Nuclear Medicine

Molecular PET and theranostics are reshaping lung disease imaging beyond FDG

This review details how PET/CT, PET/MRI, and total-body PET enable precision imaging in malignant and nonmalignant lung disease. FDG PET/CT remains central for lung cancer staging and response assessment, but newer tracers target amino acids, receptors, angiogenesis, and hypoxia. Immuno-PET and FAPI PET improve lesion detection and treatment stratification in scenarios where FDG is limited or nonspecific. Theranostic approaches such as 68Ga-DOTATATE/177Lu-DOTATATE in lung neuroendocrine tumors align diagnostic imaging with targeted radionuclide therapy. In interstitial lung disease, radiolabeled FAPI and dual-tracer FDG+FAPI PET may help separate inflammatory from fibrotic components. The authors foresee multitracer, total-body protocols that integrate diagnosis with image-guided theranostics to individualize pulmonary care. 1

FDG PET/CT offers substantial diagnostic and prognostic information in FUO

This review summarizes evidence that whole-body FDG PET/CT often identifies occult oncologic, infectious, or inflammatory causes of FUO. FDG PET/CT shows good diagnostic performance and affects management in more than half of FUO cases, including pediatric and critically ill patients. A negative FDG PET scan is associated with favorable prognosis and can help exclude several serious underlying entities. The authors highlight ongoing uncertainty about optimal timing and placement of PET/CT within FUO diagnostic algorithms. Future directions include LAFOV PET/CT and specific infection or inflammation tracers to improve sensitivity and specificity. 2

Interim PSMA-PET tumor volume independently predicts survival in high-risk mCRPC

This ENZA-p sub-study evaluated 3-month PSMA-total-tumor-volume (PSMA-TTV) from 68Ga-PSMA-11 PET/CT as a prognostic biomarker in mCRPC. Among 152 randomized patients with interim scans, any PSMA-TTV increase versus decrease at 3 months predicted shorter overall survival. Higher residual 3-month PSMA-TTV above the median was associated with markedly shorter survival and lower 2-year survival probability. These associations were independent of treatment arm and PSA response, indicating PSMA-TTV adds prognostic information beyond conventional markers. The data support further validation of interim PSMA-PET volumetrics as response criteria and as stratification tools in PSMA-targeted trials. 3