Nuclear Medicine

First-line 18F-fluorocholine PET/CT is cost-effective for guiding minimally invasive parathyroidectomy

In primary hyperparathyroidism, first-line 18F-fluorocholine PET/CT led to higher normocalcemia after imaging-guided minimally invasive parathyroidectomy than 99mTc-sestamibi SPECT/CT (85% vs 56%). Mean total hospital cost was only about €137 higher with fluorocholine, a nonsignificant difference versus sestamibi. The incremental cost-effectiveness ratio was €471 per additional cured patient, stable across sensitivity analyses. From a payer perspective, fluorocholine PET/CT enables more successful outpatient minimally invasive parathyroidectomy at minimal extra cost. 1

68Ga-FAPI-46 PET/CT enhances staging and planning in advanced epithelial ovarian cancer

In 41 treatment-naive advanced epithelial ovarian cancer patients, 68Ga-FAPI-46 PET/CT significantly outperformed 18F-FDG PET/CT for peritoneal metastasis detection. FAPI showed superior sensitivity, specificity, and accuracy for pelvic, para-aortic, and extra-abdominal lymph node involvement. Staging was upgraded in 22% of patients and PET-based scores changed in 39% compared with FDG imaging. FAPI findings altered treatment decisions in 17.1% of cases, including selection for primary debulking versus alternative strategies. Tumor burden metrics from FDG and FAPI, particularly GTV and TL-FAPI, predicted incomplete cytoreduction at debulking surgery. 2

PRRT provides meaningful disease control in high-grade G3 GEP neuroendocrine neoplasms

This meta-analysis of seven studies (317 patients) assessed PRRT with 177Lu-DOTA-TATE and/or 90Y-labeled somatostatin analogues in grade 3 GEP-NENs. The pooled objective response rate was 34%, with a disease control rate of 64% by RECIST criteria. Pooled median progression-free survival was about 14 months, and median overall survival approximately 30 months. No publication bias was detected, supporting robustness of these estimates. Findings support PRRT as a viable option to achieve substantial disease control and delay progression in selected high-grade GEP-NENs. 3

18F-florbetazine shows early promise for PET detection of cardiac amyloidosis

Autoradiography showed high-affinity 18F-florbetazine binding to myocardial AL and ATTR deposits, with nanomolar dissociation constants. In rats, the tracer exhibited rapid myocardial and renal uptake followed by efficient clearance from normal tissues. In two healthy volunteers, myocardial and renal background activity was minimal by 40 minutes post-injection. A patient with biopsy-proven AL amyloidosis demonstrated intense delayed myocardial and renal uptake consistent with organ involvement. These integrated preclinical and initial clinical data justify larger trials of florbetazine PET for non-invasive cardiac amyloidosis detection. 4