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Grand RoundsWeekly Evidence Brief

Nuclear Medicine

Edition

30-Second Takeaway

  • CAIX- and FAPI-targeted PET/CT are outperforming FDG and CT in key oncologic indications and treatment planning.
  • Routine FDG-PET/CT can reveal early denosumab-related MRONJ long before clinical symptoms, allowing preventive intervention.
  • Amyloid and tau PET increasingly provide independent prognostic and pathologic confirmation beyond structural or perfusion imaging.
  • FAPI and LAFOV kinetic PET tools are expanding quantitative multi-organ and fibroinflammatory applications beyond traditional oncology.
  • Psychotropic drugs may rapidly alter FDG brain signals independent of CBF, complicating interpretation of neuro-PET under treatment.

Week ending February 7, 2026

Emerging PET Applications Reshaping Oncologic, Cardiac, Neuro, and Systemic Imaging

CAIX-targeted [18F]AlF-NYM005 PET/CT outperforms FDG for staging clear cell RCC

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGINGFeb 3, 2026

In 61 patients with clear cell RCC, CAIX-targeted [18F]AlF-NYM005 PET/CT showed markedly higher accuracy for primary renal tumors than FDG PET/CT. Sensitivity, specificity, and accuracy for renal tumors were all substantially higher with [18F]AlF-NYM005 compared with FDG. The CAIX tracer detected many more metastatic lesions, especially in lymph nodes, pleura or peritoneum, and lung, than FDG. Staging or restaging changed in about one-third of patients when using [18F]AlF-NYM005 instead of FDG PET/CT. Tumor uptake and tumor-to-liver ratios were higher with [18F]AlF-NYM005, and uptake correlated with CAIX expression and adverse pathology.

[18F]AlF-NOTA-FAPI PET/CT refines lung cancer radiotherapy volumes and spares organs

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGINGFeb 5, 2026

This secondary analysis of 51 stage I–III lung cancer patients compared CE-CT, FDG PET/CT, and [18F]AlF-NOTA-FAPI PET/CT for radiotherapy planning. CE-CT-based gross tumor volumes were larger than PET-based volumes, mainly due to inclusion of obstructive pneumonia. Planning target volumes for IMRT and IMPT were significantly smaller when based on [18F]AlF-NOTA-FAPI compared with CE-CT. FAPI-based IMRT plans reduced radiation doses to the heart, contralateral lung, and both lungs compared with CE-CT-based plans.

FDG-PET/CT detects MRONJ months before symptoms in denosumab-treated metastatic breast cancer

ECLINICALMEDICINEFeb 5, 2026

This Austrian cohort included metastatic breast cancer patients on monthly denosumab who developed MRONJ and matched denosumab-treated controls. Nuclear medicine physicians retrospectively identified jaw abnormalities on FDG-PET/CT in 91% of MRONJ cases and 29% of controls. Imaging changes preceded clinical MRONJ diagnosis by a median of about eight months, providing a substantial window for intervention. In most MRONJ cases, readers could localize the future necrotic tooth region within two teeth on PET/CT.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Novel molecular tracers (CAIX, FAPI, amyloid, tau) are moving PET beyond morphology toward treatment-shaping and prognostic roles.
  • Theranostic pathways in neuro-oncology and RCC will likely rely on more specific PET targets instead of FDG alone.
  • Quantitative PET (volume-based metrics, kinetic modeling) is increasingly necessary for risk stratification, treatment planning, and monitoring.