Search Results (454)

Primary bone tumors encompass a heterogeneous spectrum ranging from benign entities to highly aggressive sarcomas. This review aims to summarize the current role and future perspectives of nuclear medicine in the diagnosis, staging, and management of primary bone tumors. Accurate diagnosis and staging are critical yet challenging due to histologic heterogeneity and overlapping imaging features. While radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) remain essential, nuclear medicine provides a complementary functional perspective by assessing bone turnover, vascularity, and glucose metabolism. Bone scintigraphy is highly sensitive for skeletal lesions and useful for detecting skip lesions or multifocal disease, although its specificity is limited. Hybrid single-photon emission computed tomography (SPECT)/CT enhances diagnostic confidence through precise anatomic localization and quantitation. [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET)/CT, by directly visualizing tumor metabolism, has become a cornerstone in osteosarcoma and Ewing sarcoma management, demonstrating superiority over bone scintigraphy for detecting skeletal metastases. In chondrosarcoma, [¹⁸F]FDG uptake correlates with histologic grade, although overlap with benign cartilage tumors complicates interpretation. Future directions include the integration of quantitative SPECT, artificial intelligence, and novel tracers such as [¹⁸F]sodium fluoride and [⁶⁸Ga]Ga-fibroblast activation protein inhibitor (FAPI). Collectively, nuclear medicine imaging is becoming a key element in musculoskeletal oncology, offering unique biological insights that complement anatomic imaging and contribute to improved patient management. Full article

Background/Objectives: Pulmonary nodules (PNs) are a common incidental finding on conventional imaging. Differentiating benign from malignant lesions remains a diagnostic challenge. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has become an essential imaging modality in this setting. This review aims to evaluate the clinical impact of PET/CT parameters and techniques, focusing on semi-quantitative imaging biomarkers and dual-time-point imaging. Methods: This review is organized into three main sections. First, qualitative analysis and PET key metrics are analyzed, including standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indices, highlighting their diagnostic and prognostic significance. The second section focuses on the clinical utility of dual-time-point imaging (DTPI), evaluating its ability to differentiate between benign and malignant PNs through changes in SUV over time (ΔSUVmax). We compare these advanced imaging approaches with histopathological diagnosis, the current gold-standard method, highlighting the potential of advanced PET/CT techniques in clinical decision-making. The last section focuses on future applications of PET/MR, artificial intelligence, and PET radiomics. Results: Evidence indicates that high SUV, MTV, and TLG values are significantly associated with malignant PNs and aggressiveness. Moreover, DTPI with ΔSUV, ΔMTV, and ΔTLG further enhances specificity and accuracy in characterizing PNs. Despite a lack of standardization, studies have shown better accuracy when advanced PET/CT parameters are used. Conclusions: While DTPI and semi-quantitative PET parameters are not yet universally adopted in daily clinical practice, evidence supports their role in enhancing the characterization of indeterminate PNs. More prospective studies are needed. Full article

The diagnosis of behavioral variant of frontotemporal dementia (bvFTD)—a common cause of early-onset dementia—remains challenging due to a lack of determined biomarkers. 18F-fluorodeoxyglucose-positron emission tomography (FDG–PET) scan detects early glucose metabolism alterations in specific brain regions. The detection of distinct hypometabolic patterns in early stages of bvFTD has established FDG–PET as an indispensable adjunctive diagnostic tool in inconclusive cases, as well as in distinguishing between different types of dementia. Moreover, its role in the differential diagnosis of the often overlapping bvFTD and primary psychiatric disorders (PPD) is being studied by exploring disease-specific hypometabolic areas. Finally, the identification of early metabolic alterations and even earlier alterations in distinct metabolic brain networks may assist the diagnosis of presymptomatic carriers of disease-related gene mutations and lead to the development of novel biomarkers. The aim of our review is to underscore the role of FDG–PET as an approved yet promising tool that may lead to a new era in the diagnosis of bvFTD by establishing novel biomarkers and integrating AI as an assistant modality to inform diagnosis and decision-making. Full article

