每日核医学文献速递 | 2026-07-09

夏天的小夜曲 · 发表于昨天 15:00

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📋 每日核医学文献速递南京医科大学附属泰州人民医院 · 核医学科 2026-07-09 📌 本期导读
本期精选5篇核医学与分子影像领域最新研究，涵盖FAP-RLT疗效评估、PRRT低不一致性NET、GLP-1R PET诊断胰岛素瘤、PSMA诊疗药物新进展、AI+SPECT鉴别肺结节等热点方向。

1Posttreatment 68Ga-FAP-2286 PET/CT Parameters for Response and Survival Assessment After 177Lu-FAP-2286 Radioligand Therapy in Advanced Solid Tumors

中文：177Lu-FAP-2286放射配体治疗后68Ga-FAP-2286 PET/CT参数对晚期实体瘤疗效和生存的评估价值

👤 作者：Fan M, Yao Z, Guo X, Hu M, Zhang F, Liu G, Zhang C, Zhao J, Chen Y

📖 Clinical Nuclear Medicine (IF=10.6) | PMID：42397089

📝 中文解读

成纤维细胞活化蛋白（FAP）在肿瘤相关成纤维细胞中高表达，是放射配体治疗（RLT）的新兴靶点。该研究纳入30例晚期实体瘤患者，完成2周期177Lu-FAP-2286治疗，并在治疗前后行68Ga-FAP-2286 PET/CT评估。结果显示，根据RECIST 1.1标准，PR 20%、SD 36.7%、PD 43.3%。治疗后SUVmax和TTV在46.7%患者中降低。Delta-SUVmax区分PD的AUC为0.72。Delta-SUVmax<30%的患者中位PFS显著长于>=30%组（10.3 vs 4.4个月），中位OS未达到 vs 9.8个月。多因素分析显示Delta-SUVmax与PFS（HR=5.2）和OS（HR=4.3）独立相关。研究表明，治疗后68Ga-FAP-2286 PET/CT的SUVmax变化可作为FAP-RLT早期疗效评估和预后分层的有用影像生物标志物，为FAP靶向诊疗一体化提供了新的评估手段。

📄 英文摘要

PURPOSE: Fibroblast activation protein (FAP) is highly expressed in cancer-associated fibroblasts and represents an emerging target for radioligand therapy (RLT). This study aimed to evaluate treatment outcomes of 177Lu-FAP-2286 and to investigate whether changes in quantitative parameters on 68Ga-FAP-2286 PET/CT are associated with treatment response and survival in patients with advanced solid tumors. METHODS: In this single-center retrospective study, patients with advanced solid tumors who completed 2 cycles of 177Lu-FAP-2286 therapy and underwent both baseline and posttreatment 68Ga-FAP-2286 PET/CT (8-16 wk after therapy) were included. Maximum standardized uptake value (SUVmax) and total tumor volume (TTV) were quantified using semiautomatic whole-body segmentation. Relative changes (DeltaSUVmax and DeltaTTV) were calculated. RECIST 1.1 served as the clinical reference standard. Receiver operating characteristic analysis assessed the ability of PET-derived changes to discriminate progressive disease. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: Thirty patients (median age, 65 y; range, 23-78 y) completed 2 cycles of 177Lu-FAP-2286 therapy. According to RECIST 1.1, partial response, stable disease, and progressive disease occurred in 6 (20.0%), 11 (36.7%), and 13 (43.3%) patients, respectively. SUVmax and TTV decreased in 46.7% of patients. DeltaSUVmax demonstrated moderate discrimination for RECIST-defined PD (AUC 0.72, P=0.04). Patients with DeltaSUVmax <30% had significantly longer PFS than those with DeltaSUVmax >=30% (median 10.3 vs. 4.4 mo; log-rank P<0.001). Median OS was not reached in the DeltaSUVmax <30% group compared with 9.8 months in the DeltaSUVmax >=30% group (log-rank P=0.003). In multivariable analysis, DeltaSUVmax remained independently associated with PFS (HR: 5.2, 95% CI 1.5-7.8; P=0.010) and OS (HR: 4.3, 95% CI: 1.3-14.1; P=0.015). CONCLUSIONS: In patients with advanced solid tumors treated with 2 cycles of 177Lu-FAP-2286, posttreatment changes in SUVmax on 68Ga-FAP-2286 PET/CT were associated with treatment response and survival, suggesting potential utility as an imaging biomarker for early response assessment and prognostic stratification.

