoll P, Dondi M, Paez D and
Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging
Einstein AJ, Williams MC, Weir-McCall JR, Shaw LJ, Karthikeyan G, Better N, Vitola JV, Cerci RJ, Dorbala S, Bouyoucef SE, Choi AD, Pontone G, Ozkan E, Yang LD, Bremner L, Castillo M, Cohen YA, Malkovskiy E, Ayoola I, Veduta A, Yurystovskyi D, Pynda Y, Pascual TNB, Knoll P, Dondi M, Paez D and
In recent decades, there has been marked worldwide growth in diagnostic testing for coronary artery disease (CAD), with several common imaging modalities exposing patients to ionizing radiation.
Revisiting the F3 Peptide: In Vitro Investigations of C- and N-Terminally Modified Peptide Conjugates for Radiotracer Development
Anderla M, Grillmayr M, Huemer K and Mindt TL
Revisiting the F3 Peptide: In Vitro Investigations of C- and N-Terminally Modified Peptide Conjugates for Radiotracer Development
Anderla M, Grillmayr M, Huemer K and Mindt TL
: The F3 peptide, a tumor-homing peptide known to bind cell-surface nucleolin, is frequently employed as a targeting vector in cancer research. However, the impact of the modification site on its cellular binding properties has not been investigated yet. In this work, we aimed to design an improved F3-based radioconjugate by identifying the optimal conjugation site and establishing a protocol for its biological evaluation in vitro. To achieve this, we compared F3 peptide derivatives modified at their N- or C-termini with DOTA for complexation of indium-111 (In) for SPECT or Auger electron therapy or a fluorophore (FITC) for optical imaging. : N-and C-terminal DOTA-modified F3 peptides were radiolabeled with indium-111 and compared for their in vitro stability in different physiologically relevant media. Suitable nucleolin-positive cell lines for further in vitro studies were identified by confocal microscopy of a FITC-labeled F3 peptide derivative. The radioconjugates were then investigated on MDA-MB-231 (breast cancer) and PC-3 (prostate cancer) cells for nucleolin-specific cell binding and uptake, and several parameters of the in vitro assays were varied to establish a suitable protocol. : In general, in vitro assays with F3 peptide conjugates are challenging, as the outcome depends on a number of experimental parameters, leading, in some cases, to varying results. In particular, the presence of Ca and Mg had a decisive impact on the results, likely because the metal ions compete with the binding of F3 conjugates to nucleolin. The C-terminal modified, In-labeled F3 radioconjugate performed better than the N-terminal modified analog. While several parameters of the in vitro experiments were optimized, the overall cell uptake in vitro of radioactivity was still low (<2% of applied radioactivity). : A standardized in vitro protocol for evaluating F3 peptide conjugates on cancer cells was established, revealing that the C-terminus is the preferred site for modification. Because the cellular uptake of the radiotracer was shown to likely not be sufficient for radiotracer development, further studies on the optimization of the F3 peptide conjugates, including structural modifications, are required.
Teilbereich Nuklearmedizinische Therapie
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
Tumour-absorbed dose and efficacy of peptide receptor radionuclide therapy with [Y]Y-DOTATOC in patients with refractory meningioma: a single-centre experience
Schweiger L, Santo G, Kronthaler A, di Santo G, Iglseder S, Mangesius S, Mangesius J, Stock K and Virgolini I
The management of treatment-refractory meningioma in patients with previous surgical resection and radiation therapy remains challenging due to the lack of effective systemic treatment options. Therefore, novel therapeutic applications, such as peptide receptor radionuclide therapy (PRRT) targeting somatostatin receptors, may offer a promising therapeutic strategy. We aimed to assess the lesion-based tumour-absorbed dose and efficacy of PRRT with [Y]Y-DOTATOC in patients with treatment-refractory meningioma.
