Vajauskas, Donatas

PSMA PET/CT imaging biomarkers are increasingly investigated as predictors of response and survival outcomes following [177Lu]Lu-PSMA radioligand therapy in prostate cancer. This review summarizes the current evidence and clinical relevance of these biomarkers. As [177Lu]Lu-PSMA radioligand therapy is increasingly being introduced into earlier treatment lines of prostate cancer management, the identification of reliable imaging biomarkers for response prediction and outcome assessment is becoming increasingly important. Quantitative PSMA PET/CT parameters such as whole-body (WB) mean standardized uptake value (SUVmean), WB PSMA-positive tumor volume, and tumor load, as well as qualitative features including disease distribution and phenotype (e.g., visceral metastases and FDG-avid, PSMA-negative discordant lesions), have been associated with treatment response, progression-free survival, and overall survival. However, the clinical utility of these imaging biomarkers is limited by heterogeneous study designs, small cohorts, and a lack of standardization in image acquisition, quantification, and cutoff definitions. This review critically appraises available data on baseline PSMA PET/CT-based prognostic and potentially predictive biomarkers for RLT and identifies the methodological barriers that must be addressed before these biomarkers can be implemented in clinical practice.

Transthyretin amyloid cardiomyopathy (ATTR-CM) has undergone a shift towards noninvasive diagnostics using bone tracer scintigraphy with Perugini grading. While both grades 2 and 3 are considered diagnostic, potential phenotypic differences between these groups remain uncertain. We aimed to evaluate the diagnostic yield of technetium-99 m pyrophosphate (99mTc-PYP) scintigraphy and to compare clinical and multimodality imaging characteristics across scintigraphic grades in a single-center cohort.

Plaučių vėžys išlieka pagrindinė onkologinio mirtingumo priežastis, o plaučiai dažnai tampa ir kitų piktybinių navikų metastazių vieta. Nemaža dalis pacientų dėl gretutinių ligų yra neoperabilūs. Šiems pacientams svarbi alternatyva – kompiuterine tomografija kontroliuojama terminė abliacija (TA), leidžianti sunaikinti naviką maksimaliai tausojant plaučių audinį. Tyrimu siekiama išsamiai įvertinti terminės abliacijos saugumą bei jos daromą įtaką pacientų kvėpavimo funkcijai ir bendrai gyvenimo kokybei, lyginant šį metodą chirurgine rezekcija ir stereotaksine radioterapija. Tyrimo rezultatai parodė, kad TA yra saugus ir efektyvus gydymo metodas. Lyginant su chirurgija, TA pasižymi trumpesne hospitalizacija, mažesniu komplikacijų dažniu bei geresniu plaučių funkcijos ir perfuzijos išsaugojimu, pacientai greičiau atgauna funkcinį aktyvumą išlaiko geresnę gyvenimo kokybę, patiria mažiau skausmo išlaikant aukštą vietinę ligos kontrolę. Rekomenduojama terminę abliaciją svarstyti kaip efektyvią radikalaus gydymo alternatyvą neoperabiliems, sunkių gretutinių ligų turintiems pacientams. Nustatyta, kad po plaučio perkutaninių intervencijų punkcijos kanalo embolizavimas autologiniu kraujo krešuliu sumažina poprocedūrinio pneumotorakso riziką, tad rekomenduojama šią metodiką taikyti klinikinėje praktikoje. Planuojant gydymą ypač svarbu pasitelkti hibridinę plaučių perfuzijos scintigrafiją, padedančią tiksliai įvertinti ir prognozuoti regioninius plaučių perfuzijos pokyčius.

