Search Results (2,626)

Background/Objectives: Routine liver biopsies play an important role in monitoring liver allografts but carry non-negligible risks. This pilot study assesses the feasibility of dynamic long-axial field-of-view (LAFOV) [¹⁸F]FDG PET/CT as a non-invasive alternative to biopsy. Methods: Liver transplant (LTx) recipients meeting the inclusion criteria of ≥10 months post-transplantation and scheduled routine biopsy were prospectively enrolled, along with healthy controls. All participants underwent dynamic LAFOV [¹⁸F]FDG PET/CT, followed by biopsy in LTx recipients, who were stratified by inflammatory severity using the BANFF score. Hepatic kinetic parameters (K1, k2, k3, k4) and SUVmean/SUVmax were compared using Mann–Whitney U tests. Correlations were assessed using Spearman’s rank correlation. A p-value < 0.05 was considered significant. Analyses were performed in RStudio (version 2024.12.10563). Results: Sixteen LTx recipients (mean age 48.6 years; seven female, nine male) and eight healthy controls (mean age 35.4 years; six female, two male) were included. Healthy controls had mean k3 and k4 values of 0.0037 min⁻¹ ± 0.0003 min⁻¹ and 0.0019 min⁻¹ ± 0.0011 min⁻¹, respectively. LTx recipients showed significantly higher k3 and k4 values, both when including and excluding patients with biopsy-confirmed inflammation. Descriptive comparisons between LTx recipients with and without significant inflammation (n = 3) showed no clear differences. Spearman analysis showed no significant correlations between the BANFF score and kinetic parameters. The strongest degree of correlation was found between BANFF score and k3, indicating a moderate positive but non-significant association (k3: rs = 0.396, p = 0.128). Conclusions: Elevated k3 and k4 values in LTx recipients were not explained by allograft inflammation, suggesting altered FDG kinetics post-transplant. These differences may confound [¹⁸F]FDG PET interpretation. Larger studies are needed to assess the clinical applicability of dynamic LAFOV [¹⁸F]FDG PET/CT. Full article

