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Purpose: For several years, oncological positron emission tomography (PET) has developed beyond 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG). This umbrella review of meta-analyses aims to provide up-to-date, comprehensive, high-level evidence to support appropriate referral for a specific radiopharmaceutical PET/computed tomography (CT) or PET/magnetic resonance (MR) in the diagnosis and staging of solid cancers other than brain malignancies. Methods: We performed a systematic literature search on the PubMed/MEDLINE and EMBASE databases for meta-analyses assessing the accuracy of PET/CT and/or PET/MRI with [18F]FDG, somatostatin- receptor-targeting 68Ga-DOTA-peptides, 18F-labelled dihydroxyphenylalanine ([18F]DOPA), prostate-specific membrane antigen (PSMA)-targeted radioligands, and fibroblast activation protein inhibitors (FAPI) in the diagnosis/disease characterisation and staging of solid cancers other than brain tumours. Results: The literature search yielded 449 scientific articles. After screening titles and abstracts and applying inclusion and exclusion criteria, we selected 173 meta-analyses to assess the strength of evidence. One article was selected from references. Sixty-four meta-analyses were finally considered. The current evidence corroborates the role of [18F]FDG as the main player in molecular imaging; PSMA tracers are useful in staging and re-staging prostate cancer; somatostatin-targeting peptides (e.g. [68Ga]Ga- DOTA-TOC and -TATE) or [18F]DOPA are valuable in neuroendocrine tumours (NETs). FAPI has emerged in gastric cancer assessment. According to search and selection criteria, no satisfactory meta-analysis was selected for the diagnosis/detection of oesophageal cancer, the diagnosis/detection and N staging of small cell lung cancer and hepatic cell carcinoma, the diagnosis/detection and M staging of melanoma and Merkel cell carcinoma, cervical, vulvar and penis cancers, the N and M staging of lung and gastroenteropancreatic NET, testicular cancer, and chondrosarcoma, and the M staging of differentiated thyroid, bladder and anal cancers. Conclusion: The comprehensive high-level evidence synthesised in the present umbrella review serves as a guiding compass for clinicians and imagers, aiding them in navigating the increasingly intricate seascape of PET examinations. [ABSTRACT FROM AUTHOR]

The editorial discusses technological advancements and radiopharmaceutical innovations in nuclear medicine, focusing on cardiac perfusion assessment, intraoperative PET imaging, and novel radiopharmaceuticals targeting various biological pathways in oncology and neurology. The editorial highlights advancements in scanner technology, such as digital PET and LAFOV PET, as well as dedicated PET scanners for specific anatomical regions. It also discusses the potential of radiopharmaceuticals like [18F] FES, PSMA-targeted agents, and FAPI inhibitors in improving tumour detection and personalized treatment. The editorial emphasizes the importance of balancing technological advancements and radiopharmaceutical innovation to advance patient care in nuclear medicine. [Extracted from the article]

This document is an editorial from the European Journal of Nuclear Medicine & Molecular Imaging that discusses the potential of molecular imaging in predicting and managing various diseases. The editorial emphasizes the importance of well-designed studies and high-quality methodology in producing clinical evidence. It provides an overview of selected research articles published in the Annals of Nuclear Medicine in 2022, which focus on the predictive and prognostic value of nuclear medicine imaging for different diseases. The studies cover a range of topics and suggest that certain imaging parameters can be significant predictors of various outcomes. The authors express optimism about the future potential of nuclear medicine imaging in improving patient care. [Extracted from the article]

Aim: Unspecific bone uptake is one of the main limitations of PET imaging with some PSMA-targeting radiopharmaceuticals, especially with [18F]PSMA-1007. We explored the potential association between osteoporosis and the occurrence of unspecific [18F]PSMA-1007 bone uptake investigating markers which might correlate with bone mineral density. Materials and methods: We retrospectively analyzed treatment-naïve patients with a confirmed diagnosis of prostate adenocarcinoma who underwent staging [18F]PSMA-1007 positron emission tomography (PET). Qualitative image analysis was performed independently by three experienced nuclear medicine physicians. Patients were divided in two groups according to the presence/absence of unspecific bone uptake. Clinical information, blood count parameters (assessed within 3 months to the PET scan), body mass index (BMI), and bone density as estimated by computed tomography were collected. The Kruskal–Wallis and t-test were used to compare parameters. Results: We analyzed 77 patients: 29 of them (38%) had unspecific bone uptake at [18F]PSMA-1007 PET, most commonly in the pelvic bones (69%) and ribs (62%). We did not find any significant difference in clinical parameters in the two groups. In patients with unspecific bone uptake, white blood cell, and neutrophil counts were significantly higher; in the same group, we observed lower values of BMI and bone density, although not statistically different. Conclusions: We observed unspecific bone uptake on [18F]PSMA-1007 PET in more than 1/3 of patients. In this exploratory analysis, we found a significant correlation between blood count parameters and unspecific [18F]PSMA-1007 bone uptake. We may speculate that [18F]PSMA-1007 unspecific bone uptake could be associated with osteoporosis. This hypothesis needs to be further investigated in larger populations and exploring more specific markers of osteoporosis. [ABSTRACT FROM AUTHOR]

