Search Results (817)

Ventricular tachycardia (VT) remains a major cause of morbidity and mortality in patients with structural heart disease. While catheter ablation has become a cornerstone in VT management, recurrence rates remain substantial due to limitations in electroanatomic mapping (EAM), particularly in cases of deep or heterogeneous arrhythmogenic substrates. Cardiac imaging, especially when multimodal and integrated with mapping systems, has emerged as a critical adjunct to enhance procedural efficacy, safety, and individualized strategy. This comprehensive review explores the evolving role of various imaging modalities, including echocardiography, cardiac magnetic resonance (CMR), computed tomography (CT), positron emission tomography (PET), and intracardiac echocardiography (ICE), in the preprocedural and intraprocedural phases of VT ablation. We highlight their respective strengths in substrate identification, anatomical delineation, and real-time guidance. While limitations persist, including costs, availability, artifacts in device carriers, and lack of standardization, future advances are likely to redefine procedural workflows. Full article

Lung cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. Despite advancements, the overall survival rate for lung cancer remains between 10% and 20% in most countries. However, recent progress in diagnostic tools and therapeutic strategies has led to meaningful improvements in survival outcomes, highlighting the growing importance of personalized management based on accurate disease assessment. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become essential in the management of lung cancer, serving as a key imaging modality for initial diagnosis, staging, treatment response assessment, and follow-up evaluation. Recent developments in radiomics and artificial intelligence (AI), including machine learning and deep learning, have revolutionized the analysis of complex imaging data, enhancing the diagnostic and predictive capabilities of FDG PET/CT in lung cancer. However, the limitations of FDG, including its low specificity for malignancy, have driven the development of novel oncologic radiotracers. One such target is fibroblast activation protein (FAP), a type II transmembrane glycoprotein that is overexpressed in activated cancer-associated fibroblasts within the tumor microenvironment of various epithelial cancers. As a result, FAP-targeted radiopharmaceuticals represent a novel theranostic approach, offering the potential to integrate PET imaging with radioligand therapy (RLT). In this review, we provide a comprehensive overview of FDG PET/CT in lung cancer, along with recent advances in AI. Additionally, we discuss FAP-targeted radiopharmaceuticals for PET imaging and their potential application in RLT for the personalized management of lung cancer. Full article

Gastric cancer remains the fourth leading cause of cancer-related mortality worldwide. Advanced disease is associated with a poor prognosis, emphasizing the critical importance of early diagnosis through endoscopy. In addition to prognosis, disease extent also plays a pivotal role in guiding management strategies. Therefore, accurate locoregional staging (T and N staging) is vital for optimal prognostic and therapeutic planning. Endoscopic ultrasound (EUS) has long been an essential tool in this regard, with computed tomography (CT) and, more recently, positron emission tomography–computed tomography (PET–CT) serving as alternative imaging modalities. EUS is particularly valuable in the assessment of early gastric cancer, defined as tumor invasion confined to the mucosa or submucosa. These tumors are increasingly managed by endoscopic resection techniques offering improved post-treatment quality of life. EUS has also recently been utilized in the restaging process after neoadjuvant chemotherapy, aiding in the evaluation of tumor resectability and prognosis. Its performance may be further enhanced through the application of emerging techniques such as contrast-enhanced endosonography, EUS elastography, and artificial intelligence systems. In advanced, unresectable disease, complications such as gastric outlet obstruction (GOO) severely impact patient quality of life. In this setting, EUS-guided gastroenterostomy (EUS-GE) offers a less invasive alternative to surgical gastrojejunostomy. This review summarizes and critically analyzes the role of EUS in the context of gastric cancer, highlighting its applications across different stages of the disease and evaluating its performance relative to other diagnostic modalities. Full article