Background/Objectives: Psoriatic disease is a systemic inflammatory condition associated with increased cardiometabolic risk, but the impact of contemporary systemic therapies and narrowband ultraviolet B (NB-UVB) phototherapy on vascular and systemic inflammatory markers remains incompletely characterized. We aimed to systematically synthesize prospective evidence on treatment-associated changes in vascular inflammation and systemic inflammatory biomarkers in adults with moderate-to-severe psoriatic disease. Specifically, we evaluated changes assessed by 18F-FDG PET/CT imaging and circulating biomarkers following biologic therapies or NB-UVB phototherapy. Methods: We systematically searched MEDLINE, Embase, Web of Science, Scopus, and CENTRAL from inception to 31 January 2026 for prospective interventional and observational studies in adults with psoriasis or psoriatic arthritis treated with biologic agents targeting TNF-α, IL-12/23, IL-17, or IL-23, or with NB-UVB phototherapy. Eligible studies were required to report serial assessments of vascular inflammation by 18F-FDG PET/CT (typically aortic target-to-background ratio) and/or systemic inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, TNF-α, GlycA, or hematologic indices such as the neutrophil-to-lymphocyte ratio) over at least 8 weeks of follow-up. We imposed no language restrictions and included only full-text, peer-reviewed prospective studies. Risk of bias was evaluated using RoB 2 for randomized trials and ROBINS-I for nonrandomized studies. Random-effects meta-analyses were prespecified for outcomes reported by at least two clinically comparable studies; however, because of substantial heterogeneity in reporting and methodology, effect estimates were summarized using a structured narrative synthesis. Results: Thirteen prospective studies (n ≈ 900 adults, published 2015–2025) met inclusion criteria, including four studies with serial 18F-FDG PET/CT imaging and one additional PET/CT study providing baseline observational data on vascular inflammation, as well as eight biomarker-focused prospective cohorts. Across randomized mechanistic trials and observational studies, biologic therapies reduced aortic target-to-background ratio by approximately 6–12% over 12–24 weeks (e.g., mean change from 2.42 to 2.18 with TNF-α inhibition and from 2.51 to 2.20 with IL-17 blockade), and no study reported worsening of PET-derived vascular indices under effective systemic treatment. Biologic and other systemic therapies produced concordant reductions in hs-CRP (typically by 30–50%), IL-6, TNF-α, GlycA, and blood-count-derived indices including neutrophil-to-lymphocyte ratio, with biomarker improvements frequently paralleling reductions in cutaneous disease activity and cardiometabolic risk markers. Two NB-UVB cohorts demonstrated significant hs-CRP reductions of roughly 20–30% and modulation of vitamin D-related inflammatory proteins, suggesting systemic anti-inflammatory effects, although these changes appeared less pronounced than with biologic therapy and were not accompanied by vascular imaging. Conclusions: Contemporary systemic psoriasis therapies, particularly biologic agents targeting the IL-23/Th17 axis and TNF-α, are associated with consistent reductions in aortic vascular inflammation and broad improvements in systemic inflammatory biomarkers, whereas NB-UVB phototherapy confers more modest but measurable systemic anti-inflammatory effects, although the current evidence does not allow differentiation between individual biologic classes in terms of magnitude of effect. Although reductions in vascular and systemic inflammatory markers were observed across therapies targeting TNF-α, IL-12/23, IL-17, and IL-23, the small number of mechanistic imaging studies and absence of head-to-head comparisons do not allow robust differentiation between biologic classes or support a uniform class effect. The convergence of imaging and biomarker data reinforces psoriasis as a clinically relevant model of inflammation-driven atherosclerosis and supports the concept that effective control of psoriatic inflammation may contribute to cardiovascular risk modification, highlighting the need for integrated cardiovascular risk assessment in routine care. However, the imaging evidence base remains limited to four small mechanistic PET/CT studies with relatively short follow-up, which constrains the strength and generalizability of conclusions regarding vascular inflammation. Larger, adequately powered, event-driven prospective trials with standardized imaging and biomarker endpoints are needed to determine whether these vascular and systemic anti-inflammatory effects translate into reduced cardiovascular events in psoriatic disease; because of methodological and reporting heterogeneity across the 13 included studies, these conclusions are based on a structured narrative synthesis rather than a formal quantitative meta-analysis. PROSPERO registration number: CRD420261296646. Full article

Background and Clinical Significance: Pancreatic neuroendocrine tumors (pNETs) rarely exhibit intraductal growth, a pattern that may mimic intraductal papillary mucinous neoplasms (IPMNs) or pancreatic ductal adenocarcinoma (PDAC). Preoperative recognition is challenging, particularly when associated with anatomic variants such as pancreas divisum. Case Presentation: A 63-year-old man with a history of pancreatic duct dilation presented with pruritus, weight loss, and lymphadenopathy. Cross-sectional imaging revealed a cephalopancreatic mass with upstream ductal dilatation. EUS demonstrated a hypervascular lesion with intraductal extension into the dorsal duct in the setting of pancreas divisum. EUS-FNB confirmed a well-differentiated pNET (G1) with loss of DAXX expression and preserved ATRX. Ga-68 PET/CT showed intense uptake in the primary lesion and lower-grade uptake in two additional nodules, later proven non-neoplastic. A multidisciplinary tumor board recommended preoperative optimization with somatostatin analog therapy and supervised weight reduction, followed by pylorus-preserving duodenocephalopancreatectomy. Final pathology confirmed NET G1 with intraductal growth and full concordance with preoperative EUS-FNB findings. Conclusions: in this case, a pNET showed intraductal growth within the dorsal duct in the context of pancreas divisus, further expanding the range of its reported presentations. It underscores the diagnostic value of EUS-FNB for morphologic, proliferative, and molecular characterization, and highlights the importance of multidisciplinary evaluation in guiding preoperative optimization and tailored surgical management. Full article

