Nuclear Medicine

PROACTIF: prospective 989-patient cohort supports high-dose 90Y glass microspheres across HCC stages

In this prospective all-comers cohort of 989 HCC patients, Y90 glass microspheres achieved a median overall survival of 21.8 months. Survival remained favorable in advanced disease, including 21.1 months for BCLC C and meaningful outcomes in patients with portal-vein tumor thrombosis. Multicompartment dosimetry predominated, with a strong dose–survival relationship and markedly longer survival above 200–400 Gy index-lesion doses. About 11% of patients underwent curative-intent surgery after radioembolization, showing a median overall survival of 48.6 months in this subgroup. Serious adverse events occurred in 7.5% of patients, with 3.7% treatment-related, and median time to quality-of-life deterioration was 10.6 months. 1

Bone-marrow MRD and PET-CT provide complementary, prognostic information in multiple myeloma

This meta-analysis pooled 10 cohorts with 1138 paired bone-marrow MRD and PET-CT assessments in multiple myeloma. Overall concordance was modest, with 60% observed agreement and a pooled κ of 0.14, indicating low statistical agreement between tests. Discordance predominantly reflected MRD-positive/PET-CT-negative patterns, highlighting distinct disease compartments interrogated by marrow versus imaging. In five cohorts with progression-free survival data, dual MRD-/PET-CT- negativity was associated with markedly longer progression-free survival (pooled HR 0.34). 2

Nodal SUVmax thresholds sharpen PSMA PET/CT nodal staging in intermediate/high-risk prostate cancer

This international multicentre study included 521 prostate cancer patients undergoing preoperative PSMA PET/CT and extended pelvic lymph node dissection. Standard PSMA PET/CT yielded 45.0% sensitivity, 94.3% specificity, and 64.7% positive predictive value for lymph node invasion. Adding a nodal SUVmax cutoff ≥4.9 increased positive predictive value to 81.1% and sensitivity to 71.4% for nodal invasion. Combining nodal SUVmax with PSA ≥10 ng/mL, MRI T-stage ≥T3a, and miT-stage ≥T3a identified 95% of pathological N1 cases in a high-risk group. 3

Structured, quantitative approaches refine FDG PET/CT and WBC SPECT/CT for complex infection imaging

This review summarizes best practices for F18-FDG PET/CT and radiolabeled leukocyte SPECT/CT in complex infectious disease evaluation. It emphasizes standardized acquisition protocols and multiparametric, quantitative interpretation instead of purely visual assessment. Integration of functional data with CT morphology is stressed to distinguish active infection from sterile inflammation and postoperative or degenerative changes. The article details pharmacologic confounders, technical artifacts, and biological mimics, and advocates structured reporting to convey clear, actionable conclusions. 4