Background: The accurate prediction of pathological complete response (pCR) following total neoadjuvant therapy (TNT) is crucial for optimising treatment protocols in locally advanced rectal cancer (LARC). Although conventional imaging techniques such as MRI show limitations in assessing treatment response, metabolic imaging utilising 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) provides distinctive information by quantifying tumour glycolytic activity. This study investigates the predictive value of sequential 18F-FDG PET-CT parameters, focusing on Total Lesion Glycolysis (TLG), in predicting pCR after TNT. Methods: We conducted a retrospective analysis of 33 LARC patients (T3–4/N0–1) treated with TNT (neoadjuvant-chemoradiation followed by consolidation FOLFOX chemotherapy). Sequential PET-CT scans were performed at baseline, interim (after 4 cycles of FOLFOX), and post-TNT. Metabolic parameters, including maximum standardised uptake value (SUVmax) and TLG, were measured. Receiver operating characteristic (ROC) analysis assessed the predictive performance of these parameters for pCR. Results: The pCR rate was 21.2% (7/33). Post-TNT TLG ≤ 10 demonstrated excellent predictive accuracy for pCR (AUC 0.887, 92.3% sensitivity, 85.7% specificity, and 96.0% PPV), outperforming SUVmax (AUC 0.843). Interim TLG ≤ 10 also showed a strong predictive value (AUC 0.824, 100% sensitivity, and 71.4% specificity). Conclusions: TLG may serve as a reliable metabolic biomarker for predicting pathologic complete response (pCR) after total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC). Its inclusion in clinical decision-making could improve patient selection for organ preservation strategies, thereby reducing the need for unnecessary surgeries in the future. However, given that the study is based on a small retrospective design, the findings should be interpreted with caution and used alongside other decision-making tools until more comprehensive data are collected from larger studies. Full article

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The etiology of heart failure is multifactorial, encompassing ischemic heart disease, hypertension, valvular disorders, cardiomyopathies, and metabolic and infiltrative diseases. Despite advances in pharmacologic and device-based therapies, heart failure continues to carry a substantial burden of morbidity, mortality, and healthcare utilization. With the advancement and increased accessibility of cardiac imaging modalities, the diagnostic accuracy for identifying the underlying etiologies of nonischemic cardiomyopathy has significantly improved, allowing for more precise classification and tailored management strategies. This review aims to provide a comprehensive analysis of the current understanding of heart failure, encompassing epidemiology, etiological factors, with a specific focus on diagnostic imaging modalities including the role of echocardiography and strain imaging, cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT), and nuclear positron emission tomography (PET) imaging and recent advances in the diagnosis and management of heart failure. Full article

Tumor hypoxia involves limited oxygen supply within the tumor microenvironment and is closely associated with aggressiveness, metastasis, and resistance to common cancer treatment modalities such as chemotherapy and radiotherapy. Traditional methodologies for hypoxia assessment, such as the use of invasive probes and clinical biomarkers, are generally not very suitable for routine clinical applications. Radiomics provides a non-invasive approach to hypoxia assessment by extracting quantitative features from medical images. Thus, radiomics is important in diagnosis and the formulation of a treatment strategy for tumor hypoxia. This article discusses the various imaging techniques used for the assessment of tumor hypoxia including magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT). It introduces the use of radiomics with machine learning and deep learning for extracting quantitative features, along with its possible clinical use in hypoxic tumors. This article further summarizes the key challenges hindering the clinical translation of radiomics, including the lack of imaging standardization and the limited availability of hypoxia-labeled datasets. It also highlights the potential of integrating radiomics with multi-omics to enhance hypoxia visualization and guide personalized cancer treatment. Full article