Low-count positron emission tomography (PET) is inherently affected by Poisson-dominated noise, which degrades image contrast, structural delineation, and quantitative reliability. This study systematically evaluated residual learning-based deep neural networks to investigate the influence of residual block depth on PET image restoration performance under low-count conditions. We employed a physically controlled striatum phantom, fabricated using 3D printing technology, to ensure reproducible acquisition conditions and controlled physical variability. PET images were acquired using a clinical PET/computed tomography (CT) system with list-mode acquisition. Low-count images reconstructed from short-duration acquisition were paired with high-count reference images reconstructed from extended acquisitions. We compared conventional filtering techniques, including median, Wiener, and modified median Wiener filters, with residual network (ResNet)-based models incorporating 8, 16, and 32 residual blocks. Image quality was quantitatively assessed using contrast-to-noise ratio (CNR), coefficient of variation (COV), line profile analysis, universal quality index (UQI), and perceptual image patch similarity (LPIPS). The results demonstrated that ResNet-based restorations substantially outperformed conventional filtering techniques in contrast recovery, signal stability, and structural preservation. The ResNet-16 model achieved the most balanced performance, yielding the highest CNR (9.02) and lowest COV (0.105), while also demonstrating superior structural and perceptual similarity, as indicated by UQI (0.9224) and LPIPS (0.0174), relative to the high-count reference images. Deeper network configurations exhibited diminishing returns and reduced structural consistencies. These findings indicate that an intermediate residual block depth is optimal for low-count PET image restoration and highlight the importance of architectural optimization in deep learning-based PET image enhancement with phantom-based evaluation frameworks. Full article

Background/Introduction: Standardized staging imaging for Langerhans Cell Histiocytosis (LCH) is lacking. This study aims to identify patient and disease factors that influence imaging selection and propose a clinical decision algorithm that supports more deliberate, radiation- and cost-conscious use of imaging. Methods: A retrospective review of patients with biopsy-proven LCH, evaluated at a single institution, was conducted from 2001 to 2025. Age, sex, and presenting location at diagnosis were compared across imaging groups (Positron emission tomography/computed tomography [PET/CT], bone scintigraphy, and skeletal survey). Disease extent (unifocal, multifocal, multisystem) was summarized according to the imaging modality each patient received. Results: The cohort included 78 patients: 30 PET/CT, 11 bone scans, and 37 skeletal surveys. Median age differed significantly by modality: PET/CT 34 years (interquartile range [IQR] 8–56) vs. bone scan 13 years (3–37) vs. skeletal survey 7 years (2–14) (p < 0.001). Imaging selection varied significantly by anatomic location (p = 0.016): bone lesions were assessed with skeletal survey (52.8%), PET/CT (28.3%), and bone scan (18.9%). All pulmonary cases received PET/CT imaging. Six of the 78 patients had multisystem disease, and all six had been staged with PET/CT (Fisher’s exact p = 0.006, PET/CT vs. skeletal survey; Bonferroni-adjusted p = 0.018). Conclusions: In addition to age, the initial presentation site influences the choice of imaging modality. Given the higher radiation burden and cost of PET/CT, further research is needed to determine whether this observed practice pattern translates to improved clinical outcomes. Full article

