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Introduction: Breast cancer is a complex disease and constitutes the leading cause of cancer in women globally. Conventional treatment modalities include surgery, chemotherapy, radiation therapy, and hormonal therapy; all of these have their limitations and often result in significant side effects or toxicity. Targeted radionuclide therapy based on a theranostic approach has been successfully applied in several malignancies, such as prostate cancer, thyroid cancer, and neuro-endocrine tumours. Several studies have also highlighted the potential of theranostic applications in breast cancer. Aim: This review aims to provide an overview of the most promising current and future theranostic approaches in breast cancer. Discussion: The discussion includes pre-clinical as well as clinical data on some of the most successful targets used to date. Examples of potential theranostic approaches include those targeting the Human epidermal growth factor receptor 2 (HER2) expression, angiogenesis, aspects of the tumour microenvironment, Gastrin-releasing peptide receptor (GRPR), Prostate-specific membrane antigen (PSMA) and Chemokine receptor 4 (CXCR-4) expression. Several challenges to widespread clinical implementation remain, which include regulatory approval, access to the various radiopharmaceuticals and imaging technology, cost-effectiveness, and the absence of robust clinical data. Conclusion: Theranostic approaches have the potential to greatly improve diagnosis, treatment, and outcomes for patients with breast cancer. More research is needed to fully explore the potential of such approaches and to identify the best potential targets, considering feasibility, costs, efficacy, side effects and outcomes. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a major global health problem. Theragnostic is a term that refers to the integration of diagnostic and therapeutic modalities into a single system for personalized medicine. Theragnostic care in HCC involves the use of imaging techniques to diagnose the cancer and assess its characteristics, such as size, location, and extent of spread. Theragnostics involves the use of molecular and genetic tests to identify specific biomarkers that can help guide treatment decisions and, post-treatment, assess the dosimetry and localization of the treatment, thus guiding future treatment. This can be done through either positron emission tomography (PET) scanning or single photon emission tomography (SPECT) using radiolabeled tracers that target specific molecules expressed by HCC cells or radioembolization. This technique can help identify the location and extent of the cancer, as well as provide information on the tumor's metabolic activity and blood supply. In summary, theragnostics is an emerging field that holds promise for improving the diagnosis and treatment of HCC. By combining diagnostic and therapeutic modalities into a single system, theragnostics can help guide personalized treatment decisions and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim/Purpose: Fibroblast activation protein-(FAP)-ligands, a novel class of tracers for PET/CT imaging, demonstrated promising results in previous studies in various malignancies compared to standard [18F]FDG PET/CT. 68Ga-labeled fibroblast activation protein inhibitor-([68Ga]Ga-DOTA-FAPI)-PET/CT impresses with sharp contrasts in terms of high tumor uptake and low background noise leading to clear delineation. [18F]FDG PET/CT has limited accuracy in bladder cancer due to high background signal. Therefore, we sought to evaluate the diagnostic potential of [68Ga]FAPI in patients with bladder cancer. Material and Methods: This retrospective analysis consisted of 8 patients (median age 66), 7 of whom underwent both [68Ga]FAPI and [18F]FDG PET/CT scans with a median time interval of 5 days (range 1–20 days). Quantification of tracer uptake was determined with SUVmax and SUVmean. Furthermore, the tumor-to-background ratio (TBR) was derived by dividing the SUVmax of tumor lesions by the SUVmax of adipose tissue, skeletal muscle, and blood pool. Results: Overall, 31 metastases were detected in five patients including lymph node metastases (n = 23), bone metastases (n = 4), lung metastases (n = 3), and a peritoneal metastasis (n = 1). In one patient, [68Ga]FAPI demonstrated significant uptake in the primary tumor located in the bladder wall. [68Ga]FAPI-PET/CT demonstrated significantly higher uptake compared to [18F]FDG PET/CT with higher mean SUVmax (8.2 vs. 4.6; p = 0.01). Furthermore, [68Ga]FAPI detected additional 30% (n = 9) lesions, missed by [18F]FDG. TBR demonstrated favorable uptake for [68Ga]FAPI in comparison to [18F]FDG. Significant differences were determined with regard to metastasis/blood pool ([68Ga]FAPI 5.3 vs [18F]FDG 1.9; p = 0.001). Conclusion: [68Ga]FAPI-PET/CT is a promising diagnostic radioligand for patients with bladder cancer. This first described analysis of FAP-ligand in bladder cancer revealed superiority over [18F]FDG in a small patient cohort. Thus, this so far assumed potential has to be confirmed and extended by larger and prospective studies. [ABSTRACT FROM AUTHOR]