Background/Objectives: Nivolumab has significantly improved outcomes in patients with metastatic non-small cell lung cancer (NSCLC); however, reliable prognostic biomarkers remain an unmet need. To address this gap, we developed the SUVmax-IPI, a novel prognostic index combining maximum standardized uptake value (SUVmax) from ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) with systemic inflammatory markers. This study aimed to evaluate the prognostic value of SUVmax-IPI in patients with NSCLC receiving nivolumab therapy. Methods: This multicenter retrospective analysis included 187 patients with metastatic NSCLC receiving nivolumab across 5 tertiary institutions. The SUVmax-IPI incorporated pretreatment SUVmax and laboratory-based inflammatory prognostic index (IPI) parameters. Survival outcomes were evaluated using Kaplan–Meier analysis with log-rank testing and multivariate cox regression. Results: Receiver operating characteristic (ROC) analysis established an optimal SUVmax-IPI cut-off of 241.9. Patients with SUVmax-IPI ≤ 241.9 had significantly better survival outcomes: median overall survival (OS) was 35 versus 15 months (p = 0.002). For progression-free survival (PFS), although a numerical difference favored patients with SUVmax-IPI ≤ 241.9 (median: 15 vs. 8 months), this did not reach statistical significance (log-rank p = 0.175). Multivariate analysis confirmed SUVmax-IPI as an independent predictor of survival (p = 0.002). Conclusions: The SUVmax-IPI represents a promising prognostic tool for patients with metastatic NSCLC who received at least 3 months of nivolumab, integrating metabolic and inflammatory parameters to predict survival outcomes. Full article

Background: Non-invasive diagnostic tools for the assessment of pulmonary arterial hypertension (PAH) are currently being intensively studied. Positron emission tomography (PET)/computed tomography (CT) with [18F]-fluorodeoxyglucose ([18F]-FDG) and [13N]-ammonia is the gold standard for assessing myocardial metabolism and perfusion. The relationship between right ventricle (RV) myocardial metabolism and perfusion and cardiopulmonary exercise testing (CPET) has not been studied. Objective: to evaluate correlations between the CPET parameters and RV perfusion and metabolism in IPAH patients. Methods: The study comprised 34 IPAH patients (34.2 ± 8.9 years, 4 males, 6 prevalent). Myocardial metabolism and perfusion were assessed using PET/CT with [18F]-FDG and [13N]-ammonia, respectively. CPET, cardiac MRI and invasive hemodynamics were also evaluated. Results: Significant negative correlations were registered between [18F]-FDG and [13N]-ammonia uptake by the RV (SUVmax _RV/LV) and the oxygen consumption, oxygen pulse and positive correlation with the ratio of minute ventilation to carbon dioxide production. The low-risk IPAH patients significantly differed from the intermediate-to-high-risk group in CPET indices and in SUVmax _RV/LV metabolism and SUVmax _RV/LV perfusion parameters. No reliable differences in CPET indices and [18F]-FDG and [13N]-ammonia uptake by the RV were registered between intermediate- and high-risk patients. Conclusions: CPET is a reliable non-invasive diagnostic tool that could distinguish low-risk young IPAH patients without comorbidities from those at intermediate-to-high risk. Significant correlations between CPET parameters and RV myocardial metabolism and perfusion indices, MRI, and invasive hemodynamics confirm the high diagnostic value for CPET. Full article

18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) could be useful to assess inflammation of the aortic wall, a potential early indicator of aneurysm formation. Nonetheless, its current clinical assessment presents several limitations. The study aimed to develop and validate an innovative technique to obtain thoraco-abdominal aortic wall PET uptake maps. PET/magnetic resonance (MR) was acquired in 82 patients with aortic aneurysms. The thoraco-abdominal aorta was segmented and expanded inward and outward (by 1 to 5 mm) and discretized into 80 standardized wall patches. Standard uptake values (SUV) were calculated for each patch and the thrombus. For inter-observer reproducibility, a second blinded observer analyzed 26 random patients. Validation against manual expert measurements was performed. The feasibility of the patch-wise PET analysis was 98.4%. Inter-observer Dice scores were 0.89 for lumen and 0.82 for thrombus segmentations. SUV mapping presented excellent reproducibility, modestly improving with wall thickness (ICC 0.950 to 0.966), while its agreement with expert measurements improved with thinner walls (ICC 0.848 to 0.755). An optimal balance between reproducibility and accuracy was obtained at 6 mm wall thickness. Reproducible and accurate thoraco-abdominal aortic wall 18F-FDG uptake maps can be obtained from PET/MR, potentially facilitating the exploration of local factors associated with vascular inflammation. Full article