Peptide receptor radionuclide therapy in neuroendocrine tumours: advances, combination strategies, and future directions
Virgolini IJ, Di Santo G and Santo G
Peptide receptor radionuclide therapy in neuroendocrine tumours: advances, combination strategies, and future directions
Virgolini IJ, Di Santo G and Santo G
Peptide receptor radionuclide therapy (PRRT) has established itself as a pivotal component in the management of advanced, somatostatin receptor (SSTR)-positive neuroendocrine tumours (NETs). The NETTER-1 phase III trial demonstrated that [Lu]Lu-DOTATATE significantly prolongs progression-free survival (PFS) and improves quality of life in patients with midgut NETs refractory to somatostatin analogues, leading to regulatory approval by both EMA (2017) and FDA (2018). The recent NETTER-2 phase III trial further extended these findings by supporting the first-line use of PRRT in Grade 2 and 3 gastroentero-pancreatic (GEP)-NETs (Ki-67 ≥ 10 ≤ 55%). Beyond standard β-emitting therapy, several developments are reshaping the field: the clinical adoption of SSTR antagonists such as radiolabelled JR-11 and LM3, targeted α-particle-emitting therapies (Ac, Pb, Bi) for resistant disease, and rational combination strategies with chemotherapy, DNA-repair inhibitors, and immunotherapy. Parallel innovation in radiopharmaceutical chemistry has yielded new peptide ligands, including cholecystokinin-2 receptor (CCK2R)-targeted compounds such as DOTA-MGS5, which show promise for rare NETs such as medullary thyroid carcinoma (MTC) and small-cell lung cancer (SCLC). This review summarises clinical evidence, translational advances, and future perspectives for PRRT as a cornerstone of precision nuclear oncology. Emphasis is placed on expanding indications, integrating α-emitters, improving safety and dosimetry, and developing novel theragnostic ligands that enable personalised treatment strategies for NETs patients.
Real-world outcomes of [Lu]Lu-PSMA-I&T in [F]FDG-positive metastatic castration-resistant prostate cancer: factors related to response and survival
Santo G, di Santo G, Kronthaler A, Farsad M, Rossetti LM, Lehmann P, Scherbauer F, Cicone F and Virgolini IJ
Real-world outcomes of [Lu]Lu-PSMA-I&T in [F]FDG-positive metastatic castration-resistant prostate cancer: factors related to response and survival
Santo G, di Santo G, Kronthaler A, Farsad M, Rossetti LM, Lehmann P, Scherbauer F, Cicone F and Virgolini IJ
Little is known about predictors of response to radionuclide therapy with PSMA-ligands in patients with [F]FDG-positive metastatic castration-resistant prostate cancer (mCRPC). We assessed the correlation between baseline characteristics, including dual tracer PET parameters, and response to [Lu]Lu-PSMA-I&T in a cohort of patients with [F]FDG-positive mCRPC. Prognostic factors related to progression-free survival (PFS) and overall survival (OS) were also investigated.
Limitations in diagnostics and quantification of small lesions with low uptake in the clinical context of prostate F/Ga-PSMA PET/MRI
Lindemann ME, Jentzen W, Küper A, Costa PF, Gratz M, Umutlu L, Nagarajah J, Nekolla SG, Rausch I, Herrmann K, Quick HH and Kersting D
Limitations in diagnostics and quantification of small lesions with low uptake in the clinical context of prostate F/Ga-PSMA PET/MRI
Lindemann ME, Jentzen W, Küper A, Costa PF, Gratz M, Umutlu L, Nagarajah J, Nekolla SG, Rausch I, Herrmann K, Quick HH and Kersting D
The aim of this study was to investigate the limits of diagnostics and therapy planning for patients with prostate cancer using non-time-of-flight F/Ga-PSMA PET/MRI under clinically challenging imaging conditions with small lesion sizes and low uptake. Lesion detectability and quantification accuracy were evaluated for different acquisition and reconstruction parameters in a systematic phantom study and subsequent on patient data.
Peptide receptor radionuclide therapy alone or in combination with temozolomide plus/minus capecitabine in [F]FDG-positive metastatic neuroendocrine tumors
di Santo G, Santo G, Wirth L, Kronthaler A, Gastl G, Djanani A and Virgolini IJ
Peptide receptor radionuclide therapy alone or in combination with temozolomide plus/minus capecitabine in [F]FDG-positive metastatic neuroendocrine tumors
di Santo G, Santo G, Wirth L, Kronthaler A, Gastl G, Djanani A and Virgolini IJ
Recent data demonstrate that one possibility for increasing Peptide Receptor Radionuclide Therapy (PRRT) results lies in the combination of PRRT with chemotherapy. This study aimed to evaluate response and outcome in [F]FDG-positive metastatic neuroendocrine tumor (mNET) patients treated with PRRT alone or in combination with temozolomide (TEM) plus/minus capecitabine (CAP).