💡 研究要点

2Efficacy of peptide receptor radionuclide therapy in patients with oligodiscordant gastroenteropancreatic neuroendocrine tumours

中文：肽受体放射性核素治疗在低不一致性胃肠胰神经内分泌肿瘤中的疗效

👤 作者：Mok C, Chow W, Sabahi Z, Bernard EJ, Roach PJ, Bailey DL, Diakos CI, Pavlakis N, Chan DL

📖 European Journal of Nuclear Medicine and Molecular Imaging (IF=9.7) | PMID：42402519

📝 中文解读

PRRT是进展期神经内分泌肿瘤（NET）的标准治疗，但传统标准要求所有病灶均表达SSTR。临床中存在一类低不一致性（oligodiscordant）患者，即仅有<=3个FDG高摄取但DOTATATE不摄取病灶。该研究首次回顾性分析了13例此类患者接受177Lu-DOTA-TATE PRRT的疗效。结果显示，中位OS为27.3个月，中位PFS为15.1个月，中位至下一治疗时间（TTNT）为15.0个月。仅1例出现治疗相关髓系肿瘤，无显著肾毒性。研究表明，联合PRRT与全身治疗或其他局部治疗（手术、肝定向治疗、放疗）在低不一致性NET中有效且毒性可接受。该研究拓展了PRRT的适用人群，为FDG/DOTATATE双示踪剂显像指导个体化治疗提供了新证据，建议在经验丰富的NET中心多学科决策。

📄 英文摘要

BACKGROUND: The use of peptide receptor radionuclide therapy (PRRT) is well established in the treatment of advanced or unresectable neuroendocrine tumours (NETs) after progression on somatostatin analogues (SSA), with randomised clinical trials such as NETTER-1 and NETTER-2 showing improvement in progression free survival (PFS) as well as tumour response. Current landmark trials only considered patients suitable for PRRT if all known lesions displayed SSTR expression, via avidity on planar scintigraphy or Gallium-68 DOTATATE PET/CT. However, there is a select group of patients with oligodiscordant disease (3 or less lesions which are FDG avid but not DOTATATE avid) on dual DOTATATE/FDG PET imaging who may benefit from PRRT in combination with additional therapies such as liver directed therapy (LDT) or chemotherapy. There is currently no data regarding the efficacy and outcomes of PRRT in oligodiscordant disease. This study is the first to describe the treatment patterns and outcomes of patients with oligodiscordant disease receiving PRRT. METHODS: A single-centre retrospective review was performed in patients with advanced gastroenteropancreatic NETs with oligodiscordant disease who received at least one cycle of PRRT with [177Lu]Lu-DOTA-TATE from 2020 to 2024. Safety was assessed by renal and haematological parameters (CTCAE v5.0) during PRRT, and at 3 months post completion of treatment. Response to treatment was evaluated on molecular imaging with Gallium-68 DOTATATE PET/CT. Kaplan-Meier method was used to perform median progression free survival (PFS), overall survival (OS), and time to next treatment (TTNT) analyses. RESULTS: Thirteen patients met the inclusion criteria, the median age was 66 years, and 54% were male. Primary site: small bowel (7), pancreas (4), colorectal (2). WHO grade: none had grade 1 disease, ten grade 2 and three had grade 3 disease. Median OS was 27.3 months (95% CI 19.7 - not reached), median PFS 15.1 months (95% CI 7.1-20.1), and median TTNT 15.0 months (95% CI 6.7-39.6). One of 15 patients developed treatment related myeloid neoplasm on long term follow-up, confirmed by bone marrow biopsy. No patients developed significant renal toxicity on follow-up. CONCLUSION: In patients with advanced NETs with oligodiscordant disease identified on dual PET imaging, the combination of PRRT with systemic therapy or other therapies (surgery, liver directed therapy, radiotherapy) can be effective with acceptable toxicity and should be considered as a possible option for treatment in selected patients. The sequencing of treatment modalities and exact strategy employed is best decided at an experienced NET centre with multi-disciplinary input.