Intraosseous hibernoma (IOH) is a rare benign tumor composed of brown adipose tissue within the bone, frequently mimicking metastatic lesions and leading to diagnostic challenges. This systematic review aimed to consolidate and analyze all published IOH cases to improve recognition and inform management. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, Google Scholar, and the Cochrane Library from database inception to March 2025. Studies were eligible for inclusion if they reported histopathologically confirmed cases of intraosseous hibernoma (IOH) in human patients. A total of 62 cases from 30 studies were included. The mean age was 59.2 years, with a female predominance. Lesions were most frequently located in the pelvis and spine and were typically identified incidentally during cancer staging or imaging performed for unrelated indications. Imaging often revealed sclerotic patterns on computed tomography (CT), hyperintense signals on magnetic resonance imaging (MRI) T2-weighted and short tau inversion recovery (STIR) sequences, and mild to moderate uptake on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT). Immunohistochemistry consistently showed S100 protein positivity. Most patients underwent biopsy and were managed conservatively, with no cases of malignant transformation reported. IOH is a benign entity with distinctive radiologic and immunohistochemical features that may mimic malignancy. Awareness of its presentation can reduce misdiagnosis and unnecessary interventions, supporting biopsy-based confirmation and conservative management in most cases. Full article

Background/Objectives: The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, is a known predictor of cardiovascular disease and overall mortality. We examined the relationship between the NLR and the metabolic activity of hematopoietic organs and visceral fat, and their association with the risk of atherosclerotic cardiovascular disease (ASCVD) in an asymptomatic healthy population. Methods: We retrospectively analyzed individuals who underwent F-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) as part of their health check-ups. Metabolic activity was quantified using standardized uptake values (SUVs) from the lumbar vertebral bone marrow, spleen, visceral, and subcutaneous fat, normalized to target-to-background ratios (TBRs) using the superior vena cava. NLR was calculated from absolute neutrophil and lymphocyte counts. Correlations between NLR, clinical parameters, organ TBRs, and ASCAD risk were analyzed. Results: Among 303 participants from three hospitals, the median NLR was 1.5 (range: 0.5–5.55). NLR showed weak correlation with the TBRs of bone marrow, visceral fat, and subcutaneous fat, as well as high-density lipoprotein cholesterol and body mass index (BMI). In logistic regression analysis adjusted for age and sex, BMI and the TBRs of bone marrow and visceral fat were independent predictors of elevated NLR (≥ 1.5). When integrating these parameters, NLR demonstrated strong predictive performance for identifying a high ASCVD risk (≥20% over 10 years), with an area under the curve of 0.826. Conclusions: In an asymptomatic healthy population, NLR is associated with FDG metabolic parameters of hematopoietic organs and adipose tissue. These combined measures may serve as valuable marker for identifying individuals at elevated ASCVD risk. Full article

The purpose was to determine the ability of 18-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) scans performed within 24 h of percutaneous image-guided ablation of primary and metastatic malignancies to predict ablation effectiveness and local tumor progression (LTP). This single-center retrospective review included patients who underwent image guided ablation (microwave ablation (MWA), cryoablation, or irreversible electroporation (IRE)) between August 2018 and February 2024 for primary and metastatic malignancies. The primary outcome measure encompassed correlating post-ablation 18F-FDG PET-CT findings with LTP development per tumor, assessed using the chi-square test. The secondary outcome measure was local tumor progression-free survival (LTPFS) per tumor, evaluated using the Kaplan–Meier survival curves, and potential confounders were identified in multivariable analysis utilizing Cox proportional hazards regression models. A total of 132 patients, who underwent 159 procedures for 224 tumors, were included. During follow-up, LTP developed in 120 out of 224 tumors (53.6%). The presence of residual nodular 18F-FDG avidity on PET-CT within 24 h after the ablation significantly correlated with the development of LTP at follow-up imaging (p < 0.001). The positive predictive value of nodular 18F-FDG avidity was 86.7%. In multivariable analysis, the hazard ratio (HR) for 18F-FDG avidity was 2.355 (95% CI 1.614–2.647; p < 0.001). The presence of 18F-FDG avidity on PET-CT within 24 h after the ablation was highly correlated with development of LTP and decreased LTPFS. The detection of residual tumor tissue may allow early re-treatments, especially in tumors with nodular uptake, contributing to increased LTPFS. Full article

