Karolien Goffin

Precise lesion localisation is central to favourable surgical outcomes in patients with drug-resistant epilepsy due to focal cortical dysplasia. We validated the Anatomy-Corrected Asymmetry Index of fluorodeoxyglucose positron emission tomography to objectively delineate regions of hypometabolism and predict surgical outcome in patients with focal cortical dysplasia. We first established normative Anatomy-Corrected Asymmetry Index thresholds using five independent and heterogeneous healthy control cohorts (n = 179) to assess reproducibility. We subsequently validated our findings in 40 pathologically confirmed focal cortical dysplasia patients who underwent resective surgery. The primary analysis assessed the association between the extent of resection of defined hypometabolic clusters and 24-month seizure freedom (Engel Class I). After excluding subjects with segmentation artefacts to ensure accurate threshold definition, we established a normative threshold of -19 with a minimum cluster size of 2.0 mL. In the patient cohort, 29 subjects had high-quality segmentations. Patients with at least one localising cluster achieved significantly higher seizure freedom rates compared to those without clusters (76.5% vs. 22.2%, P = 0.014). The percentage of resected hypometabolic volume was significantly associated with Engel Class I outcome (P = 0.011). Sensitivity analysis demonstrated that a more permissive threshold of -16 identified localising clusters in two additional seizure-free patients who were false negatives at the standard threshold. The Anatomy-Corrected Asymmetry Index provides a standardised metric that predicts seizure freedom in focal cortical dysplasia epilepsy surgery. Clinical implementation requires rigorous quality control of anatomical segmentations to ensure diagnostic accuracy. The online version contains supplementary material available at 10.1007/s00259-026-07864-9.

Purpose This study aims to evaluate differences in PET/CT imaging of meningioma using both gallium-68- and fluorine-18-labelled somatostatin receptor (SSTR) tracers, to characterize incidentally detected meningiomas on SSTR PET/CT, and to analyse institutional experience with Peptide Receptor Radionuclide Therapy (PRRT) in meningioma. Methods This single centre retrospective study included all SSTR PET/CT scans of meningioma patients (2007-2024) performed with [⁶⁸Ga]Ga-DOTATOC, [⁶⁸Ga]Ga-DOTATATE or [¹⁸F]AlF-NOTA-octreotide. For lesions ≥ 1cm³, tumour uptake was quantified using three distinct delineation methods: an absolute SUV threshold of 2.3, a relative threshold of 1.73 × SUV_peak of a meningeal reference region, and a relative threshold of 11% of the lesion’s SUV_max. Tumour-to-background ratios were calculated. Meningioma patients treated with PRRT were identified from our institutional registry (2016-2024). Results Of 4,136 SSTR PET/CTs, 152 patients with 171 SSTR-expressing meningiomas were included. Incidental meningiomas were found in 3.7% of patients imaged for unrelated indications. Quantitative analysis of 86 lesions (≥ 1 cm³) showed robust uptake for [¹⁸F]AlF-NOTA-octreotide (n = 7), [⁶⁸Ga]Ga-DOTATATE (n = 73), and [⁶⁸Ga]Ga-DOTATOC (n = 6), without significant between-tracer differences across delineation strategies. All tracers demonstrated high tumour‐to‐meningeal uptake ratios with ratios ranging from 51 to 146 for [¹⁸F]AlF-NOTA-octreotide, 10-329 for [⁶⁸Ga]Ga-DOTATATE, and 12-76 for [⁶⁸Ga]Ga-DOTATOC, confirming excellent tumour-to-background contrast. Among 12 heavily pretreated patients receiving PRRT, disease control rate was 50%, median progression-free survival 8 months, and overall survival 20 months. Conclusion SSTR PET/CT enables high-contrast meningioma visualisation. [¹⁸F]AlF-NOTA-octreotide seems clinically interchangeable with gallium-68-labelled tracers, while offering logistical advantages. PRRT achieves meaningful disease stabilisation, supporting further validation in prospective randomised studies.

