Nuclear Medicine

FDG PET/CT markedly improves NSCLC recurrence detection versus CT in high-risk surveillance windows

This secondary analysis of the SUPE_R randomized trial compared 899 FDG PET/CT and 852 CT scans in 692 stage IA–IIIC NSCLC patients after curative therapy. For recurrence detection, PET/CT showed higher sensitivity than CT (88% vs 62%) but lower specificity (89% vs 96%). Sensitivity gains were greatest after chemoradiotherapy (100% vs 46%) and in the first 0–6 months post-treatment (83% vs 41%). The authors conclude PET/CT is especially valuable for high-risk periods, whereas CT remains preferable for routine low-risk surveillance due to better specificity. 1

Preoperative PSMA PET staging improves biochemical outcomes in high-risk prostate cancer

This multi-institutional cohort included 1,475 high-risk cN0M0 prostate cancer patients undergoing radical prostatectomy with ePLND staged by PSMA PET or conventional imaging. After propensity matching, PSA persistence was lower with PSMA PET staging than with conventional imaging (3.2% vs 14%). Thirty-six–month biochemical recurrence-free survival was higher with PSMA PET than with conventional imaging (90.9% vs 82.2%). On multivariable analysis, PSMA PET independently predicted reduced biochemical recurrence risk (HR 0.48; 95% CI 0.29–0.77). 2

FDG PET status and change predict outcomes after PRRT rechallenge in metastatic NETs

This multicenter retrospective study followed 100 advanced/metastatic NET patients treated with PRRT rechallenge using serial SSTR and FDG PET/CT. Half of patients were FDG-positive before first PRRT, and many changed FDG status after each PRRT course, including conversions to FDG-negative or FDG-positive. NET grade 3 and FDG positivity after the first PRRT independently predicted shorter time to progression on multivariate analysis. FDG positivity after both the first and second PRRT periods independently predicted worse overall survival after long-term follow-up. Bone metastases strongly correlated with FDG positivity before and after first PRRT, identifying a poorer-prognosis subgroup. 3

Systematic review maps extensive nonmalignant uptake patterns on FAPI PET

This updated rapid systematic review synthesized 380 studies reporting 8,230 nonmalignant FAPI PET findings across anatomical regions. Most reports came from China and were case reports or small series, reflecting early, heterogeneous clinical experience. Frequent oncologic pitfalls included FAPI uptake in infectious and inflammatory diseases, fibrotic processes, and benign neoplasms. Emerging nonmalignant indications included interstitial lung disease, cardiac conditions, and various arthritides. The authors emphasize careful clinical correlation and structural imaging to avoid misclassifying benign FAPI-avid foci as malignancy. 4