Extramedullary haematopoiesis (EMH) refers to haematopoietic proliferation outside the bone marrow, most often arising as a compensatory response to ineffective marrow function in chronic anaemias and myeloid neoplasms, particularly myelofibrosis and other myeloproliferative neoplasms. While the liver and spleen are typical sites, renal involvement remains particularly uncommon and may mimic infiltrative malignancy or infection on cross-sectional imaging. We report a 35-year-old woman with biopsy-proven grade 2 myelofibrosis who presented with constitutional symptoms, namely asthenia, progressive weight loss, and intermittent fever, in the setting of pancytopenia. Contrast-enhanced CT demonstrated bilateral thoracic paravertebral and presacral soft-tissue masses, with left peripelvic/pelvicalyceal infiltration, raising concern for infiltrative malignancy or infection. [¹⁸F]-FDG-PET/CT showed low-grade uptake in the paravertebral and presacral lesions, while the renal lesion remained indeterminate because of adjacent urinary tracer activity. Given the haemorrhagic risk of renal biopsy in a cytopenic patient, [^99mTc]-sulphur colloid scintigraphy with SPECT/CT was performed and demonstrated concordant tracer uptake in all lesions, supporting multifocal EMH. After disease-directed treatment, follow-up CT at 12 months showed marked regression of the renal and other EMH lesions. This case highlights renal peripelvic EMH as a rare imaging pitfall and underscores the value of multimodality imaging when biopsy is high risk. Full article

Background: Precise staging of prostate cancer is vital for treatment planning and prognosis. While [⁶⁸Ga]Ga-PSMA-11 PET-CT has demonstrated high diagnostic accuracy in detecting metastatic disease, the interpretation of indeterminate or potentially benign PSMA-avid bone lesions remains a clinical challenge in routine practice. Methods: We conducted a retrospective single-centre study involving 214 patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET-CT between January 2021 and January 2024. Patients with prior known bone metastases or alternative PSMA radiotracers were excluded. Only those with follow-up imaging were included for diagnostic accuracy analysis. Follow-up modalities included PSMA PET-CT, CT, MRI, and bone scintigraphy. Final classification (metastatic or benign) was based on radiological and clinical assessment. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using follow-up imaging as the reference standard. Lesions classified as indeterminate were analysed separately and excluded from diagnostic performance calculations. Results: Of the 214 included patients, 142 had follow-up imaging. Among 80 patients with bone lesions initially reported as metastatic, 74 (92.5%) were confirmed. Among 28 patients initially reported as having benign bone lesions, 26 (92.9%) remained benign on follow-up. Thirty-four patients with indeterminate lesions were reviewed; four were ultimately metastatic. Excluding indeterminate cases, sensitivity, specificity, PPV, and NPV were 97.4%, 86.7%, 94.9%, and 92.9%, respectively. Diagnostic discordance was primarily associated with benign uptake in the ribs, iliac bones, pubic rami and degenerative changes. Conclusions: [⁶⁸Ga]Ga-PSMA-11 PET-CT shows excellent sensitivity and positive predictive value for detecting metastatic bone disease in prostate cancer. However, benign lesions may also exhibit uptake, emphasising the importance of integrating imaging results with PSA levels, Gleason scores, and TNM staging. Prospective studies are needed to validate these findings and assess their impact on long-term outcomes. Full article

Background/Objectives: Novel hotspot displacement radiomic features (normalized hotspot-to-centroid distance [NHOC]/normalized hotspot-to-perimeter distance [NHOP]) are robust against image resampling and spatial resolution variations. However, their reproducibility under respiratory motion remains unvalidated. This study aimed to evaluate the reproducibility, reliability, and survival prognostic value of NHOC/NHOP features in thoracic ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) images with and without respiratory motion correction and to determine whether these features maintain stability and predictive performance for overall survival (OS) compared with respiratory-stable reference features. Methods: We analyzed 138 patients (203 lesions) who underwent ¹⁸F-FDG PET/CT with and without data-driven respiratory gating. Reproducibility and reliability were assessed using the coefficient of variation (CoV) and intraclass correlation coefficient (ICC), respectively. OS prediction was evaluated using Cox regression and concordance index (c-index) analyses. Results: Except for NHOCmax and NHOPpeak, which showed ICC values of 0.782 and 0.93, respectively, the novel morphological features generally exhibited poor reproducibility and moderate reliability (CoV > 20% and ICC < 0.75). In contrast, reference features (entropy-based and sphericity) demonstrated excellent robustness. Motion-corrected NHOCmax showed significant OS prediction for both spatially resampled and non-resampled images. No significant differences in c-indices were observed between motion-corrected and non-corrected features. Conclusions: The marked sensitivity of novel hotspot-displacement features to respiratory motion substantially limits their clinical applicability in thoracic disease. To ensure reproducibility and generalizability in future research, prioritizing inherently robust radiomic parameters, such as entropy-based features, is strongly recommended. Full article

