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Aim: [123I]Ioflupane (DaTSCAN) has a high binding affinity to the dopamine (DA) transporter (DaT) and tenfold less affinity to serotonin (5-HT) transporter (SERT). Both neurotransmitters are considered to contribute to body weight regulation. This study assesses the association between body mass index (BMI) and DaTSCAN availability in brain. Method: Scans from 74 consecutive patients who had undergone DaTSCAN single-photon emission computed tomography–computed tomography (SPECT-CT) were used to obtain semi- and absolute quantitative data in several volumes of interest (VOIs). Relative semi-quantitative specific binding ratios (SBRs) from Chang attenuated SPECT were obtained from GE DaTQUANT. Absolute normalised concentration (NC) was calculated from attenuation/scatter corrected SPECT-CT images, using an adapted version of the EARL Ltd (European Association of Nuclear Medicine (EANM) Research 4 Life) template. Scans were subdivided into either degenerative parkinsonism (abnormal = 49), borderline (n = 14) or scan without evidence of dopaminergic deficit (SWEDD = 11) using visual assessment and SBR values by two nuclear medicine consultants. Results: SBRs did not correlate with BMI. However, NC values correlated negatively in the entire cohort, with the strongest correlation in the frontal (r = − 0.649. p = 0.000), occipital (r = − 0.555, p = 0.000) regions and pons (r = − 0.555, p = 0.000). In the abnormal (n = 49) and SWEDD group (n = 11), NC of the frontal region was the most correlated with BMI (r = − 0.570, p = 0.000; r = − 0.813, p = 0.002, respectively). In the borderline group (n = 14), the left posterior putamen displayed the strongest correlation (r = − 0.765, p = 0.001). Conclusion: Absolute NC values demonstrate a strong inverse correlation with BMI, strongest in the extrastriatal regions. Due to the predominately non-overlapping distribution of DaT and SERT, this study suggests greater involvement of SERT in obesity with possible interplay with DA transmission. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.Design: Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.Setting: PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).Participants: None.Intervention(s): None.Main Outcome Measure(s): None.Results: PET-CT service provision has grown over the period 2006-2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.Conclusions: Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services. [ABSTRACT FROM AUTHOR]

Background: Alkaline phosphatase (ALP) declines and pain responses can occur during radium-223 ( 223 Ra) treatment, but their association with treatment outcomes is unclear., Methods: For patients with metastatic castration-resistant prostate cancer treated with 223 Ra in the REASSURE study, we investigated whether ALP decline (Week 12) and/or pain response (during treatment) are associated with improved overall survival (OS). The Brief Pain Inventory-Short Form (BPI-SF) was used to assess pain at baseline and pain response (in patients with baseline BPI-SF score ≥2)., Results: Of 785 patients with baseline and Week 12 ALP measurements, 779 were eligible for the OS analyses. Overall, 80% of patients had an ALP decline. Median OS was longer in patients with than without an ALP decline (18.1 versus 14.2 months; HR 0.74; 95% CI 0.60-0.92). In patients with an ALP decline, there was no clear OS difference between those with versus without a pain response. For patients without ALP decline, median OS was longer in those with versus without a pain response (16.2 versus 10.9 months; HR 0.50; 95% CI 0.32-0.77)., Conclusions: Decreases in ALP and/or pain during 223 Ra treatment are associated with improved OS. This may help support clinical decisions., Clinical Trial Registration: ClinicalTrials.gov identifier NCT02141438. Analyses from the radium-223 REASSURE global study suggest that declines in alkaline phosphatase and pain during treatment may predict longer survival in patients with advanced