Radiotracing the Future: Non-FDG Radiotracers Nuclear Medicine.

Positron Emission Tomography/Computed Tomography (PET/CT) is an advanced hybrid imaging modality that synergistically combines metabolic and anatomical data, revolutionizing diagnostic accuracy and therapeutic monitoring in various pathologies. While 18F-fluorodeoxyglucose (FDG) remains the cornerstone radiotracer for many oncologic and nononcologic applications, its limitations-such as nonspecific uptake in inflammation and limited sensitivity in certain tumor subtypes-have catalyzed the development and clinical adoption of non-FDG radiotracers. These novel agents exhibit diverse biological targets, enabling more precise characterization of tissue physiology and pathology.

Optimization and scale-up of [Ga]Ga-FAPI-46 production on a Modular-Lab PharmTracer platform for clinical application.

Background: Due to the increasing application of the fibroblast activation protein (FAP) targeting radiotracer [Ga]Ga-FAPI-46 in cancer diagnostics by PET/CT, there is a need for a convenient way for routine production of high activities of this tracer. The aim of the current work is the optimization and scale-up of an automated method for [Ga]Ga-FAPI-46 production on a PharmTracer module using two GalliaPharm generators.

Results: Several labeling conditions were evaluated and the best results were obtained with 40 μg of precursor, 3 mg ascorbic acid as anti-radiolysis agent, 0.

Identification of PET/CT radiomic signature for classification of locally recurrent rectal cancer: A network-based feature selection approach.

Background: The modern approach to treating rectal cancer, which involves total mesorectal excision directed by imaging assessments, has significantly enhanced patient outcomes. However, locally recurrent rectal cancer (LRRC) continues to be a significant clinical issue. Identifying LRRC through imaging is complex, due to the mismatch between fibrosis and inflammatory pelvic tissue.

[68Ga]Ga-FAPI-46 PET/CT for Staging Suspected/Confirmed Lung Cancer: Results on the Surgical Cohort Within a Monocentric Prospective Trial.

Background/objectives: To evaluate T&N-staging diagnostic performance of [68Ga]Ga-FAPI-46 PET/CT (FAPI) in a suspected/confirmed lung cancer surgical cohort.

Methods: Patients were enrolled in a prospective monocentric trial (EudraCT: 2021-006570-23) to perform FAPI, in addition to conventional-staging-flow-chart (including [18F]F-FDG PET/CT-FDG). For the current purpose, only surgical patients were included.

The role of combined FDG and SST PET/CT in neuroendocrine tumors.

Somatostatin receptor (SST) positron emission tomography with computed tomography (PET/CT) is the gold standard for functional imaging of neuroendocrine tumors (NETs), but FDG PET/CT is increasingly recognized for its prognostic value, particularly for higher-grade NETs and to detect disease heterogeneity. Despite the established role of pathological grading, clinical heterogeneity within the tumor burden often complicates accurate prognostication. Evidence suggests FDG PET/CT can outperform WHO grading in predicting outcomes by identifying aggressive, undifferentiated tumor clones that influence long-term prognosis and treatment decisions.

Radionuclide Theranostics in Neuroendocrine Neoplasms: An Update.

Purpose Of Review: This paper aims to address the latest findings in neuroendocrine tumor (NET) theranostics, focusing on new evidence and future directions of combined diagnosis with positron emission tomography (PET) and treatment with peptide receptor radionuclide therapy (PRRT).

Recent Findings: Following NETTER-1 trial, PRRT with [177Lu]Lu-DOTATATE was approved by FDA and EMA and is routinely employed in advanced G1 and G2 SST (somatostatin receptor)-expressing NET. Different approaches have been proposed so far to improve the PRRT therapeutic index, encompassing re-treatment protocols, combinations with other therapies and novel indications.

State-of-the-Art Hybrid Imaging of Neuroendocrine Neoplasms.

Neuroendocrine neoplasms (NENs) may be challenging to diagnose due to their small size and diverse anatomical locations. Hybrid imaging techniques, specifically positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI), represent the current state-of-the-art for evaluating NENs. The preferred radiopharmaceuticals for NEN PET imaging are gallium-68 (68Ga) DOTA-peptides, which target somatostatin receptors (SSTR) overexpressed on NEN cells.