Well-differentiated neuroendocrine neoplasms (NENs) are characterized by hyperexpression on the cell membrane of somatostatin receptors (SSTRs). The demonstration of SSTRs, mainly the subtype 2 (SSTR2), is the prerequisite for diagnostic and therapeutic strategies with radiolabeled somatostatin analogs (SSAs). SSTRs can be routinely demonstrated in vivo by SSA-positron emission tomography/computed tomography (SSA-PET/CT) and in vitro by immunohistochemistry (IHC). This systematic review and meta-analysis aimed to gather evidence from the available literature on the correlation between the in vivo PET/CT and in vitro IHC SSTR expression in NEN patients. A systematic review and meta-analysis were conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. A comprehensive literature search was performed in PubMed/MEDLINE and Cochrane Library, selecting studies correlating SSTR expression in NENs via IHC and SSA-PET/CT. Data extraction, quality assessment, and statistical analysis were performed. Eleven studies met the inclusion criteria for systematic review (345 patients). Of these, eight studies (299 patients) provided sufficient quantitative data for meta-analysis. The pooled concordance between SSA-PET/CT and IHC was 76% (95% CI: 67.7–84.2), indicating a good correlation between in vivo and in vitro SSTR2 expression. Heterogeneity among studies was moderate (I² = 65%), reflecting different patient cohorts and methodologies regarding both SSA-PET/CT and IHC. No significant publication bias was detected. Our results confirmed good agreement between in vivo tumor uptake with SSA-PET/CT and in vitro SSTR2 expression with IHC, highlighting the potential of using IHC for clinical decision-making in NEN patients when SSA-PET/CT is not available. Full article

Background: The recent introduction of whole-body positron emission tomography/ computed tomography (PET/CT) scanners and multi-bed, multi-time point acquisition technique enable calculating fluorodeoxyglucose (FDG) kinetics in the whole body. However, validating parametric, Patlak-derived data is difficult on phantoms. Methods: This prospective study investigated the effect of quantification methods mean, max, and peak on the metabolic rate (MR-FDG) and distribution volume (DV-FDG) quantification, as well as the diagnostic accuracy of parametric Patlak FDG-PET scans in diagnosing lung lesions and lymph node metastases, using histopathology and follow-up as reference standards. Dynamic whole-body FDG PET was acquired for 80 minutes in 34 patients with indeterminate lung lesions and kinetic parameters extracted from lung lesions and representative mediastinal and hilar lymph nodes. Results: All quantification methods—mean, max, and peak—demonstrated high diagnostic accuracy (AUC: MR-FDG: 0.987–0.991 and 0.893–0.905; DV-FDG: 0.948–0.975 and 0.812–0.825) for differentiating benign from malignant lymph nodes and lung lesions. Differences in the magnitude of MR-FDG (−4.76–14.09) and DV-FDG (−10.64–46.10%) were substantial across methods. Variability was more pronounced in lymph nodes (MR-FDG: 1.37–3.48) than in lung lesions (MR-FDG: 3.31–5.04). The variability was lowest between mean and max quantification, with percentage differences of 40.87 ± 5.69% for MR-FDG and 39.26 ± 7.68% for DV-FDG. Conclusions: The choice of method to measure MR-FDG and DV-FDG greatly influences the results, especially in smaller lesions with large and systematic differences. For lung lesions, a conversion factor between mean and max methods of 40% provides acceptable agreement, facilitating retrospective comparisons of measurements, e.g., in meta-analyses. Full article

Objectives: The aim of the study was to compare the diagnostic efficiency between combined endobronchial ultrasound (EBUS)/endoesophageal ultrasound (EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) for preoperative staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC). Material and Methods: Between June 2011 and December 2017, a single-institution prospective randomized trial was conducted, and 250 patients with cytologically confirmed NSCLC, clinical stages cI–IIIA, were included. Positron emission tomography/computed tomography (PET/CT) was performed in all patients. After exclusions, 204 patients were randomized into the EBUS/EUS or TEMLA arms. Patients without N2/N3 metastases after mediastinal staging underwent surgery. The diagnostic yield and complication rates of the EBUS/EUS and TEMLA groups were compared. Results: There were 103 patients in the EBUS/EUS group, and N2 metastases were found in nine cases (8.7%). Ninety-four patients underwent surgery; in six cases, previously unsuspected N2 metastases were revealed. One hundred and one patients were randomized to the TEMLA group, which detected N2/N3 metastases in 15 cases (15.1%). Three patients were not operated on due to postoperative complications following TEMLA. Eighty-three patients underwent surgery, and a single N2 metastatic nodule was detected in one case. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV were 94%, 100%, 99%, 100%, and 99% for TEMLA, respectively, and 60%, 100%, 94%, 100%, and 94% for EBUS/EUS, respectively. There was a significant difference in sensitivity (60% vs. 94%) between the EBUS/EUS and TEMLA groups in favor of the TEMLA group. Postoperative complications occurred in 6/101 (6%) patients after TEMLA, while no complications were observed in the EBUS/EUS group. Conclusions: TEMLA demonstrated superior sensitivity for detecting N2/3 disease compared to EBUS/EUS in terms of diagnostic performance for mediastinal staging of cI–IIIA NSCLC. Due to its more invasive nature, TEMLA was associated with a higher number of complications compared with EBUS/EUS. Full article