This article is part of the Topical Collection on Infection and Inflammation Introduction The COVID-19 pandemic is in transition. Nuclear medicine patients Patients, being encouraged to follow proper hygiene procedures, are something that remains relevant during the transition phase and also in a post-COVID-19 world. Nuclear medicine imaging Currently, most nuclear medicine departments are reducing patient numbers by cutting down on the appointments given for routine, elective studies, and focusing on more urgent cases. [Extracted from the article]

Abstract Background The clinical utility of radiomics is hampered by a high correlation between the large number of features analysed which may result in the “bouncing beta” phenomenon which could in part explain why in a similar patient population texture features identified and/or cut-off values of prognostic significance differ from one study to another. Principal component analysis (PCA) is a technique for reducing the dimensionality of large datasets containing highly correlated variables, such as texture feature datasets derived from FDG PET images, increasing data interpretability whilst at the same time minimizing information loss by creating new uncorrelated variables that successively maximize variance. Here, we report on PCA of a texture feature dataset derived from 123 malignant melanoma lesions with a significant range in lesion size using the freely available LIFEx software. Results Thirty-eight features were derived from all lesions. All features were standardized. The statistical assumptions for carrying out PCA analysis were met. Seven principal components with an eigenvalue > 1 were identified. Based on the “elbow sign” of the Scree plot, only the first five were retained. The contribution to the total variance of these components derived using Varimax rotation was, respectively, 30.6%, 23.6%, 16.1%, 7.4% and 4.1%. The components provided summarized information on the locoregional FDG distribution with an emphasis on high FDG uptake regions, contrast in FDG uptake values (steepness), tumour volume, locoregional FDG distribution with an emphasis on low FDG uptake regions and on the rapidity of changes in SUV intensity between different regions. Conclusions PCA allowed to reduce the dataset of 38 features to a set of 5 uncorrelated new variables explaining approximately 82% of the total variance contained within the dataset. These principal components may prove more useful for multiple regression analysis considering the relatively low numbers of patients usually included in clinical trials on FDG PET texture analysis. Studies assessing the superior differential diagnostic, predictive or prognostic value of principal components derived using PCA as opposed to the initial texture features in clinical relevant settings are warranted.

The cathelicidin-derived peptide (CDP1) is a human antimicrobial peptide that preferentially targets bacterial membranes in response to infection. CDP1 was functionalised with NODAGA and DOTA for complexation with gallium-68 to evaluate its potential as an infection imaging tracer. The synthesis of [68Ga]Ga–NODAGA–CDP1 and [68Ga]Ga–DOTA–CDP1 were optimised for pH, molarity, incubation time and temperature, and product purification. The integrity and protein binding were investigated employing [68Ga]GaCl3 and [68Ga]Ga–DOTA–TATE as internal references. [68Ga]Ga–NODAGA–CDP1 displayed good labelling properties with higher product yield compared to [68Ga]Ga–DOTA–CDP1. In contrast, [68Ga]Ga–DOTA–CDP1 showed better stability and is the preferred candidate for an in vivo investigation. [ABSTRACT FROM AUTHOR]