Background and Objectives Prostate cancer (PC) remains one of the most prevalent solid malignancies affecting men globally. Despite curative-intent treatments such as radical prostatectomy (RP) or radiotherapy (RT), biochemical recurrence (BCR) occurs in approximately 27% to 53% of patients, often without corresponding findings on conventional imaging modalities. BCR following RP is typically defined by a prostate-specific antigen (PSA) level exceeding 0.2 ng/mL, confirmed by at least two consecutive measurements, whereas in post-RT patients, BCR is identified when PSA rises more than 2 ng/mL above the nadir. Timely and accurate localization of recurrent disease—whether confined locally or metastasized—is critical to guide appropriate salvage therapy. In this context, prostatespecific membrane antigen (PSMA) PET/CT has emerged as a highly sensitive imaging technique, demonstrating superior detection rates in patients with PSA relapse when compared to traditional imaging. Material and Method We retrospectively analyzed medical data of 29 patients, who previously underwent RP or RT treatment for prostate cancer, assessing the clinical profile of patient with suspected prostate cancer relapse who underwent 68Ga-PSMA PET/CT examination between August and December of 2024 in the Department of Nuclear medicine, Kaunas Hospital of Lithuanian University of Health Sciences. Data of PET/CT scan result and pre-test PSA values were retrospectively analyzed. Using three different mesurments of PSA we calculated PSA doubling time. Statistical analysis was performed using IBM SPSS (version 29.0.1.0). PET/CT scan result in relation to pre-scan PSA were assessed by receiver operating characteristic (ROC) curve. The chi-square test was used, if the expected cell count was more than 33.3% Fisher’s exact test was applied. A p-value of <0.05 was considered statistically significant. Results Out of 29 patients who underwent 68Ga-PSMA scan 22 (75,9%) of the patients were PET/CT positive. Patients with PSA values <1 ng/ml, 1–10 ng/ml, and >10 ng/ml had a 46% (CI 17–77), 92% (CI 64–99), and 100% (CI 48–100) chance, respectively, of being PET/CT positive. Patients with PSA<1 ng/ml were statistically significantly more likely to be PET/CT negative (p<0,05). 5 (22,7%) patients who were PET/CT positive had PSA value <1 ng/ml compared to 6 (85,7%) of the patients who were PET/CT negative. No patients who were PET/CT negative had PSA value >10 ng/ml, while 5 (22,7%) patients who were PET/CT positive had PSA value >10 ng/ml. A PSA of 0,685 ng/ml (AUC = 0,808; CI: 0,633-0,984) was found to be the optimal cut-off point for predicting positive or negative scans. Out of all the patients who had positive PET/CT scan 18 (81,8%) had PSA value >0,685 ng/ml and out of all patients who had negative PET/CT scan 6 (85,7%) of the patients had PSA value <0,685 ng/ml, this difference was statistically significant (p<0,05). PSA doubling time showed no statistically significant difference between the two groups of patients. 17 (77,3%) of the patients who were PET/CT positive had doubling time less than 1 year while 5 (71,4%) of the patients who were PET/CT negative had doubling time less than 1 year. Out of 22 patients who were PET/CT positive, 16 (72,7%) had distant metastasis, 4 (18,2%) had local metastasis and 2 (9,1%) of the patients only had local recurrence with no metastasis, PSA value and PSA doubling time showed no statistical difference between these three groups. Conclusions and Recommendations Results of this study show that pre-test PSA value of <1 ng/ml is significantly associated with negative PET/CT. PSA cut-off point of 0.685 ng/ml can serve as a useful predictor for scan positivity or negativity in clinical practice. Slightly more PET/CT positive patients had PSA doubling time of less than one year but this difference was not statistically significant.

Plaučių vėžys vis dar tebėra didžiulė grėsmė ne tik pasaulio, Europos Sąjungos, bet ir Lietuvos gyventojams. Siekiant pagerinti pagalbą plaučių vėžiu sergantiems ligoniams, suvienodinti specialistų požiūrį į šios ligos diagnostikos ir gydymo standartus, Lietuvos sveikatos mokslų universiteto ir Lietuvos sveikatos priežiūros specialistų draugijų iniciatyva bei bendru darbu nuo 2007-ųjų kas kelerius metus išleidžiamos „Plaučių vėžio diagnostikos ir gydymo rekomendacijos“. Išlaikydami tradicijas ir tęstinumą pristatome aštuntąsias atnaujintas ir papildytas „Plaučių vėžio diagnostikos ir gydymo rekomendacijas“, kurios yra gausaus autorių, savo srities ekspertų ir pagrindinių Lietuvos sveikatos priežiūros specialistų draugijų atstovų, kolektyvo ilgametės patirties, bendro nuolatinio darbo rezultatas. Plaučių vėžio gydymas išlieka viena dinamiškiausių onkologijos sričių, todėl ankstesnes rekomendacijas buvo būtina atnaujinti apžvelgiant svarbiausias prigijusias naujoves. Plaučių vėžio profilaktika, ankstyva diagnostika ir atrankinė patikra yra viena iš prioritetinių sričių naujame Europos Sąjungos kovos su vėžiu plane. Kai kuriose Europos Sąjungos šalyse jau yra įdiegtos nacionalinės plaučių vėžio patikros programos, kitose, taip pat ir Lietuvoje, vykdomos ar jau atliktos bandomosios programos. Tačiau, kol nėra patvirtinta nacionalinė plaučių vėžio patikros programa Lietuvoje, šiose rekomendacijose paliekame tikslinės plaučių vėžio atrankinės patikros gaires, kurios sėkmingai pritaikytos daugelyje Europos Sąjungos šalių ir yra patvirtintos Lietuvoje Plaučių vėžio metodiniame dokumente. Tikimės, kad netolimoje ateityje galėsime pristatyti ir nacionalinę plaučių vėžio atrankinės patikros programą. [...].