To investigate the diagnostic performance and interreader agreement of intraprostatic prostate cancer (PCa) detection, local extension and staging using [1

Fibroblast activation protein (FAP)-binding radiopharmaceuticals have emerged as promising candidates for both diagnostic and therapeutic applications in oncology due to their selective targeting of cancer-associated fibroblasts (CAFs). This review evaluates the current literature on the therapeutic use of FAP-targeted radiopharmaceuticals in human studies, with a focus on their safety, efficacy, and clinical applicability. Data on radionuclide type, clinical outcome, radiological and metabolic response and adverse events were extracted and summarized. The included studies demonstrated that lutetium-177,yttrium-90 and actinium-225 (in combination therapy) labeled FAP inhibitors exhibit high tumor uptake, with varying but mostly sufficient retention and a favorable safety profile. While mild adverse events such as fatigue, nausea and grade 1 or 2 hematotoxicity were observed, severe toxicities were rare. FAPI-based radionuclide therapies generally show high disease control rates, with promising results from tandem and combination strategies. The heterogeneity of tumor types and small sample sizes limited the generalizability of findings. FAP-targeted radioligand therapy appears to be a promising treatment option for patients with advanced cancer who have exhausted standard therapies. However, further large-scale, prospective clinical trials are necessary to determine optimal dosing strategies, long-term safety and efficacy across different tumor types. Emerging approaches, such as covalently binding FAP-targeted radiopharmaceuticals and the use of alpha-emitters such as actinium-225, lead-212 and bismuth-213, may further enhance treatment outcomes and warrant future investigation.

Purpose To investigate the relationship between [¹⁸F]PSMA-1007 PET parameters and biochemical recurrence-free survival (BCR-FS) in high-risk primary prostate cancer patients receiving neoadjuvant hormonal treatment. Methods This prospective randomized, double-blind, placebo-controlled phase II trial included 89 high-risk primary prostate cancer patients who received a pelvic [¹⁸F]PSMA-1007 PET/MRI prior to and following neoadjuvant hormonal treatment. Patients were randomly assigned to neoadjuvant hormonal treatment with degarelix + apalutamide (n = 45) or degarelix + matching placebo (n = 44) for 3 months followed by radical prostatectomy and extended pelvic lymph node dissection. The following [¹⁸F]PSMA-1007 PET parameters were determined on the pre- and posttreatment [¹⁸F]PSMA-1007 PET: (i) semi-quantitative [¹⁸F]PSMA-1007 PET parameters such as SUV_max, SUV_mean, PSMA-expressing volume and total lesion activity, and their absolute and relative differences; (ii) number of pelvic lymph node, distant and extraprostatic (i.e. pelvic lymph node and distant) metastases determined on [¹⁸F]PSMA-1007 PET; (iii) [¹⁸F]PSMA-1007 PET-based response criteria (aPERCIST and RECIP 1.0); (iv) molecular imaging TNM-stage as determined by PROMISE V2. Results 35% of included patients developed BCR within a median follow-up time of 38 months. Multivariate regression analyses revealed that PSMA-expressing volume posttreatment, the number of distant metastases pretreatment and miN1 + miN2 vs. miN0 pretreatment were significant predictors of BCR-FS with hazard ratios of 1.184 (95% CI 1.070–1.309, p = 0.0010), 5.820 (95% CI 2.498–13.561, p < 0.0001) and 4.024 (95% CI 1.740–9.307, p = 0.0011), respectively. Conclusion Our results indicate that [¹⁸F]PSMA-1007 PET might be used to aid in patient stratification for determining which patients would benefit from additional (neo)adjuvant treatment.