Dear Editor, Xeroderma pigmentosum (XP) is a rare, autosomal, recessive disease caused by defective repair of UV-induced DNA lesions due to various genetic defects affecting genes involved in the nucleotide excision repair pathway. Ocular lesions were prominent, as mentioned in a well-documented clinical study of patients with XP from South Africa.[2] Neurological examination was unremarkable in all patients. Two families were diagnosed with XP-D ( I ERCC2 i gene) while the analysis was inconclusive in two young patients (aged 4 and 6 years), who could benefit from whole exome/genome analysis. [Extracted from the article]

The article indicates that targeted radionuclide therapy has the potential to selectively deliver radiation to diseased cells with minimal toxicity to surrounding tissues. It observes that the process of tailoring therapy for a patient is based on selecting appropriate radiopharmaceuticals and mechanisms. The article also suggests that peptide receptor radionuclide therapy (PRRNT) as the treatment of choice in adult patients with neuro-endocrine cancer who are inoperable or who have metastases.

Summary Aim: The goal of the study is to correlate serum calcium levels with the results of dual-phase 99mTc-sestamibi parathyroid scintigraphy to find the best cut-off level of the serum calcium that correlates with a positive presurgery. Methods: In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the 99mTc-MIBI scintigraphy and with this data determined the level of calcium above which the 99mTc-MIBI scintigraphy was likely to be positive and below which the study was likely to be negative. Results: In total, 11 men (18%) and 50 women (82%) had a positive 99mTc-MIBI study. Overall 67% of those patients with a positive 99mTc-MIBI study had a PTH >200 ng l−1 compared to only 9% of those with a negative 99mTc-MIBI scintigraphy; however, for those with a positive study on an early 99mTc-MIBI scintigraphy, this rose to 85%. Overall a serum calcium of >2·70 mmol l−1 was found in 82% of patients with a positive 99mTc-MIBI study but only 14% of those with a negative 99mTc-MIBI study, this is rose to 97% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l−1 rarely have positive 99mTc-MIBI scintigraphy. Conclusion: 99mTc-MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend 99mTc-MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l−1. [ABSTRACT FROM AUTHOR]

Bladder artifact during bone single-photon emission computed tomography (SPECT) is a common source of error. The extent and severity of bladder artifacts have been described for filtered back projection (FBP) reconstruction. Ordered subset expectation maximization (OSEM) may help to address this problem of bladder artifacts, which render up to 20% of the SPECT images unreadable. The objective of this study was to evaluate the relationship of the bladder to acetabulum ratio in guiding the choice of the number of iterations and subsets used for OSEM reconstruction, for reducing bladder artifacts found on FBP reconstruction. One hundred five patients with various indications for bone scans were selected and planar and SPECT images were acquired. The SPECT images were reconstructed with both FBP and OSEM using four different combinations of iterations and subsets. The images were given to three experienced nuclear physicians who were blinded to the diagnosis and type of reconstruction used. They then labeled images from the best to the worst after which the data were analyzed. The bladder to acetabulum ratio for each image was determined which was then correlated with the different iterations and subsets used. The study demonstrated that reconstruction using OSEM led to better lesion detectability compared to FBP in 87.62% of cases. It further demonstrated that the iterations and subsets used for reconstruction of an image correlate with the bladder to acetabulum ratio. Four iterations and 8 subsets yielded the best results in 48.5% of the images, whilst 2 iterations and 8 subsets yielded the best results in 33.8%. The number of reconstructed images which yielded the best results with 2 iterations and 8 subsets was the same as or more than those with 4 iterations and 8 subsets when the bladder/acetabulum ratio (A/B) was between 0.2 and 0.39. A ratio below 0.2 or above 0.39 supports the usage of 4 iterations and 8 subsets over 2 iterations and 8 subsets. We conclude that bladder to acetabulum ratio can be used to select the optimum number of iterations and subsets for reconstruction of bone SPECT for accurate characterization of lesions. This study also confirms that reconstruction with OSEM (vs. FBP) leads to better lesion detectability and characterization. [ABSTRACT FROM AUTHOR]