The rapid growth of artificial intelligence, particularly in the field of deep learning, has opened up new advances in analyzing and processing large and complex datasets. Prospects and emerging trends in this area engage the development of methods, techniques, and algorithms to build autonomous systems that perform tasks with minimal human action. In medical practice, radiological imaging technologies systematically boost progress in the clinical monitoring of cancer through the information that can be analyzed in these images. This review gives insight into deep learning-based approaches that strengthen the assessment of the response to the treatment of non-small-cell lung cancer. This systematic survey delves into the various approaches to morphological and metabolic changes observed in computerized tomography (CT) and positron emission tomography (PET) imaging. We highlight the challenges and opportunities for feasible integration of deep learning computer-based tools in evaluating treatments in lung cancer patients, after which CT and PET-based strategies are contrasted. The investigated deep learning methods are organized and described as instruments for classification, clustering, and prediction, which can contribute to the design of automated and objective assessment of lung tumor responses to treatments. Full article

We present a case with unusual findings on nuclear imaging after mild SARS-CoV-2 infection. During evaluation for an incidentaloma, 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography imaging showed activity in the thyroid gland, in the lower thoracic spinal column, in portal lymph nodes, and in the terminal ileum and surrounding lymph nodes, all suspicious for metastatic cancer. The patient underwent extensive invasive and non-invasive diagnostic procedures, including biopsies of all the suspicious foci, only showing a small low-grade thyroid cancer that would often be followed and not immediately operated on. Three months later, the findings had either disappeared or were considered reactive. The patient later recalled having had mild COVID-19 seven days prior to the PET/CT. Full article

Background/Objectives: Extranodal NK-/T-cell lymphoma (ENKTCL) is a rare and highly aggressive lymphoma with a bad prognosis. The aim of our analysis is to evaluate existing research on the potential usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography or positron/computed tomography (2-[18F]FDG PET or PET/CT) in the management of patients with ENKTCL. Methods: A complete search of the literature was conducted across Scopus, PubMed/MEDLINE, and Embase databases, focusing on articles published up to March 2025. Results: A total of 21 studies that investigated the role of 2-[18F]FDG PET or PET/CT in ENKTCL were included in our analysis. The main findings from the literature analysis were (1) 2-[18F]FDG PET/CT seems to be helpful in staging settings, showing a better diagnostic performance than conventional imaging and a positive impact on clinical stage; (2) 2-[18F]FDG PET/CT had excellent negative predictive value for detecting bone marrow involvement, especially in early-stage disease; and (3) qualitative and semiquantitative PET parameters might predict prognosis. Conclusions: Despite several limitations affecting this analysis, especially related to the heterogeneity of the studies included, 2-[18F]FDG PET/CT seems to be a useful tool for the evaluation of ENKTCL. Full article