prostate cancer and may help doctors make decisions with their patients., Competing Interests: Competing interests: JMO’S reports consulting or advisory roles for Bayer, Janssen, Astellas Pharma, Sanofi and Novartis. Speakers’ Bureau from Bayer, Janssen and Novartis. His institution has received research funding from Bayer. DH reports consulting or advisory roles from Astellas Pharma, Bayer, Eisai, Ipsen, Organon and Pfizer. Honoraria from Astellas Pharma, AstraZeneca, Bayer, Bristol-Myers Squibb, EUSA, Ferring, Ipsen, Janssen-Cilaq, Merck, Sharp & Dome (MSD), Novartis, Novo Nordisk, Sanofi and Pfizer. His institution has received research funding from AstraZeneca, Bristol-Myers Squibb, Eisai, Janssen-Cilaq, MSD, Pfizer and Roche. EC reports consulting or advisory roles from Bayer, Janssen, AstraZeneca, Astellas Pharma, Merck, Pfizer and MSD Oncology. Travel, accommodation or expenses from Bayer, Janssen, Roche, Astellas Pharma and AstraZeneca. Expert testimony from Pfizer. Honoraria from Astellas Pharma, Janssen-Cilag, AstraZeneca, Bayer, Pfizer, Roche and Clovis Oncology. Her institution has received research funding from AstraZeneca, Bayer, Janssen and SYNLAB. SG reports consulting or advisory roles from Bristol-Myers Squibb, Bayer, Pfizer, Exelixis, Corvus Pharmaceuticals, Sanofi/Genzyme, EMD Serono, Seattle Genetics/Astellas, Eisai, Merck, AVEO, AstraZeneca and QED Therapeutics. His institution has received research funding from Pfizer, Merck, Agensys, Novartis, Bristol-Myers Squibb, Bayer, Eisai, Seattle Genetics/Astellas, Calithera Biosciences, Corvus Pharmaceuticals, Surface Oncology, Exelixis, Aravive, Aveo and Gilead Sciences. SD reports consulting or advisory roles from GE Healthcare, Bayer and Advanced Accelerator Applications. SB has no conflicts of interest to declare. ME reports consulting or advisory roles from Advanced Accelerator Applications, Bayer and Ipsen. Travel, accommodation or expenses from Ipsen. IJdeJ reports speakers’ bureau from AstraZeneca. Travel, accommodation or expenses from Bayer. SL has no conflicts of interest to declare. PGH reports consulting or advisory roles from Bayer, Amgen, Novartis, Janssen, AstraZeneca, Astellas Pharma, Merck, Pfizer, Takeda and MSD Oncology. Travel, accommodation or expenses from Bayer, Janssen, Astellas Pharma and Pfizer. BT reports consulting or advisory roles from Astellas Pharma, Bayer, Ferring, Janssen, Takeda, Steba Biotech, Sanofi, Myovant Sciences, Pfizer/Astellas. Speakers’ bureau from Amgen, Janssen and Astellas Pharma. Travel, accommodation or expenses from Amgen, Astellas Pharma, Bayer, Ferring, Janssen and Sanofi. Expert testimony from Tookad. Honoraria from Amgen, Astellas Pharma, Bayer, Ferring, Sanofi, Janssen, Pfizer and Myovant Sciences. His institution has received research funding from Ferring. NDJ reports consulting or advisory roles from Sanofi, Bayer, Astellas Pharma, Janssen, Clovis Oncology, EUSA pharma and Pfizer. Speakers’ bureau from Pierre Fabre, Ferring, Sanofi, Astellas Pharma, Janssen Oncology, Merck and AstraZeneca. Travel, accommodation or expenses from Sanofi and Janssen. Honoraria from Sanofi, Bayer, Janssen and Astellas Pharma. His institution has received research funding from Janssen, Astellas Pharma, Pfizer, Sanofi, Novartis and AstraZeneca. JM is an employee of Bayer and reports stock and other ownership interests from Bayer (myself and an immediate family member), Pfizer (myself and an immediate family member), Lilly (myself and an immediate family member). PS is an employee of Bayer. OS reports consulting or advisory roles from Bayer, Sanofi, AstraZeneca, Dendreon, Constellation Pharmaceuticals, Advanced Accelerator Applications, Pfizer, Bristol-Myers Squibb, Bavarian Nordic, EMD Serono, Astellas Pharma, Progenics, Blue Earth Diagnostics, Myovant Sciences, Myriad Genetics, Novartis, Clarity Pharmaceuticals, Fusion Pharmaceuticals, Isotopen Technologien, Janssen, Noxopharm, Clovis Oncology, Noria Therapeutics, Point Biopharma, TeneoBio, Telix Pharmaceuticals and