Background: Radiotherapy (RT) combined with androgen deprivation therapy (ADT) is a standard treatment for non-metastatic high-risk (HR) prostate cancer (PC). However, the benefit of elective nodal irradiation (ENI) in clinically node-negative (cN0) patients, although suggested, remains controversial, particularly in the elderly. We report the outcomes of elderly HR PC patients treated with prostate-only RT (PORT) and ADT in a “real-word” setting. Methods: Between 2016 and 2022, 43 consecutive elderly patients (median age 76 years) with HR- or very HR-PC according to NCCN criteria version 1.2026 (cN0, cT3-cT4 and/or ISUP Grade Group 4–5 and/or PSA serum levels at diagnosis ≥ 20 ng/mL) were treated at our institution. All patients were staged with abdominal MRI or CT and bone scan; nineteen patients (44.2%) also underwent 68Ga-PSMA-11 or 18F-fluorocholine PET/CT. All patients received PORT (predominantly moderate hypofractionation, 67.5–70 Gy in 25–28 fractions) and ADT (median duration 24 months). To ensure consistency, all oncological endpoints—Biochemical Failure-Free Survival (BFFS; Phoenix criteria), Disease-Free Survival (DFS), Metastasis-Free Survival (MFS), Prostate Cancer-Specific Survival (PCSS), and Overall Survival (OS)—were calculated from a unified time-zero (initiation of first oncological treatment). DFS was defined as a composite endpoint including biochemical failure, radiological recurrence, or initiation of salvage therapy. Results: at a median follow-up of 60 months, no patient reached the Phoenix threshold, resulting in a 100% 5- and 7-year BFFS. However, 4 patients (9.3%) experienced radiological recurrence detected via PET/CT before reaching the nadir + 2 threshold, yielding an estimated 5-year and 7-year DFS of 94.7% and 71.8%, respectively. The 5- and 7-year MFS was of 97.6% and 88.7%, respectively. Seven deaths occurred, all non-PC related, resulting in a 5-year OS of 86.7% and a Prostate Cancer-Specific Survival of 100%. Gastrointestinal toxicity was notably low (no acute or late G3-G4 events). Conclusions: Our findings suggest that PORT, when combined with long-term ADT and modern staging, provides excellent disease control and a favorable safety profile in elderly HR PC patients. Given the high rate of competing mortality in this population, treatment de-escalation via PORT appears to be a clinically reasonable strategy. These results are hypothesis-generating and warrant validation in prospective randomized trials. Full article

This narrative critical review addresses class imbalance in medical imaging, particularly within the context of multi-sensor and multi-modal environments, poses a critical challenge to developing reliable AI diagnostic systems. The integration of heterogeneous data from sources like CT, MRI, and PET presents a unique opportunity to address data scarcity for rare conditions through fusion techniques. This review provides a structured analysis of strategies to tackle class imbalance, categorizing them into data-centric (e.g., advanced resampling like SMOTE-ENC for mixed data types, GAN-based synthesis) and model-centric (e.g., loss function engineering, transfer learning, and ensemble methods) approaches. Crucially, we highlight how multi-sensor feature fusion and decision-level fusion paradigms can inherently enrich representations for minority classes, offering a powerful frontier beyond single-modality learning. We evaluate each method’s merits, clinical viability, and compliance considerations (e.g., FDA). Finally, we identify emerging trends where imbalance-aware learning synergizes with multi-sensor fusion frameworks, federated learning, and explainable AI, charting a roadmap toward robust, equitable, and clinically deployable diagnostic tools. Our quantitative synthesis shows that data-centric strategies can improve minority class recall by 12–35% in datasets with imbalance ratios (majority:minority) ≥10:1, while model-centric strategies achieve an average AUC improvement of 0.08–0.21 in multi-sensor medical imaging tasks with sample sizes ranging from 50 to 50,000. Full article