[Lu]Lu-DOTATATE for Recurrent Meningioma (LUMEN-1, EORTC-2334-BTG): Study Protocol for a Randomized Phase II Trial
Albert NL, Tabouret E, Le Rhun E, Sahm F, Furtner J, Tonn JC, Alfano C, Silva JP, Govaerts AS, Gorlia T, Mirante O, Minniti G, Weller M, Preusser M and
[Lu]Lu-DOTATATE for Recurrent Meningioma (LUMEN-1, EORTC-2334-BTG): Study Protocol for a Randomized Phase II Trial
Albert NL, Tabouret E, Le Rhun E, Sahm F, Furtner J, Tonn JC, Alfano C, Silva JP, Govaerts AS, Gorlia T, Mirante O, Minniti G, Weller M, Preusser M and
There are no established treatment options for patients with meningioma recurring after surgery and radiotherapy. Somatostatin receptor type 2 (SSTR2) is highly expressed in meningiomas, and SSTR2-targeting radionuclide therapy with [Lu]Lu-DOTATATE has shown potential activity in the treatment of meningioma in uncontrolled and small studies. EORTC-2334-BTG (LUMEN-1, NCT06326190) is a randomized, multicenter, phase II trial in patients with recurrent World Health Organization (WHO) grade 1, 2, or 3 meningioma. In total, 136 patients will be randomized in a 2:1 ratio to [Lu]Lu-DOTATATE (≤4 doses of 7.4 GBq given every 4 wk) or local standard of care (hydroxyurea, bevacizumab, sunitinib, octreotide, everolimus, or observation). The main eligibility criteria include age 18 y or older; neuropathologically confirmed meningioma of WHO grade 1, 2, or 3; WHO performance score of 0-2; measurable disease on MRI (≥10 × 10 mm); radiologically documented progression of any existing tumor (growth > 25% or new lesions) or appearance of new lesions within the last 2 y; SSTR positivity by PET imaging (SUV > 2.3); at least 1 prior surgery and at least 1 line of radiotherapy; and no prior systemic therapy. The primary efficacy endpoint is locally assessed progression-free survival according to Response Assessment in Neuro-Oncology MRI meningioma criteria, and secondary endpoints include radiologic response rate, overall survival, safety, health-related quality of life, and neurologic function. The trial protocol includes a comprehensive exploratory translational research program with dosimetry and imaging-based and tissue-based investigations. LUMEN-1 was activated in March 2025 and will enroll patients in 35 sites in 10 countries across Europe, with primary endpoint collection planned after 2 y and study completion after 5 y. To our knowledge, EORTC-2334-BTG (LUMEN-1, NCT06326190) is the first prospective randomized trial investigating the efficacy of [Lu]Lu-DOTATATE in patients with recurrent meningioma.
Rechallenge and Extended [Lu]Lu-PSMA Therapy in Metastatic Prostate Cancer
Mirshahvalad SA, Iravani A, Fendler WP, Maurer T, Eiber M, Sharifian F, Manoochehry S, Rendl G, Schweighofer-Zwink G, Pirich C, Sathekge M and Beheshti M
Rechallenge and Extended [Lu]Lu-PSMA Therapy in Metastatic Prostate Cancer
Mirshahvalad SA, Iravani A, Fendler WP, Maurer T, Eiber M, Sharifian F, Manoochehry S, Rendl G, Schweighofer-Zwink G, Pirich C, Sathekge M and Beheshti M
Continuation of effective and well-tolerated systemic treatment is often performed in care for metastatic castration-resistant prostate cancer. Likewise, continued administration of [Lu]Lu-PSMA radiopharmaceutical therapy beyond the approved number of cycles holds promising potential to enhance therapeutic efficacy. Rechallenge therapy involves readministration of [Lu]Lu-PSMA cycles after a break, whereas extended therapy continues treatment beyond the standard 6 cycles without interruption. Both approaches aim to improve disease control and prolong survival in patients with metastatic castration-resistant prostate cancer. However, practices vary: some clinicians continue treatment in patients with early favorable responses, whereas others recommend pausing therapy after significant prostate-specific antigen declines, even after a few cycles. In this narrative review, we show that safety profiles for continued [Lu]Lu-PSMA radiopharmaceutical therapy are generally favorable, and most adverse events are mild to moderate in severity. Hematotoxicity, particularly anemia and thrombocytopenia, is the most significant concern, with few patients experiencing high-grade adverse events. In addition, cumulative irradiation, particularly during extended therapy, necessitates careful monitoring of hematologic and renal function. Biochemical responses to rechallenge and extended [Lu]Lu-PSMA therapy are promising, with at least 50% reductions in prostate-specific antigen levels observed in a significant proportion of highly selected patients. Moreover, survival outcomes are encouraging, showing the extension of overall and progression-free survival beyond the known data for standard therapy. Despite these advances, challenges remain in optimizing patient selection, managing cumulative toxicities, and harmonizing treatment protocols. In addition, variability in trial designs, influenced by international regulatory differences, limits the current evidence and necessitates consideration of each treatment approach within its regulatory context. Prospective studies are needed to refine therapeutic strategies, implement consistent clinical and imaging response criteria, and identify predictive biomarkers to improve both efficacy and safety.
