Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive parathyroid hormone secretion, typically due to a solitary parathyroid adenoma (PA). Accurate preoperative localization is crucial for successful minimal invasive surgical management. Four-dimensional computed tomography (4DCT) is increasingly used as a first-line imaging modality due to its superior sensitivity and specificity compared to ultrasound and [99mTc]Sestamibi SPECT. Recent studies have highlighted the potential role of [18F]Choline PET/CT in PA detection. This study evaluates the feasibility of a combined [18F]Choline PET/4DCT protocol as a 'one-stop shop' imaging solution for PHPT patients.

Pediatric lymphoma comprises 15-20% of the childhood cancer spectrum and represents the most curable end of the disease spectrum with current cure rates exceeding 90% for Hodgkin Lymphoma (HL) and over 80% for non-Hodgkin lymphoma (NHL). Whilst these cure rates were achieved over a decade ago, there has been a paradigm shift with current management regimens employing risk-stratified, response-adapted strategies, targeted therapies and increasingly immunotherapy. Ongoing efforts are focused on maintaining and further improving the high cure rates but at the same time limiting the price of cure in term of late effects that survivors have faced in the past decades especially for HL. The current review summarizes the recent advances in the management of pediatric lymphomas and the standard-of-care options for these conditions. Increasing use of PET-CT imaging for staging/risk-stratification and response assessment has played a big role in refinement of treatment strategies. Improved supportive care, reduction in indications, doses, and fields for radiation, and refinement of models of delivery have further contributed to limiting both acute and long-term toxicity. For HL, it is expected that chemo-radiotherapy is likely to get reduced and increasingly replaced by antibody-drug conjugates and immune-checkpoint inhibitors. For NHL, chemotherapy is expected to continue to play a major part along with monoclonal antibodies. Future strategies include increasing use of CAR-T cell therapy especially for NHL for relapsed/ refractory disease.

Morphological and molecular imaging are critical for evaluating pediatric lymphoma; image-derived parameters like metabolic tumor volume are highly prognostic. Advanced image analysis methods, such as radiomics and artificial intelligence, can extract relevant parameters and reveal subtle patterns to enhance diagnostic and prognostic evaluations. This systematic review will assess the current evidence of these techniques in PL.

To review the current and emerging role of advanced cardiovascular imaging modalities for the detection, characterization, and follow-up of cardiotoxicity in pediatric oncology patients, in light of recent cardio-oncology guidelines. This narrative review synthesizes evidence from recent international guidelines - including the 2022 ESC Cardio-Oncology Position Paper and AHA scientific statements - alongside primary literature. The diagnostic roles of echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CCTA), and molecular imaging techniques are critically discussed. While echocardiography remains the first-line modality, its limited sensitivity for subclinical damage prompts the use of more advanced techniques. CMR provides unparalleled tissue characterization, allowing detection of diffuse fibrosis, inflammation, and early systolic dysfunction via T1/T2 mapping, ECV quantification, and myocardial strain. CCTA may detect radiation-induced coronary disease in high-risk survivors. Investigational imaging tools, such as F-FDG PET, I-MIBG SPECT, and FAP-targeted PET, show potential in identifying early metabolic and sympathetic abnormalities before structural changes occur. Advanced cardiovascular imaging - particularly CMR - has become central to modern cardio-oncology care in pediatrics. Current recommendations advocate for personalized, risk-adapted imaging strategies, yet most protocols are extrapolated from adult data. Pediatric-specific frameworks are urgently needed to refine long-term surveillance and reduce cardiovascular late effects in childhood cancer survivors.

[F]FDG PET/CT plays a pivotal role in the contemporary management of malignant lymphoma, and is crucial for accurate staging, response assessment, and treatment planning in pediatric Hodgkin lymphoma (pHL). Treatment response evaluation in pHL and in particular interim [F]FDG PET/CT done after few cycles of chemotherapy is critical for early prediction of outcome. It helps in identifying patients who would respond well and might safely omit radiotherapy, thereby reducing the risk of late adverse effects. Consequently, consensus international guidelines emphasize the standardized use of [F]FDG PET/CT in pHL, thus facilitating comparison of clinical trial outcomes and optimizing individualized patient care worldwide. In the present review we aim to summarize essential aspects of [F]FDG PET/CT in pHL, by providing new approaches and future developments.