Objective: To evaluate ¹⁸F‐fluorodeoxyglucose ( ¹⁸ F‐FDG) positron emission tomography (PET) as a biomarker in suspected non‐convulsive status epilepticus (NCSE) by characterizing electroclinical‐metabolic correlations and quantifying focal hypermetabolism. Methods: We included adult patients with rhythmic and periodic patterns (RPPs) undergoing ¹⁸ F‐FDG PET for suspected NCSE. Two neurologists reviewed patient electroencephalography (EEG) recordings (0–30 min post‐injection) using 2021 American Clinical Neurophysiology Society (ACNS) criteria. ¹⁸ F‐FDG PET images were blindly assessed by two nuclear medicine specialists for the presence and lobar location of focal hypermetabolism. Structural magnetic resonance imaging (MRI) studies enabled PET co‐registration and segmentation. Patients with available MRI scans were compared to external age/sex‐matched and in‐house validation healthy control datasets. We calculated intra‐subject standardized uptake value (SUV) z ‐scores within the gray matter and then compared this approach to SUV ratio (SUVR) methods (using either the cerebellum or the pons as reference region) using consensus visual assessment as the reference standard. For hypermetabolic volume quantification, we chose the lowest threshold with 100% specificity ( z ≥ 3.0) to eliminate false‐positive volumes, which yielded 62% sensitivity. Resulting volumes were correlated with lateralized periodic discharge (LPD) main modifiers (frequency, prevalence, evolution, plus‐factors). Results: Of 24 adult patients (median age 62 years, 15 female), 17 (71%) had LPDs. Qualitatively, focal hypermetabolism was present in 92% of patients ( n = 22), with strong concordance between visual PET findings and EEG lateralization in patients with LPDs. Twenty‐three patients underwent MRI and were compared to external age/sex‐matched ( n = 23) and in‐house validation ( n = 22) healthy control datasets. Our technique outperformed traditional SUVR methods (AUC = 0.92 vs 0.55–0.64, p < .001) in detecting focal hypermetabolism. In patients with LPDs, hypermetabolic volumes ranged from 0 to 21.4 mL, with substantial volumes (>10 mL) observed across all discharge frequencies. Significance: ¹⁸ F‐FDG‐PET revealed focal hypermetabolism in most suspected NCSE cases, including in cases with equivocal EEG patterns. In patients with LPDs, the extent of focal hypermetabolism was highly variable across different frequencies.

Traditionally, radiotherapy in metastatic renal cell carcinoma (RCC) was applied for the palliation of symptoms and the control of critical sites such as bone lesions and brain metastases. However, technological advances in radiotherapy (RT) planning and delivery made it possible to precisely deliver high dose radiotherapy at a confined target volume. One such approach is stereotactic body radiotherapy (SBRT). In patients presenting with limited metastatic burden, known as oligometastatic RCC (omRCC), SBRT can be of interest to maintain local control, in order to defer the onset of either a first or a subsequent line of systemic treatment. In this narrative review, we summarize the prospective and retrospective evidence on SBRT as a treatment option for omRCC, and give insight into the future perspectives.

The aim of the present study was to extend the creatinine-based Lund-Malmö GFR equation for use with rescaled cystatin C (r-LMR_Cys) and validate it against measured GFR (mGFR) in the EKFC cystatin C cohort of children (n = 2,293) and adults (n = 7,727). Rescaling was obtained by dividing each biomarker by a Q-value, representing the population-specific median biomarker level among healthy individuals. Validation included median bias/precision/accuracy (percent estimates within ±30% of mGFR, P₃₀). Performance was compared with the EKFC-equation (EKFC_Cys), the CAPA cystatin C equation, the corresponding equations based on rescaled creatinine (r-LMR_Cr and EKFC_Cr) and the arithmetic mean of r-LMR_Cr and CAPA (r-LMR_Cr+CAPA), r-LMR_Cr and r-LMR_Cys (r-LMR_Mean), and EKFC_Cr and EKFC_Cys (EKFC_Mean). The overall P₃₀ of r-LMR_Cys in adults was 86.2% (95% CI 85.4%-86.9%), which was 6.6 percentage points (pp; 95% CI 5.8-7.4 pp) higher than for CAPA and similar to r-LMR_Cr (P₃₀ 87.4%, 95% CI 86.6%-88.1%). r-LMR_Cys and EKFC_Cys exhibited similar performance both overall and across subgroups of age, sex, GFR and BMI and in children. All three arithmetic mean equations had similar P₃₀-accuracy and generally performed better than the corresponding single-marker equations. Our results show that the Lund-Malmö GFR equation can be adapted for use with rescaled cystatin C with performance that is similar to the best-performing equations based on rescaled creatinine. The generality of the applied biomarker rescaling principle implies that the future demand for population- and biomarker-specific GFR estimating equations can be expected to decrease substantially.