Modern external beam radiotherapy (EBRT) on lung cancer improved dose distribution thanks to advanced dose calculation algorithms, but side effects and relapses can occur in any case onset. Differential diagnosis of relapses and side effects is difficult, and when computed tomography (CT) is uncertain 18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) can support the diagnosis, even if it can also be difficult to construe. The aim of this retrospective analysis was to evaluate 18F-FDG PET/CT qualitative patterns and semiquantitative parameters, both automatic and preceded by physicians, in interpreting lung lesions in the radiotherapy (RT) lung irradiation field. In total, 94 patients (pts) submitted to EBRT (3 months before) for stage II lung cancer were included (74 men, 20 women, mean age of 68 years old, range of 49–84 years old). CT scans were performed on pts, which showed lung lesions in the RT field. 18F-FDG-PET/CT scans were analyzed qualitatively as negative or positive, and the presence of the lung area with a high 18F-FDG uptake pattern was distinguished as the following: focal/wide, deep/shade, or homogeneous/inhomogeneous. Furthermore, the following semiquantitative parameters were collected: gSUVmax (global standardized uptake value max), MTV (tumor metabolic volume), metabolic spatial distribution (MSD) = proximal SUVmax/distal SUVmax, and intratumoral difference in spatial distribution (IDSD%) = [distal SUVmax/proximal SUVmax] × 100. 18F-FDG PET/CT was related to the pts’ outcome (biopsy and/or clinical–instrumental follow-up): positive for lung relapse, negative if the lesions were phlogistic. The following diagnostic performance parameters of 18F-FDG PET/CT were calculated: sensitivity (Sens), specificity (Spec), diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV). Qualitative variables were compared by Chi-squared test, while for semiquantitative parameters Student’s t-test was applied; p < 0.05 was considered statistically significant. Statistics tests were performed with MedCalc V.22.018 ©2024. In 76/94 (80.8%) pts, 18F-FDG uptake was higher compared to the background; in 18/94 (19.2%) no high 18F-FDG uptake areas were detected. Outcome was positive for lung relapse in 49/94 pts, while negative in 45/94, with disease prevalence of 52.13% (95%CI = 41.57–62.54%). In the 18/94 pts without high 18F-FDG uptake, the outcome was negative for lung relapse. In 49/76 pts with higher 18F-FDG uptake, the outcome confirmed the presence of relapse, while in 27/76 the lesion was phlogistic. Results about the Sens, Spec, DA, PPV, and NPV (95%CI) were, respectively: 100% (92.75–100%), 40% (25.7–55.67%), 71.28% (61.02–80.14%), 64.47% (58.84–69.73%), and 100% (81.47–100%). Chi-square test showed significant statistical difference between the positive and negative outcome for patterns focal/wide (p = 0.02) and deep/shade (p < 0.00001). A total of 35/49 (71.4%) pts with lung relapse had a focal lesion and 15/27 (55.6%) with phlogosis had a wide pattern. A total of 34/49 (69.4%) pts with lung relapse had a deep pattern and 25/27 (92.6%) with lung phlogosis had the shade one. Significant difference was observed in evaluating the three patterns (p = 0.00007), with prevalence of “focal/deep/homogeneous” patterns in lung relapse and “wide/shade/inhomogeneous” in phlogosis. gSUVmax, MTV, MSD, and IDSD% were in the following order: in the 76 pts, 5.63 (1.4–24.7), 42.49 (4.94–193), 3.61 (1–5.54), and 70.7% (18–100%); in the 49/76 true positive pts, 6.93 (1.5–24.7), 35.28 (4.94–85.99), 3.30 (1.05–5.54), and (18–95%); in the 27/76 false positive pts, 3.27 (1.4–19.2), 38.37 (4.94–193), 1.57 (1–2.13), and 78.6% (4.7–100%). The difference was statistically significant only for MSD (t = 2.779; p = 0.0069) and IDSD% (t = 2.769; p = 0.0071). 18F-FDG-PET/CT confirms its high sensitivity and NPV in evaluating lung lesions after RT. To improve physician confidence in interpreting lung 18F-FDG uptake without further support, MSD and IDSD% could be considered. Heterogeneity of lung lesions, especially in radiotreated tissue, can be turned from a drawback to a resource and analyzed for differentiating relapses from EBRT side effects. Considering the calculation of semiquantitative parameters that require “human intelligence”, even if slightly more time-consuming, can improve the nuclear physician’s confidence in interpreting 18F-FDG PET/CT images. Full article