Introduction: Myxoid liposarcoma (MLPS) is a rare soft tissue sarcoma comprising 5–10% of adult cases, most often in the thigh. Diagnosis is challenging due to nonspecific imaging findings and resemblance to benign lesions. Case Report: A 42-year-old male presented with a painless, enlarging upper right medial thigh mass. CT and ultrasound suggested a complex solid lesion, possibly benign. Outpatient surgical excision revealed a red, gelatinous, non-encapsulated mass. Frozen section suggested a myxomatous spindle cell tumor. Final pathology confirmed MLPS FNCLCC grade 2 (intermediate grade) with DDIT3 rearrangement on fluorescence in situ hybridization (FISH). Margins were negative but close. Postoperative PET scan and Signatera MRD assay were negative for metastasis. Given the tumor’s size (>10 cm) and known radiosensitivity, adjuvant radiotherapy (60–66 Gy) was initiated. Discussion: MLPS features myxoid stroma, plexiform vasculature, and, in high-grade tumors, a round cell component. The FUS::DDIT3 fusion gene is diagnostic. While MRI offers superior soft tissue characterization, definitive diagnosis requires pathology and molecular testing. Surgical excision with negative margins remains standard, with radiotherapy recommended for large tumors or close margins to reduce recurrence. This case highlights the limitations of preoperative imaging and the value of intraoperative pathology in guiding management. Conclusions: Early recognition, accurate diagnosis, and tailored multimodal treatment are essential for MLPS. Given the potential for recurrence, late extrapulmonary metastases, long-term surveillance with imaging, and molecular assays are critical for optimizing outcomes. Full article

Testicular metabolism can be non-invasively assessed using FDG-PET/CT, which provides insights into physiological and age-related changes. Understanding normal testicular FDG uptake is essential to distinguish between benign variation and pathological findings. In this retrospective study, 80 men (mean age: 54.7 years, range: 26–79) who underwent PET/CT for lung nodule evaluation were analyzed, excluding individuals with testicular disease, prior surgery, or elevated blood glucose (>180 mg/dL). FDG uptake (SUV_mean) and testicular volume were measured for each testis, and correlations with age, blood glucose, and volume were assessed using standard statistical methods. The mean testicular SUV_mean was 2.62 ± 0.50, showing a significant negative correlation with age and a weak positive correlation with testicular volume. After adjusting for volume, the negative association with age persisted, while no significant relationship with blood glucose was observed. These findings indicate that physiological testicular FDG uptake gradually declines with age, reflecting both metabolic and structural alterations. Recognizing these normal patterns is critical for accurate PET/CT interpretation and reducing the risk of false-positive findings. Full article

Computed tomography (CT) at the third lumbar vertebra (L3) is widely used for muscle quantification, but manual segmentation is labor intensive. This study externally validates an AI model, trained on a public dataset, for automated L3 muscle segmentation using an independent cohort, including a subgroup analysis of subject characteristics (e.g., age and a history of cancer). The AI model was trained on 900 CT scans with expert annotations from a publicly available repository. Validation was performed on 232 PET CT scans from the University Hospital Brussels, each manually segmented by an expert. Segmentation post-processing employed a density-based clustering algorithm to discard arm muscles and Hounsfield unit (HU) thresholding to refine the muscle segmentation. Performance was assessed using the Dice Similarity Coefficient (DSC) and Segmentation Surface Error (SSE). The model achieved a median DSC of 0.978 and a median SSE of 3.863 cm² across the validation set. At lower BMI values, the model was more prone to overestimation of muscle surface area. Most segmentation errors occurred in the abdominal wall muscles. Analysis showed no significant difference between arm positioning above the head and alongside the body, indicating robustness to minor artifacts from arm positioning. The AI model delivers accurate, automated L3 muscle segmentation, supporting larger-scale body composition studies. However, diminished accuracy at low BMI values and limited demographic diversity of the data highlight the need for broader validation. Full article