Positron emission tomography/computed tomography (PET/CT) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose ([18F]-FDG) is a well-established imaging tool in adult oncology and is increasingly utilized also in pediatric oncology due to its ability to combine functional and anatomic information, thereby enhancing diagnostic accuracy and improving patient management. However, [18F]-FDG uptake in children differs physiologically from adults, and this radiotracer is not tumor-specific, with uptake occurring in various benign conditions such as inflammation, infection, and trauma. Accurate interpretation of pediatric [18F]-FDG PET/CT requires comprehensive knowledge of the normal distribution of FDG in children, recognition of physiological variants, and awareness of common benign lesions and PET/CT-related artifacts. Misinterpretation can lead to unnecessary follow-up studies, suboptimal treatment decisions, and/or increased radiation exposure. This review discusses the typical patterns of physiologic [18F]-FDG uptake in children, common benign mimics of malignancy, and potential artifacts and pitfalls encountered in pediatric [18F]-FDG PET/CT imaging, focus especially on head and neck (lymph nodes), brown adipose tissue, bone marrow and thymus. By increasing familiarity with these patterns, this review aims to improve diagnostic confidence, reduce interpretive errors, and promote safer and more effective imaging practices in pediatric oncology.

F fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has established itself as a fundamental non invasive diagnostic technique in the investigation of patients with fever (FUO) and inflammation of unknown origin (IUO). These conditions are for definition challenging due to potential wide underlying causes, including inflammatory disease, infectious disease, malignancies and miscellanea. Sometimes no diagnosis is reached. Data about the diagnostic performances of [F]FDG PET/CT in special populations, such as pediatrics, end-stage renal disease, HIV and intensive care unit (ICU) patients, are preliminary and heterogeneous. Our review aims to describe the role of [F]FDG PET/CT imaging in these specific populations and focus on the potential clinical impact on diagnosis and patient management. Findings presented in the literature demonstrated a good diagnostic yield of FDG PET/CT in the study of these patients affected by FUO/IUO with performances similar to adult general populations. A positive PET scan is often contributory and, in some cases, even essential to diagnosis, whereas a negative scan may be equally important as it excludes focal disease and predicts a favourable prognosis. Further studies with larger populations would be desirable.

Pediatric non-Hodgkin lymphoma (NHL) is an aggressive and heterogeneous malignancy with high rates of extranodal involvement. Accurate staging and response assessment are crucial, yet challenging. While [F]FDG PET/CT is a cornerstone in adult NHL management, its role in pediatric cases remains under evaluation. A comprehensive review of the literature, international guidelines, and ongoing clinical trials was conducted, focusing on the diagnostic, prognostic, and therapeutic implications of [F]FDG PET/CT in pediatric NHL. [F]FDG PET/CT improves staging accuracy by detecting extranodal and bone marrow involvement more sensitively than conventional imaging. Its high negative predictive value supports its use in confirming complete metabolic response, potentially avoiding unnecessary biopsies. However, its positive predictive value is limited, cautioning against treatment escalation based solely on positive PET/CT results. Novel metabolic biomarkers such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) show promise for prognostic stratification but suffer from methodological variability and lack of standardization. Ongoing clinical trials aim to validate PET/CT's role in therapy response evaluation and optimize its clinical application. [F]FDG PET/CT is a valuable imaging modality for pediatric NHL, particularly in FDG-avid subtypes. Despite promising results, broader clinical adoption requires standardized imaging protocols and prospective multicenter validation to establish robust diagnostic and prognostic utility.

F FDG PET/CT plays an important role in the investigation of fever of unknown origin (FUO), particularly after failure of conventional investigations to identify the source. However, its diagnostic yield is highly influenced by a wide range of factors including patient preparation, physiological variant, and treatment related factors. This review aims to provide an overview of the most common causes experienced in clinical practice, and how to avoid common pitfalls that may affect scan interpretation. For instance, elevated blood glucose levels, prolonged steroid therapy and recent interventions may reduce scan sensitivity, while artefacts from injection sites and brown fat uptake may mimic sites of disease. Careful preparation - including dietary modification, activity restriction and appropriate access selection - combined with clinical correlation and review of non-attenuation corrected images enhances interpretation, and as always, multidisciplinary discussions remain key.

Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are diagnostically challenging conditions due to their diverse etiologies and non-specific presentations. Despite advances in diagnostic techniques, a significant proportion of cases remain unexplained, often leading to delays in treatment and increased healthcare burden. In recent years, [F]FDG-PET/CT has emerged as a powerful diagnostic tool offering whole-body metabolic imaging, particularly valuable in the early stages of disease when structural changes may be absent. In this review a literature search was conducted in PubMed and Web of Science for original studies on the use of FDG-PET/CT in adults with FUO/IUO published between January 2005 and June 2025. The authors evaluated the diagnostic yield and clinical impact of [F]FDG-PET/CT in adults with FUO/IUO based on 56 studies comprising over 7,400 patients. The [F]FDG-PET/CT was helpful in up to 90% of cases when both true-positive and true-negative results were considered. Furthermore, [F]FDG-PET/CT led to changes in patient management in a substantial proportion of cases, particularly when used early in the diagnostic algorithm. It demonstrates robust diagnostic performance, guiding therapeutic decisions, and guide subsequent interventions hereby avoiding futile examinations. Despite its growing recognition, standardization in study design and outcome reporting is needed to further consolidate its role in clinical guidelines.

Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are among the most challenging diagnoses in clinical routine. [F]FDG positron emission tomography/computed tomography (PET/CT) is a valuable diagnostic tool, particularly when conventional imaging and laboratory investigations fail to identify the root cause. While its diagnostic accuracy in FUO/IUO settings is high, several issues still remain to be addressed. Long axial field of view PET/CT and the availability of novel radiopharmaceuticals for molecular imaging may significantly advance the field of nuclear medicine and molecular imaging in FUO/IUO.

The aim is to retrospectively evaluate toxicity and outcomes of re-irradiation (re-RT) for macroscopic local relapse in patients with prostate cancer (PCa) treated with previous definitive or postoperative radiotherapy (RT).

In this review we summarize the current knowledge on fever of unknown origin (FUO). Fever of unknown origin remains a diagnostic challenge even despite increasing diagnostic possibilities since its first definition. Uniform definition of FUO is pivotal to correctly select patients that benefit from the extensive workup that may be needed. The number of conditions associated with FUO is still increasing. Epidemiologic differences and differences in diagnostic possibilities are a challenge when comparing outcomes from cohorts with different epidemiologic backgrounds. The diagnostic protocol that was proposed as early as 2007, with a central role for F-FDG-PET/CT, still remains the golden standard for the workup of FUO. Early use of new diagnostic modalities, including the use of metagenomic next generation sequencing and artificial intelligence, may shorten the diagnostic delay. In patients remaining undiagnosed, second opinion in an expert center can be considered, especially when therapeutic trials are considered. An increasing subset of patients presents with absent inflammatory parameters. Correct evaluation within a febrile episode is important in patients with intermittent disease, but these patients may also suffer from habitual or functional hyperthermia. We advise to let go of these terms and introduce the criteria for temperature elevation with missing inflammatory parameters (TEMP) syndrome.

Neuroendocrine prostate cancer (NEPC) is a rare cancer subtype with significant prognostic implications. This systematic review aims to explore the current landscape of positron emission tomography (PET) imaging and radionuclide therapy in this rare entity.

Targeted alpha therapy (TAT) has shown promise in prostate cancer patients, both hormone-sensitive and castration-resistant, with or without prior treatment. TAT's radiobiological properties explain why it is more potent than other forms of ionizing radiation, such as the clinically approved [Lu]Lu-PSMA-617. Although most TAT agents used in compassionate care or clinical trials target the prostate-specific membrane antigen (PSMA), some alternatives are yet to be used clinically, some of which aim to address PSMA-negative prostate cancer. These include [Ra]RaCl2, which is approved for palliative bone pain, and a variety of other non-PSMA antigen or receptor-targeting medicines. Whereas this study focuses on TAT medicines that are currently available for clinical use, it also explores these preclinical agents.