Background/Objectives: Accurate assessment of pulmonary function is essential before planning radical lung cancer treatment. While spirometry reflects global lung function, perfusion imaging provides detailed information on regional perfusion patterns. This study aimed to characterize the pre-treatment profile of patients and compare the impact of surgical resection, radiotherapy, and thermal ablation on global pulmonary function and regional perfusion using SPECT/CT. Methods: In this prospective study of 68 patients, pre- and post-treatment assessments were conducted using lung perfusion SPECT/CT. While the entire cohort underwent imaging, longitudinal global pulmonary function (spirometry and gas diffusion) was analyzed for 45 patients who completed the three-month follow-up. Quantitative analysis included perfusion percentages and lung volumes, while a semi-quantitative scoring system evaluated the severity of perfusion defects. Results: In the overall cohort, the affected lung perfusion and volume significantly decreased (p = 0.002). Subgroup analysis revealed that the surgical resection group experienced significant reductions in perfusion (from 54.0% to 41.0%, p = 0.002) and volume (p < 0.001) of the affected lung, whereas no statistically significant changes were observed in the thermal ablation and radiotherapy groups (p > 0.05). Notably, 60.3% of patients presented with perfusion defects before treatment. Post-treatment spirometry parameters, particularly FEV1% (threshold 83.5%, AUC = 0.783), served as reliable predictors of persistent perfusion impairment. Conclusions: Radiotherapy and thermal ablation are lung-perfusion-sparing treatments compared to surgical resection. The high prevalence of pre-existing perfusion defects emphasizes the importance of incorporating lung perfusion SPECT/CT into routine pre-treatment evaluation to optimize treatment selection.

Introduction Treatment of parathyroid adenomas (PA) traditionally relies on open surgery, which may be unsuitable for elderly or comorbid patients [1]. We report the first use of percutaneous cryoablation for PA at Kaunas Clinics, demonstrating its feasibility as a minimally invasive alternative to surgery. Case Presentation A 79-year-old woman was admitted with hypercalcemia. Intravenous (IV) fluids and loop diuretics were initiated, along with correction of hypophosphatemia. The patient had a history of total thyroidectomy 30 years prior. Ultrasound (US) revealed a lesion in the left paratracheal region, measuring 1.1 × 0.5 × 1.4 cm. Fine-needle aspiration with parathyroid hormone (PTH) washout showed markedly elevated PTH (210.6 pmol/L), confirming PA. Despite conservative management, calcium (Ca) levels remained elevated. The patient was referred to an interventional radiologist for planned cryoablation, as the patient was not eligible for surgery. Under US guidance and general anesthesia, hydrodissection (HD) with physiological saline was performed to separate the lesion from the trachea and maintained this safe plane throughout the procedure. A single 17G cryoprobe was inserted into the lesion under US guidance and two freeze-thaw cycles (10-minute and 6-minute freezes) were applied. Iceball formation was monitored using US and computed tomography (CT), confirming complete lesion coverage. Follow-up CT showed no acute post cryoablative complications. Postprocedural laboratory results demonstrated a rapid decline in PTH (34.70 to 2.45 pmol/L) and a progressive decrease in serum Ca to normal levels (3.08 to 2.39 mmol/L) within 24 hours. Discussion The procedure was technically challenging due to the patient’s history of thyroidectomy, which changed the cervical soft-tissue anatomy [2]. Identification of the recurrent laryngeal nerve was crucial and difficult; therefore, HD was used to safely separate the PA from the nerve’s expected location, maintaining a safe distance throughout the procedure [3]. Conclusions This case demonstrates that percutaneous cryoablation may serve as a safe, minimally invasive alternative to surgery for selected patients.