Paving the Way for CCK2R-Targeted Peptide Receptor Radionuclide Therapy with [Lu]Lu-DOTA-MGS5 in Patients with Small Cell Lung Cancer
Zavvar TS, Santo G, Gruber L, Kronthaler A, Hagenbuchner J, Skvortsova I, Piro I, Steiger K, Martinovic V, Minasch D, Löffler-Ragg J, di Santo G, Virgolini IJ and von Guggenberg E
Paving the Way for CCK2R-Targeted Peptide Receptor Radionuclide Therapy with [Lu]Lu-DOTA-MGS5 in Patients with Small Cell Lung Cancer
Zavvar TS, Santo G, Gruber L, Kronthaler A, Hagenbuchner J, Skvortsova I, Piro I, Steiger K, Martinovic V, Minasch D, Löffler-Ragg J, di Santo G, Virgolini IJ and von Guggenberg E
: Peptide receptor radionuclide therapy (PRRT) is an established treatment for neuroendocrine tumors (NETs), enabling targeted radiation delivery via radiolabeled peptides. Small cell lung cancer (SCLC) remains a major therapeutic challenge due to its aggressive nature and poor prognosis. Despite advances, relapse rates are high and effective therapies are limited. We previously demonstrated the diagnostic potential of the cholecystokinin-2 receptor (CCK2R)-targeting minigastrin analog [Ga]Ga-DOTA-MGS5 in PET/CT imaging of different NETs. Building on this, we developed and evaluated [Lu]Lu-DOTA-MGS5 as a therapeutic PRRT agent. : Preclinical studies investigating the receptor-mediated cellular internalization and intracellular distribution over time in A431 cells with and without CCK2R expression were performed using the fluorescent tracer ATTO-488-MGS5. Short- and long-term cytotoxic effects of [Lu]Lu-DOTA-MGS5 were evaluated on the same cell line using trypan blue exclusion and clonogenic survival assays. CCK2R expression was assessed by immunohistochemistry in 42 SCLC tissue specimens. In addition, the first PRRT with [Lu]Lu-DOTA-MGS5 was conducted in a patient with extensive disease SCLC (ED-SCLC) after confirming CCK2R-positive uptake in [Ga]Ga-DOTA-MGS5 PET/CT. : Rapid binding and internalization into A431-CCK2R cells, with progressive accumulation in intracellular compartments, was observed for ATTO-488-MGS5. Short-term irradiation effects of [Lu]Lu-DOTA-MGS5 were comparable for 4 h and 24 h incubation and were between the effects obtained with 2 and 4 Gy of external beam radiotherapy (EBRT). Clonogenic survival of A431-CCK2R cells incubated with increasing activity of [Lu]Lu-DOTA-MGS5 decreased in a dose-dependent manner. Immunohistochemistry on SCLC specimens confirmed moderate to high CCK2R expression in 16 out of 42 SCLC samples. In the first patient with SCLC treated with four cycles of [Lu]Lu-DOTA-MGS5 with a total activity of 17.2 GBq, an improvement in clinical symptoms was observed. : The preclinical and clinical results confirm the feasibility of [Lu]Lu-DOTA-MGS5 PRRT in patients with SCLC and support further clinical studies investigating the therapeutic value and clinical applicability of this new CCK2R-targeted theranostic approach in larger patient cohorts.