Future Imaging of Prostate Cancer: Do We Need More Than PSMA PET/CT?

In the setting of prostate cancer (PCa), many different imaging modalities are available to correctly assess staging, restaging, treatment response and radio-ligand therapy recruitment. The introduction of fluoride or gallium-labelled prostate specific membrane antigen (PSMA) made a revolution in PCa management, also due to its possible theragnostic use. Nowadays PSMA-PET/CT is a fundamental tool for staging and restaging PCa.

Molecular imaging Theranostics of Neuroendocrine Tumors.

Neuroendocrine neoplasms (NEN) are rare and heterogeneous tumors, originating mostly from the gastro-entero-pancreatic (GEP) tract followed by the lungs. Multidisciplinary discussion is mandatory for optimal diagnostic and therapeutic management. Well-differentiated NEN (NET) present a high expression of somatostatin receptors (SSTR) and can be studied with [68Ga]-DOTA-peptides ([68Ga]Ga-DOTANOC, [68Ga]Ga-DOTATOC, [68Ga]Ga-DOTATATE) PET/CT to assess disease extension and the eligibility for peptide receptor radionuclide therapy (PRRT).

[68Ga]Ga-DOTANOC Uptake at Pancreatic Head/Uncinate Process: Is It a Persistent Diagnostic Pitfall Over Time?

Purpose: [68Ga]Ga-DOTA-peptide uptake in the pancreatic head/uncinate process (UP) is a frequent PET/CT finding. Although mostly physiologic, it can represent a pitfall in PET/CT reading, especially when focal. An increased frequency of UP uptake has been reported in patients (pts) affected by diabetes mellitus (DM).

New PET Radiotracers for the Imaging of Neuroendocrine Neoplasms.

Neuroendocrine neoplasms (NEN) are a heterogeneous group of tumours derived from cells of neuroendocrine origin and can potentially arise everywhere in the human body. The diagnostic assessment of NEN can be performed using a variety of PET radiopharmaceuticals. Well-differentiated NEN (NET) present a high expression of SSTR (somatostatin receptors) and can therefore be studied with 68Ga-DOTA-peptides ([68Ga]Ga-DOTANOC, [68Ga]Ga-DOTATOC, [68Ga]Ga-DOTATATE).

Two birds with one stone: can [68Ga]Ga-DOTANOC PET/CT image quality be improved through BMI-adjusted injected activity without increasing acquisition times?

Objectives: To assess how patients' dependent parameters may affect [68Ga]Ga-DOTANOC image quality and to propose a theoretical body mass index (BMI)-adjusted injected activity (IA) scheme, to improve imaging of high weight patients.

Methods: Among patients prospectively enrolled (June-2019 and May-2020) in an Institutional Ethical Committee-approved electronic archive, we included those affected by primary gastro-entero-pancreatic (GEP) or lung neuroendocrine tumour and referred by our Institutional clinicians (excluding even minimal radiopharmaceutical extravasation, movement artefacts, renal insufficiency). All PET/CT images were acquired following EANM guidelines and rated for visual quality (1 = non-diagnostic, 2 = poor, 3 = moderate, 4 = good).

Radiolabeled Somatostatin Analogues for Diagnosis and Treatment of Neuroendocrine Tumors.

Neuroendocrine neoplasms (NENs) are rare and heterogeneous tumors that require multidisciplinary discussion for optimal care. The theranostic approach (DOTA peptides labelled with Ga for diagnosis and with Y or Lu for therapy) plays a crucial role in the management of NENs to assess disease extension and as a criteria for peptide receptor radionuclide therapy (PRRT) eligibility based on somatostatin receptor (SSTR) expression. On the diagnostic side, [Ga]Ga-DOTA peptides PET/CT (SSTR PET/CT) is the gold standard for imaging well-differentiated SSTR-expressing neuroendocrine tumors (NETs).

Can Q.Clear reconstruction be used to improve [68 Ga]Ga-DOTANOC PET/CT image quality in overweight NEN patients?

Aim/introduction: Digital PET/CT allows Q.Clear image reconstruction with different Beta (β) levels. However, no definitive standard β level for [68 Ga]Ga-DOTANOC PET/CT has been established yet.