💡 研究要点

3Glucagon-like peptide-1 receptor PET in indolent and aggressive insulinoma: Diagnostic performance, quantitative differences, and clinical implications

中文：GLP-1受体PET在惰性和侵袭性胰岛素瘤中的诊断效能、定量差异及临床意义

👤 作者：Xu J, Liang Y, Xu X, Huang D, Chen J, Song S

📖 European Journal of Nuclear Medicine and Molecular Imaging (IF=9.7) | PMID：42400625

📝 中文解读

胰高血糖素样肽-1受体（GLP-1R）PET/CT在胰岛素瘤定位诊断中具有重要价值，但不同类型胰岛素瘤的诊断效能差异尚不明确。该前瞻性研究纳入96例疑似胰岛素瘤患者（64例惰性、25例侵袭性、7例非胰岛素瘤），均行68Ga-exendin-4 PET/CT，部分加行68Ga-DOTANOC PET/CT。结果显示，惰性胰岛素瘤中GLP-1R PET的灵敏度达98.4%、特异度71.4%、准确度95.8%，但侵袭性胰岛素瘤的检出率显著降低至76.0%。相反，68Ga-DOTANOC PET/CT在侵袭性组中阳性率更高（92.0% vs 67.7%）。在侵袭性亚组中，GLP-1R阳性病灶数量独立预测了低血糖控制不佳（OR=2.0）。该研究明确了GLP-1R PET在惰性与侵袭性胰岛素瘤中的诊断效能差异，提出GLP-1R阳性肿瘤负荷可作为低血糖控制的影像生物标志物，两种显像模式具有互补作用。

📄 英文摘要

PURPOSE: To evaluate the diagnostic performance, quantitative characteristics, and clinical implications of Glucagon-Like Peptide-1 Receptor (GLP-1R) PET using 68Ga-exendin-4 in patients with indolent and aggressive insulinomas, and to refine its role in comprehensive disease assessment. METHODS: In this prospective study, patients presenting with hypoglycemia and fulfilling Whipple's triad were enrolled. All patients underwent 68Ga-exendin-4 PET/CT, and a subset also received 68Ga-DOTANOC PET/CT. The pathology of surgery and biopsy served as the reference standard. Patients were stratified into indolent and aggressive insulinoma groups. Diagnostic performance metrics were calculated, and logistic regression analysis was performed to identify predictors of hypoglycemia control. RESULTS: Ninety-six patients with suspected insulinoma were enrolled in this study (64 indolent, 25 aggressive insulinomas, and 7 non-insulinomas). For indolent insulinomas, 68Ga-exendin-4 PET/CT demonstrated a sensitivity of 98.4%, specificity of 71.4%, and accuracy of 95.8%. Detection rate for aggressive insulinomas was significantly lower than that for indolent tumors (76.0% vs. 98.4%, P=0.002). Conversely, 68Ga-DOTANOC PET/CT demonstrated a higher positivity rate in aggressive insulinomas compared with indolent cases (92.0% vs. 67.7%, P=0.047). In the aggressive subgroup, the number of GLP-1R-avid lesions independently predicted poor hypoglycemia control (OR=2.0, 95% CI: 1.1-3.7, P=0.027). CONCLUSION: GLP-1R PET provides excellent diagnostic accuracy for indolent insulinomas but has reduced sensitivity in aggressive disease. In contrast, somatostatin receptor PET/CT is more effective for detecting aggressive tumors. GLP-1R-positive tumor burden may serve as a potential imaging biomarker for hypoglycemia control, supporting the complementary roles of these modalities in insulinoma management.

💡 研究要点

4Development and Advantages of O-(Carboxymethyl)-L-tyrosine-Based PSMA-Targeting Theranostics for Prostate Cancer

中文：基于O-(羧甲基)-L-酪氨酸骨架的PSMA靶向前列腺癌诊疗一体化药物的开发与优势

👤 作者：Li L, Zhao R, Wang G, Jin W, Zhu L, Zhu Z, Kung HF

📖 Journal of Medicinal Chemistry (IF=7.3) | PMID：42418373

📝 中文解读

PSMA是前列腺癌诊断和放射配体治疗的成熟靶点。该Perspective文章系统介绍了基于O-(羧甲基)-L-酪氨酸（O-CMT）骨架的PSMA靶向药物平台。该骨架作为多功能连接子，可增强结合亲和力并优化药代动力学。PET示踪剂68Ga-P16-093在临床研究中表现出高肿瘤摄取和低尿路背景。基于此成功开发的治疗型药物177Lu-P17-087具有快速体内动力学，177Lu-P17-088相比177Lu-PSMA-617（PLUVICTO）具有更好的肿瘤滞留和延长的循环时间。该模块化骨架支持结构多样化，包括替代螯合剂和双靶向策略。引入双膦酸基团的P17-079可同步靶向PSMA和骨转移灶。该平台为下一代前列腺癌诊疗一体化放射性药物的开发提供了灵活的设计策略，有望进一步提升PSMA靶向诊疗的精准性和疗效。