Background/Objectives: Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are highly sensitive clinical imaging modalities, frequently employed in conjunction with magnetic resonance imaging (MRI) or computed tomography (CT) for diagnosing a wide range of disorders. Efficient and robust radiolabeling methods are needed to accommodate the increasing demand for PET and SPECT tracer development. Copper-mediated radiohalogenation (CMRH) reactions enable rapid late-stage preparation of radiolabeled arenes, yet synthetic challenges and radiolabeling precursors’ instability can limit the applications of CMRH approaches. Methods: A series of aryl-boronic acids were converted into their corresponding aryl-boronic acid 1,1,2,2-tetraethylethylene glycol esters [ArB(Epin)s] and aryl-boronic acid 1,1,2,2-tetrapropylethylene glycol esters [ArB(Ppin)s] as stable and versatile precursor building blocks for radiolabeling via CMRH. General protocols for the preparation of ¹⁸F-labeled and ¹²³I-labeled arenes utilizing CMRH of these substrates were developed and applied. The radiochemical conversions (RCC) were determined by radio-(U)HPLC. Results: Both ArB(Epin)s and ArB(Ppin)s-based radiolabeling precursors were prepared in a one-step synthesis with chemical yields of 49–99%. Radiolabeling of the aryl-boronic esters with fluorine-18 or iodine-123 via CMRH furnished the corresponding radiolabeled arenes with RCC of 7–99% and 10–99%, respectively. Notably, a radiohalogenated prosthetic group containing a vinyl sulfone motif was obtained with an activity yield (AY) of 18 ± 3%, and applied towards the preparation of two clinically relevant PET tracers. Conclusions: This approach enables the synthesis of stable radiolabeling precursors and thus provides increased versatility in the application of CMRH, thereby supporting the development of novel PET and SPECT radiotracers. Full article

Background/Objectives: Pulmonary lymphangitic carcinomatosis (PLC) is a rare, aggressive manifestation of metastatic cancer characterized by lymphatic infiltration of the lungs, typically indicating advanced disease and poor prognosis. Methods: This comprehensive narrative review evaluates the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) imaging in assessing PLC. Results: Current evidence demonstrates that [18F]FDG PET/CT achieves high diagnostic accuracy, with sensitivity and specificity ranging from 86 to 97% and 84 to 100%, respectively, particularly when employing semiquantitative metrics such as peritumoral standardized uptake value (SUVmax) thresholds (e.g., ≥2.1). PET/CT surpasses high-resolution computed tomography (HRCT) in distinguishing PLC from mimics like pulmonary sarcoidosis by identifying distinct metabolic patterns: bronchovascular hypermetabolism in PLC versus subpleural nodular uptake in sarcoidosis. Prognostically, metabolic tumor burden (e.g., SUVmax × involved lobes) and novel cPLC classifications (localized to the ipsilateral or contralateral lung) independently predict progression-free survival. However, challenges persist, including non-specific tracer uptake in inflammatory conditions and variability in SUV measurements due to technical factors. Emerging digital PET/CT systems, with enhanced spatial resolution, may improve the detection of focal PLC and reduce false negatives. While [18F]FDG PET/CT is invaluable for whole-body staging, therapeutic monitoring and biopsy guidance, the standardization of protocols and multicenter validation of prognostic models are critical for clinical integration. Future research should explore novel tracers (e.g., PSMA for prostate cancer-related PLC) and machine learning approaches to refine diagnostic and prognostic accuracy. Conclusions: This review underscores the role and the transformative potential of [18F]FDG PET/CT in PLC management while advocating for rigorous standardization to maximize its clinical utility. Full article

Background/Objectives: Lung cancer is one of the most prevalent malignant diseases in humans. Numerous studies have demonstrated the significance of [¹⁸F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the staging of this condition. Methods: The pictorial evaluation is based on a recent study comparing preoperative imaging with postoperative histopathological findings following thoracic surgery. It confirmed the value of PET/CT in assessing primary tumor extent and metastatic lymph node involvement; but also revealed discrepancies in primary tumor (T) and lymph nodes (N) classification in 25% and 14% of patients, respectively. Results: The aim of this pictorial review is to highlight and further analyze the causes of inaccurate staging, identify potential diagnostic pitfalls, and provide practical recommendations to help avoid misinterpretation of PET/CT findings. Additionally, the impact of the newly introduced ninth edition of the International Association for the Study of Lung Cancer (IASLC) primary tumor, lymph nodes, and metastasis (TNM) staging system for lung cancer is discussed. Conclusions: In this pictorial review, we presented various sources of error in preoperative staging observed at our institution. Awareness of these potential pitfalls may aid in improving staging accuracy and distinguishing physiological or reactive (benign) processes from pathological findings. Full article