Background/Objectives: Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with a strong clinical impact on patients affected by the disease and a challenging diagnosis. Methods: This comprehensive narrative review evaluates the role of [18F]fluorodesoxyglucose ([18F]FDG) positron emission tomography (PET)-based radiomics and machine learning (ML) analyses in the assessment of CS. Results: The value of [18F]FDG PET-based radiomics and ML has been investigated for the clinical settings of diagnosis and prognosis of patients affected by CS. Even though different radiomics features and ML models have proved their clinical role in these settings in different cohorts, the clear superiority and added value of one of them across different studies has not been demonstrated. In particular, textural analysis and ML showed high diagnostic value for the diagnosis of CS in some papers, but had controversial results in other works, and may potentially provide prognostic information and predict adverse clinical events. When comparing these analyses with the classic semiquantitative evaluation, a conclusion about which method best suits the final objective cannot be drawn with the available references. Different methodological issues are present when comparing different papers, such as image segmentation and feature extraction differences that are more evident. Furthermore, the intrinsic limitations of radiomics analysis and ML need to be overcome with future research developed in multicentric settings with protocol harmonization. Conclusions: [18F]FDG PET-based radiomics and ML show preliminary promising results for CS evaluation, but remain investigational tools since the current evidence is insufficient for clinical adoption due to methodological heterogeneity, small sample sizes, and lack of standardization. Full article

Objective: To evaluate the diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (¹⁸F-FDG PET/MR) in the preoperative staging of hypopharyngeal cancer (HPC), compare it with conventional enhanced computed tomography (CT) and MR, and further explore the prognostic value of its metabolic and diffusion metrics for HPC. Methods: This retrospective study included 33 patients with pathologically confirmed HPC. All patients underwent preoperative ¹⁸F-FDG PET/MR, CT, and MR examination. The staging performance of the three modalities was evaluated using pathological staging as a reference. Additionally, metabolic indicators and diffusion-related parameters from PET/MR were collected to investigate their impact on larynx preservation and survival. Results: PET/MR demonstrated accuracies of 90.9% and 71.4% in the preoperative T and N staging, respectively, significantly higher than those of CT (54.5%, p = 0.001; 42.9%, p = 0.021) and MR (66.7%, p = 0.016; 42.9%, p = 0.021). On the whole, significant differences emerged in the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), minimum apparent diffusion coefficient (ADCmin), and mean ADC (ADCmean) and combined ratios across different T stages, while SUVmax, mean SUV (SUVmean), total lesion glycolysis (TLG), and MTV varied significantly across different N stages. The ADCmin and ADCmean showed good predictive capability for larynx preservation, with AUCs of 0.857 and 0.920 (p < 0.05), respectively. In Cox multivariate analysis of overall survival, high-level ADCmean (p = 0.004) and low-level TLG/ADCmean (p = 0.022) were significantly associated with better survival. Conclusion: In HPC, ¹⁸F-FDG PET/MR imaging significantly surpasses CT and MR in preoperative diagnostic staging. Its diffusion-related parameters have substantial prognostic value, with high ADC values associated with larynx preservation. ADCmean and TLG/ADCmean are potential prognostic indicators for HPC. Full article

Immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have revolutionized cancer therapy, substantially improving survival across a broad range of malignancies. However, these agents are associated with a unique profile of endocrine immune-related adverse events (irAEs), including thyroiditis, hypophysitis, adrenalitis, and pancreatitis, which differ significantly from the toxicities seen with conventional chemotherapy. These complications often arise unpredictably during treatment and may result in irreversible hormone deficiencies requiring lifelong replacement, underscoring the importance of early detection. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) has emerged as a valuable tool not only for oncologic staging and response assessment but also for detecting metabolic changes in endocrine organs. PET/CT can identify irAEs before the appearance of clinical symptoms or biochemical abnormalities. Emerging evidence suggests that the presence of endocrine irAEs identified by ¹⁸F-FDG PET/CT may correlate with improved treatment response and survival, possibly reflecting enhanced immune activation. This comprehensive review discusses the role of ¹⁸F-FDG PET/CT in the early recognition of therapy-induced endocrine toxicities, facilitating timely intervention through hormone replacement or immunosuppressive therapy while minimizing unnecessary treatment interruptions. Effective integration of metabolic imaging with clinical and laboratory evaluation requires coordinated multidisciplinary collaboration among oncologists, endocrinologists, and nuclear medicine physicians to optimize outcomes and reduce endocrine-related morbidity in the era of precision oncology. Full article

We aimed to establish non-invasive diagnostic models comparable to pathology testing and explore reliable digital imaging biomarkers to classify diffuse large B-cell lymphoma (DLBCL) and invasive ductal carcinoma (IDC). Our study enrolled 386 breast nodules from 279 patients with DLBCL and IDC, which were pathologically confirmed and underwent ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) examination. Patients from two centers were separated into internal and external cohorts. Notably, we introduced 2.5D deep learning and machine learning to extract features, develop models, and discover biomarkers. Performances were assessed using the area under curve (AUC) and confusion matrix. Additionally, the Shapley additive explanation (SHAP) and local interpretable model-agnostic explanations (LIME) techniques were employed to interpret the model. On the internal cohort, the optimal model PT_TDC_SVM achieved an accuracy of 0.980 (95% confidence interval (CI): 0.957–0.991) and an AUC of 0.992 (95% CI: 0.946–0.998), surpassing the other models. On the external cohort, the accuracy was 0.975 (95% CI: 0.913–0.993) and the AUC was 0.996 (95% CI: 0.972–0.999). The optimal imaging biomarker PET_LBP-2D_gldm_DependenceEntropy demonstrated an average accuracy of 0.923/0.937 on internal/external testing. Our study presented an innovative automated model for DLBCL and IDC, identifying reliable digital imaging biomarkers with significant potential. Full article

Background: Despite its central role in pediatric pre-surgical evaluation of drug-resistant focal epilepsy, conventional analog ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT (aPET) systems often yield modest epileptogenic zone (EZ) detection rates (~50–60%). Silicon photomultiplier–based digital PET/CT (dPET) promises enhanced image quality, but its performance in pediatric epilepsy remains untested. Methods: We retrospectively analyzed 22 children (mean age 11.5 ± 2.6 years) who underwent interictal brain ¹⁸F-FDG PET/CT: 11 on an analog system (Discovery ST, 2018–2019) and 11 on a digital system (Biograph Vision 450, 2020–2021). Three blinded nuclear medicine physicians independently scored EZ localization and image quality (4-point scale); post-surgical histology and ≥1-year clinical follow-up served as reference. Results: The EZ was correctly identified in 8/11 analog scans (72.7%) versus 10/11 digital scans (90.9%). Average image quality was significantly higher with dPET (3.0 ± 0.9 vs. 2.1 ± 0.9; p < 0.05), and inter-reader agreement improved from good (ICC = 0.63) to excellent (ICC = 0.91). Conclusions: Our preliminary findings suggest that dPET enhances image clarity and reader consistency, potentially improving localization accuracy in pediatric epilepsy presurgical workups. Full article