Rethinking Dosimetry: A European Perspective
Tran-Gia J, Cicone F, Koole M, Giammarile F, Gear J, Deshayes E, Minguez Gabiña P, Cremonesi M, Wadsley J, Bernhardt P, Bardiès M, Gnesin S, Sandström M, Garske-Román U, Revheim MR, Verburg FA, Konijnenberg M, Krause BJ, Lassmann M and Stokke C
Rethinking Dosimetry: A European Perspective
Tran-Gia J, Cicone F, Koole M, Giammarile F, Gear J, Deshayes E, Minguez Gabiña P, Cremonesi M, Wadsley J, Bernhardt P, Bardiès M, Gnesin S, Sandström M, Garske-Román U, Revheim MR, Verburg FA, Konijnenberg M, Krause BJ, Lassmann M and Stokke C
Radiopharmaceutical therapy (RPT) is entering a new era of personalization, driven by advances in molecular imaging, radiopharmaceutical development, and a growing body of clinical evidence linking absorbed dose to treatment outcomes. Although external-beam radiotherapy has long integrated dosimetry into standard practice, RPT historically relied on fixed radiopharmaceutical activities and absorbed dose-effect relationships adapted from external-beam radiotherapy, often without accounting for the unique pharmacokinetics, absorbed dose rate dynamics, and biologic responses of systemically administered radiopharmaceuticals. As RPT expands into earlier disease stages, at which patients have longer life expectancies and better performance status, the role of dosimetry in optimizing treatment is becoming increasingly evident. However, despite growing recognition of its benefits, the implementation of dosimetry in clinical practice remains limited, partly because of a self-reinforcing cycle in which the lack of routine dosimetry limits clinical evidence, which in turn hinders its broader adoption. Breaking this cycle is essential to advancing RPT and ensuring that evaluation of dosimetry is based on clinical merit rather than logistic constraints. This article examines the current landscape of RPT dosimetry, highlighting key challenges and opportunities from a European perspective and aiming to foster a more factual and constructive discussion on the topic. We discuss the fundamental differences between dosimetry-driven treatment planning and posttherapy absorbed dose verification, emphasizing the latter as a practical entry point for clinical adoption. We underscore the need for harmonized standards, improved imaging resolution, and tailored absorbed dose-effect relationships that reflect the heterogeneity of RPT delivery and the complexity of tumor and organ responses. The paper also addresses regulatory, infrastructural, and resource barriers to RPT dosimetry implementation and highlights ongoing European initiatives to strengthen frameworks, enhance stakeholder collaboration, and integrate absorbed dose biomarkers into authorization processes and clinical decision-making. By rethinking dosimetry and promoting standardized, evidence-based approaches, the field can advance beyond fixed-activity protocols toward truly individualized RPT. However, achieving clinically feasible integration of dosimetry into routine practice requires structured efforts to generate high-quality clinical evidence and improve accessibility. Ultimately, reliable, patient-centered dosimetry has the potential to enhance therapeutic efficacy, manage toxicity more effectively, and support the long-term evolution of RPT as a cornerstone of precision oncology.
Epidermal radionuclide therapy with rhenium-188 in non-melanoma skin cancer: a short narrative review
Castellucci P, Vetrone L, Baraldi C, Dika E, Zagni F, Strigari L, Martínez Albero E, Vega Pérez D, Mirzaei S and Fanti S
Epidermal radionuclide therapy with rhenium-188 in non-melanoma skin cancer: a short narrative review
Castellucci P, Vetrone L, Baraldi C, Dika E, Zagni F, Strigari L, Martínez Albero E, Vega Pérez D, Mirzaei S and Fanti S
Non-melanoma skin cancer (NMSC), represents the most common malignancy in fair-skinned populations and constitutes a growing public health burden. Although surgery remains the standard of care, a significant proportion of patients are poor surgical candidates due to age, comorbidities, tumor location or personal preference, highlighting the need for effective non-surgical alternatives.