Theragnostics. Travel, accommodation or expenses from Bayer, Johnson & Johnson, Sanofi, AstraZeneca and Progenics. Expert testimony from Sanofi. Stock and other ownership interests from Lilly, GlaxoSmithKline, AbbVie, Cardinal Health, United Health Group, PSMA Therapeutics, Clarity Pharmaceuticals, Noria Therapeutics and Clovis Oncology. His institution has received research funding from Bayer, Sanofi, Endocyte, Merck, InVitae, Constellation Pharmaceuticals, Advanced Accelerator Applications, AstraZeneca and Dendreon. He has received research funding from SOTIO and Janssen. Ethics approval and consent to participate: The conduct of REASSURE complies with the principles of the Declaration of Helsinki and the guidelines and regulations of the European Medicines Agency, US Food and Drug Administration, applicable local laws and regulations, and International Conference on Harmonisation Good Clinical Practice. All patients provided signed informed consent, and approvals were obtained from ethical committees or institutional review boards in the participating countries (a list of the ethics committees/institutional review boards that approved the study is provided in Supplementary Table 3)., (© 2025. The Author(s).)

Introduction: The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99m Tc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99m Tc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99m Tc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial., Methods and Analysis: A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99m Tc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99m Tc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99m Tc-sestamibi SPECT/CT., Ethics and Dissemination: Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally., Trial Registration Number: ISRCTN12572202., Competing Interests: Competing interests: GDS has received educational grants from Pfizer, AstraZeneca and Intuitive Surgical; consultancy fees from Pfizer, Merck, EUSA Pharma and CMR Surgical; Travel expenses from Pfizer and Speaker fees from Pfizer. SD provides educational consultancy for GE Healthcare, Bayer, AAA and AVAANT diagnostics., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Imaging with β-amyloid (Aβ) positron emission tomography (PET) has the potential to aid the diagnosis of the cause of cognitive impairment affecting people living with HIV (PLWH) when neurodegenerative disorders are considered. We evaluated the clinical utility of [18F]Florbetaben (FBB) in PLWH with cognitive symptoms., Methods: Imaging with FBB PET was performed in 20 patients with cognitive concerns about dementia. Neuropsychological testing, plasma neurofilament light protein, plasma Aβ40, Aβ42, and cerebrospinal fluid Aβ42, tau, and HIV RNA were obtained. FBB PET images were assessed visually by 3 readers blinded to the clinical diagnosis and quantitatively by obtaining a composite cortical to cerebellar cortex standardized uptake value ratio (SUVR). FBB SUVR from 10 age-matched healthy controls was compared with SUVR of PLWH., Results: Most participants were men (90%) of white ethnicity (90%) with a median age (interquartile range) of 59 (43-79) years. Median CD4 count was 682 (74-1056). All patients were on combination antiretroviral therapy with plasma and cerebrospinal fluid HIV RNA <40 copies/mL. Fourteen patients had objective cognitive impairment including 2 who met clinical criteria for a diagnosis of dementia. No significant differences in composite SUVRs between PLWH and controls [mean (SD): 1.18 (0.03) vs. 1.16 (0.09); P = 0.37] were observed. Four patients were FBB+ with the highest SUVR in the posterior cingulate, superior temporal, and frontal superior lobe. Amyloid PET results contributed to a change in diagnosis and treatment for 10 patients., Conclusion: [18F]Florbetaben PET has potential as an adjunctive tool in the diagnosis of PLWH with cognitive impairment, increasing diagnostic certainty and optimizing management., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)