📄 英文摘要

Prostate-specific membrane antigen (PSMA) is a well-established target for diagnostic imaging and radioligand therapy (RLT) in prostate cancer (PCa). This Perspective highlights PSMA-targeting agents incorporating the O-(carboxymethyl)-L-tyrosine scaffold, a versatile linker that enhances binding affinity and optimizes pharmacokinetics. The PET tracer [68Ga]Ga-P16-093 demonstrates high tumor uptake and low urinary background in clinical studies. Its success has enabled the development of therapeutic counterparts, including [177Lu]Lu-P17-087 which shows rapid in vivo kinetics, and [177Lu]Lu-P17-088 which exhibits improved tumor retention and prolonged circulation compared with [177Lu]Lu-PSMA-617 (PLUVICTO). The modular scaffold supports structural diversification, including alternative chelators and dual-targeting strategies. Incorporating a bisphosphonate moiety in P17-079 enables simultaneous targeting of PSMA and bone metastases. This adaptable platform facilitates the development of next-generation radiopharmaceuticals as theranostics for the treatment of PCa.

💡 研究要点

5Diagnostic performance of machine learning models based on dual-phase 99mTc-MIBI SPECT/CT semiquantitative parameters for differentiating benign and malignant pulmonary nodules

中文：基于双时相99mTc-MIBI SPECT/CT半定量参数的机器学习模型鉴别肺结节良恶性的诊断效能

👤 作者：Zhang K, Zhou X, Zhang Y, Jin G, Li P, Xing Y

📖 PLOS ONE (IF=3.7) | PMID：42406747

📝 中文解读

肺结节的良恶性鉴别是临床挑战。该研究回顾性纳入132例肺结节患者（良性30例、恶性102例），均行双时相（注射后20分钟和2小时）99mTc-MIBI SPECT/CT检查。计算早期和延迟肿瘤-正常比（T/N）及滞留指数（RI），结合临床变量建立机器学习模型。结果显示，恶性结节早期摄取显著增高，滞留指数降低。多因素分析发现CEA升高和RImax是恶性独立预测因子。基于这些半定量参数的机器学习模型表现出优异的诊断效能：随机森林AUC达0.979，SVM为0.944，ANN为0.881，Logistic回归为0.805。研究表明，基于双时相99mTc-MIBI SPECT/CT半定量参数的机器学习策略可为肺结节良恶性鉴别提供实用、可解释的辅助工具，尤其适用于复杂影像分析条件有限的场景。该研究展示了核医学SPECT显像与人工智能结合的应用潜力。

📄 英文摘要

PURPOSE: To evaluate the diagnostic value of machine learning models based on dual-phase 99mTc-MIBI SPECT/CT semiquantitative parameters for differentiating benign and malignant pulmonary nodules. METHODS: This retrospective study included 132 patients with pulmonary nodules, including 30 benign and 102 malignant lesions. All patients underwent dual-phase 99mTc-MIBI SPECT/CT at approximately 20 minutes and 2 hours after tracer injection. Semiquantitative parameters, including early and delayed tumor-to-normal ratios (T/N) and retention indices (RI), were calculated. Clinical variables and imaging parameters were analyzed using univariable and multivariable logistic regression, and selected variables were further used to develop machine learning models. RESULTS: Malignant nodules showed significantly higher early-phase uptake and lower retention index values than benign nodules. Multivariable analysis identified elevated CEA and RImax as independent predictors of malignancy. Machine learning models built on these simple semiquantitative parameters showed promising diagnostic performance, with an AUC of 0.944 (95% CI: 0.883-0.990) for SVM on the training set, 0.805 (95% CI: 0.678-0.912) for Logistic Regression (LR), 0.881 (95% CI: 0.800-0.949) for Artificial Neural Network (ANN), and 0.979 (95% CI: 0.951-0.995) for Random Forest (RF), demonstrating their effectiveness in classifying pulmonary nodules. CONCLUSION: Dual-phase 99mTc-MIBI SPECT/CT semiquantitative parameters provide useful information for distinguishing benign from malignant pulmonary nodules. A machine learning strategy based on simple and interpretable parameters may offer a practical tool for pulmonary nodule assessment, especially in settings where complex imaging analysis is not feasible.

💡 研究要点

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南京医科大学附属泰州人民医院 · 核医学科

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