Metastatic castration-resistant prostate cancer (mCRPC) is an unavoidable advanced condition associated with short-term survival and poor prognosis. It is a heterogeneous disease, difficult to monitor based only on serum PSA levels. For this reason, systematic use of PSMA PET-based response criteria should be considered to assess therapy efficacy in mCRPC to improve treatment decision-making, patients' outcomes, and cost-effectiveness. Our review focuses on most common morphologic and metabolic response criteria and their application for the detection and therapy response assessment of PC patients, particularly in the setting of mCRPC, highlighting relative strengths and weaknesses, as well as potential future applications in the era of RLT.

This study aims to further strengthen the evidence of tumor sink effect (TSE) and to confirm this phenomenon in patients undergoing Ac/Lu-PSMA tandem radioligand therapy.

Prostate cancer (PCa) is a heterogeneous disease and prevalent malignancy in men, necessitating accurate imaging techniques to facilitate effective diagnosis and management. Recent evidence has demonstrated that [F]fluorodeoxyglucose ([F]FDG) and prostate-specific membrane antigen (PSMA)-targeted PET tracers positron emission tomography/computed tomography (PET/CT) imaging can provide complementary biological information, thereby improving diagnostic accuracy and the assessment of lesion heterogeneity in patients with PCa. However, optimal protocols for PSMA/FDG dual-tracer PET/CT and PET/magnetic resonance (PET/MR) imaging remain under investigation. Total-body PET/CT, with its enhanced sensitivity, enables imaging with low tracer activity and facilitates the development of novel dual-tracer PET/CT imaging protocols. PET/MR offers additional valuable information for the diagnosis and local staging of PCa due to its superior soft tissue resolution and multiparametric capabilities. Thanks to the longer MR acquisition time, it is possible to perform low-activity radiotracer PET imaging with the same long-time MR acquisition. Additionally, advancements in time-of-flight technology and the improved sensitivity of PET systems further make low-activity radiotracer PET/MR imaging clinically feasible. Given that expertise in total-body PET/CT imaging technology and access to PET/MR scanners are limited to a relatively small number of institutions worldwide, this review provides clinical exploration to optimize workflows for [Ga]Ga-PSMA-11 and [F]FDG dual-tracer PET/CT and PET/MR imaging, with a focus on radiation dose reduction through dual-low-activity-tracer imaging protocols.

With the growth and surge of prostate cancer theranostics globally, multiple targeted radionuclide therapy (TRT) agents have been utilized to aim to provide a tumoricidal effect to patients who would benefit from TRT. Despite the fact that approved isotopes such as Strontium-89, Samarium-153 and Radium-223 exist, Lutetium-177 prostate specific membrane antigen (PSMA) has revolutionized the impact of radioligand therapy (RLT) in this domain. Key defining clinical trials such as the VISION, TheraP and PSMAfore trials have given clear evidence of the benefit of PSMA RLT in the treatment landscape of metastatic castrate resistant prostate cancer. A number of other radioisotopes in the PSMA RLT domain have also more recently come into the field, notably Terbium-161, Copper- 67 and Iodine-131. Targeted Alpha Therapy (TAT) has grown significantly as well over the last few years owing to physical properties of its high linear energy transfer and DNA damage provided by alpha particles in comparison to beta particles. Actinium-225 PSMA based TAT has formed the basis of prostate cancer theranostics since its initial application, however, many other alpha isotopes are being explored owing to some of the side effects that Actinium-225 presents. Astatine-211, owing to its shorter half-life, has become a more attractive option for its potential utilization in prostate cancer theranostics. Whilst there is preclinical work detailing its efficacy in suppressing tumor growth and limited toxicity profiles, translation into humans is still in its infancy and requires further exploration. A number of clinical trials have utilized Astatine-211 in other malignancies with virtually no work related to prostate cancer. Moreover, the logistics and infrastructure required to support global efforts to make Astatine-211 more readily available should be high on the agenda as well. This narrative review of the literature aims to showcase the current status of Astatine-211 efforts in prostate cancer care with available data (including clinical trials).