Such scenario has changed significantly when PSMA-ligand PET entered the scene, in particular, following the publication of proPSMA, the first prospective, randomised, multi-centre trial comparing [ SP 68 sp Ga]Ga-PSMA-11 PET/CT with standard-of-care imaging in the staging setting [[12]]. Subsequent studies have also confirmed PSMA-ligand PET/CT as the current most sensitive and specific imaging technique for lymph node staging, identifying pathological lymph nodes up to approximately 5 mm, with even better performance as the PCa risk increases [[13]]. Since the discovery of PSMA as a specific target for prostate cancer (PCa) cells, PSMA-binding radiopharmaceuticals gradually revolutionised the management of patients, getting a salient place in the spotlight of a florid scientific debate and academic activity over the past decade [[1]]. European guidelines update on PSMA PET/CT for prostate cancer staging - snap back to reality. [Extracted from the article]

The article discusses the challenges posed by unspecific bone uptakes (UBUs) in PSMA PET imaging. UBUs are incidental findings that can mimic metastatic bone disease, leading to potential misdiagnosis and inappropriate treatment decisions. The article highlights the complexity of the issue and the limitations of using Standardised Uptake Values (SUVs) to differentiate UBUs from bone metastases. It emphasizes the importance of a comprehensive and holistic approach to interpreting medical images, considering all relevant clinical data. The article concludes by advocating for diagnostic strategies that prioritize specificity and patient outcomes. [Extracted from the article]

Present and future of target therapies and theranostics: refining traditions and exploring new frontiers - highlights from annals of Nuclear Medicine 2021 Conclusions This editorial spotlighted the central role of radionuclide therapy in the field of nuclear medicine showing the booming preclinical and clinical research on targeted therapy and theranostics, from the well-established treatment with iodine-131, to theranostics of neuroendocrine tumours and metastatic castration-resistant prostate cancer, to the field of new drug development. Iodine-131 is the standard of care treatment not only in hyperthyroidism, but also in well-differentiated thyroid cancer, for thyroid remnant ablation, adjuvant purposes and persistent/recurrent disease treatment [[23]]. Springer; 2021;35:529-39. 17 Huang K, Schatka I, Rogasch JMM, Lindquist RL, De Santis M, Erber B. Explorative analysis of a score predicting the therapy response of patients with metastatic, castration resistant prostate cancer undergoing radioligand therapy with 177Lu-labeled prostate-specific membrane antigen. [Extracted from the article]

This document is a response to a letter to the editor regarding a systematic review on unspecific bone uptake (UBU) in PSMA PET. The authors of the response clarify their stance on the matter, agreeing that the radionuclide fluorine-18 is not the primary factor behind UBUs. They emphasize the importance of a nuanced approach to interpreting these findings and recognize the capabilities and limitations of various PSMA-targeting agents without undermining their utility in clinical practice. The authors hope that their clarification will contribute to the ongoing discussion on the appropriate use and interpretation of PSMA PET imaging. [Extracted from the article]

Optical imaging in lung cancer - follow the light, towards molecular imaging-guided precision surgery Lung cancer is one of the most common and lethal neoplasms, representing the leading cause of cancer-related death [[1]]. 10 Azari F, Kennedy G, Bernstein E, Delikatny J, Lee JYK, Kucharczuk J. Evaluation of OTL38-generated tumor-to-background ratio in intraoperative molecular imaging-guided lung cancer resections. [Extracted from the article]

8381142 4 Liu G, Hu P, Yu H. Ultra-low-activity total-body dynamic PET imaging allows equal performance to full-activity PET imaging for investigating kinetic metrics of 18F-FDG in healthy volunteers. 10.1007/s00259-020-05173-3. 33479842 5 Alberts I, Hünermund JN, Prenosil G. Clinical performance of long axial field of view PET/CT: a head-to-head intra-individual comparison of the Biograph Vision Quadra with the Biograph Vision PET/CT. 10.1007/s00259-021-05207-4. 33594473 3 Li Y, Vigneron DB, Xu D. Current human brain applications and challenges of dynamic hyperpolarized carbon-13 labeled pyruvate MR metabolic imaging. [Extracted from the article]