Objective: To evaluate Tc-99m-PSMA SPECT/CT detection of biochemical recurrence (BCR) of prostate cancer across serum PSA levels in patients treated with radical prostatectomy or radiation therapy, to explore clinical/pathologic predictors of scan positivity and metastatic disease, and to assess its potential role as a pragmatic alternative when PSMA PET/CT is unavailable in resource-limited settings. Materials and Methods: In this prospective single-center study, we included 132 men with biochemical recurrence who underwent Tc-99m-PSMA SPECT/CT between January 2024 and December 2025 after predefined inclusion and exclusion criteria were applied, and they were further stratified by primary treatment (radical prostatectomy or radiation therapy). Patients were followed up for up to 6 months after imaging to verify observed findings (histopathology, confirmatory imaging and PSA response) and a logistic regression was applied to identify predictors of scan positivity and metastatic disease. Results: In men initially treated with radical prostatectomy, detection increased from 38.9% at PSA 0.2 to <2 ng/mL to 63.2% at 2 to <4 ng/mL, 71.4% at 4 to <7 ng/mL, and 90% at PSA ≥ 7 ng/mL (overall 69.1%). In the radiation therapy cohort, detection was 58.3% at PSA 2 to <4 ng/mL, rising to 85.7% at 4 to <7 ng/mL and 96% at PSA ≥ 7 ng/mL (overall 84.3%). In the multivariable analysis, PSA doubling (log2[PSA]) independently predicted scan positivity and metastatic disease in both cohorts, while seminal vesicle invasion independently predicted metastatic spread in the post-prostatectomy group. Conclusions: Tc-99m-PSMA SPECT/CT is a useful tool for detecting prostate cancer BCR, with performance strongly dependent on PSA and higher detection in patients with higher PSA levels. Increasing PSA independently predicted scan positivity and metastatic disease, while seminal vesicle invasion was independently associated with metastatic spread. In settings where PSMA PET/CT is unavailable, Tc-99m-PSMA SPECT/CT may represent a practical alternative, particularly for patients with elevated PSA. Full article

Objectives: Lesion-level dynamics may reveal pulmonary tuberculosis (PTB) heterogeneity and help identify factors associated with treatment outcomes. Methods: A total of 288 serial Computed Tomography (CT) scans from 125 PTB patients were obtained from the National Institute of Allergy and Infectious Diseases (NIAID) TB Portals database (2008–2023). Lesions were segmented and annotated to obtain volume and imaging features, and a conservative longitudinal volume quantification method was used to characterize dynamic volume patterns. The proportion of lesions with different patterns was analyzed at the patient level to assess trajectory diversity. Firth’s penalized logistic regression was used to identify factors associated with treatment outcomes. Results: Among 435 lesions in 125 patients, five patterns emerged: Stable, Decrease, Increase, Mix-I-D (increase then decrease), and Mix-D-I (decrease then increase). Multiple patterns coexisted in 66.7% of treatment success patients and all treatment failure patients. Mix-D-I lesions were identified more frequently in treatment failure patients (25.0% vs. 1.4%, p = 0.027), and in multivariable analysis, the presence of Mix-D-I lesions was statistically associated with treatment failure (p = 0.024). Conclusions: PTB lesions showed high trajectory heterogeneity. The presence of Mix-D-I lesions may point to an unfavorable treatment course, suggesting lesion dynamics could serve as a potential indicator for poor outcomes. By quantifying lesion-level trajectories on serial CT scans, we extend PET/CT-based evidence and support the value of routine monitoring in clinical management of tuberculosis. Full article