Introduction Myocardial perfusion scintigraphy (SPECT) is a non-invasive nuclear medicine examination method allowing asessment of regional myocardial perfusion changes and left ventricular (LV) functional parameters [1]. Perfusion disorders in different coronary artery basins can separately affect ventricular mechanical synchrony, systolic and diastolic function and mechanics before development of global functional decline [2]. Aim To evaluate how the severity of coronary artery stenosis and regional myocardial perfusion changes, determined by SPECT, are related to: 1) left ventricular systolic function; 2) left ventricular diastolic function; 3) left ventricular mechanical parameters. Methods A retrospective analysis of gated myocardial perfusion SPECT data from 16 patients examined at the Hospital of Lithuanian University of Health Sciences was performed. Patients were included if they underwent myocardial perfusion SPECT and had available invasive coronary angiography results. Perfusion indices included summed stress score (SSS) and summed difference score (SDS). Coronary artery stenosis severity in the right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx) was categorized as none, >35% and >70%. Patients were additionally grouped according to perfusion impairment. LV functional (ejection fraction (EF), stroke volume) and mechanical parameters (systolic/diastolic eccentricity, peak phase) were derived using QGS/QPS software. Statistical analysis was performed in IBM SPSS Statistics 29.0 using Student’s t-test or Mann–Whitney U test, with p 0.05). In patients with >70% stenosis (n=5) in LCx basin, stroke volume was statisticaly significantly higher than in patients without stenosis (n=11) (p=0.025). On evaluating the >35% stenosis threshold, only LAD basin (n=10) showed a significantly lower ejection fraction (p=0.004). Mechanical analysis showed that patients with >70% LCx stenosis (n=5) had greater systolic (p=0.009) and diastolic (p=0.017) ecentricity. In group with >35% LCx stenosis (n=9), only an increase in systolic ecentricity was observed (p=0.013). In the LAD basin, in group with >35% stenosis (n=8), a prolonged peak phase was observed (p=0.012). RCA stenosis was not associated with significant changes in LV functional or mechanical parameters. Conclusions Regional perfusion defects and coronary stenosis were associated with changes in 1) LV systolic function (higher stroke volume and lower stress EF), 2) LV diastolic function (suggesting early diastolic dysfunction), 3) LV mechanics: LCx stenosis was associated with higher stroke volume and increased systolic/diastolic eccentricity, while LAD >35% stenosis was associated with lower stress ejection fraction and prolonged peak phase.

Introduction Positron emission tomography/computed tomography (PET/CT) using [18F] fluorodeoxyglucose ([18F]FDG) is the standard imaging modality for response assessment in Hodgkin lymphoma (HL). However, post-radiotherapy (RT) interpretation may be challenging due to inflammation-related uptake. Case Presentation A 55-year-old woman was diagnosed with nodular lymphocyte-predominant HL. Initial PET/CT revealed metabolically active lymphadenopathy above and below the diaphragm, consistent with Lugano stage III disease. The patient received six cycles of BEACOPP chemotherapy. Postchemotherapy PET/CT demonstrated partial metabolic response with persistent FDG uptake in a left common iliac lymph node (Deauville score 4). Following multidisciplinary discussion, consolidative RT was completed to this site. At 8 weeks post-RT PET/CT again showed persistent FDG uptake in the same lymph node (Deauville score 4), raising concern for residual disease. Biopsy was considered but was technically challenging. Considering the risk of falsepositive findings in early post-RT imaging, the decision was made to repeat PET/CT 12 weeks later (approximately 20 weeks after RT). Follow-up imaging demonstrated complete metabolic response (Deauville 2), with slight FDG uptake below blood pool in the left common iliac lymph node Discussion Current recommendations advise performing PET/CT at least 8–12 weeks after RT to reduce inflammation-related false-positive results [1–4]. This case illustrates that a rigid earlyimaging approach is not always appropriate: 8 week post-RT PET/CT suggested possible persistent disease, which could have led to unnecessary salvage therapy, including chemotherapy and autologous stem cell transplantation. By delaying treatment escalation and repeating PET/CT, complete metabolic response was confirmed, avoiding overtreatment. Conclusions This case highlights the importance of appropriate timing of PET/CT after RT in HL. Delayed metabolic assessment can prevent false-positive interpretation and unnecessary treatment escalation, highlighting the value of multidisciplinary decision-making.

Background/Objectives: The role of extended pelvic lymph node dissection (ePLND) in prostate cancer remains uncertain. Sentinel lymph node (sLN) mapping improves diagnostic precision, yet some patients have no detectable sentinel nodes (“untraceable” sLNs). This study evaluates whether untraceable sLNs predict the absence of lymph node invasion (LNI) and can guide surgical decision-making during radical prostatectomy (RP) with ePLND. Methods: Patients with intermediate- or high-risk prostate cancer and with no radiologically evident LNI were included in the study. A 99mTc-nanocolloid was used as an sLN tracer. RP with sLN dissection and ePLND was performed <20 h after injection. Patients were categorized into two groups: Group 1, traceable sLNs and Group 2, untraceable sLNs (no radiological or intraoperative signal). Results: A total of 53 patients were included. LNI was present in 10 patients (18.9%). Group 1 had 41 patients (77.4%), and Group 2 had 12 patients (22.6%). None of the patients in Group 2 had LNI following ePLND, whereas 10 of 41 patients (24.4%) in Group 1 were node-positive (p = 0.016). Baseline clinical and pathological characteristics were comparable between groups. A total of 17/53 of men (32.1%) experienced biochemical recurrence, overall, with higher observed events in Group 1 (15/41, 36.6%) vs. Group 2 (2/12, 16.7%). However, this difference did not reach statistical significance (p = 0.2). Conclusions: A proportion of PCa patients have no radiologically or intraoperatively detectable sLNs, and none of the patients with untraceable sLNs exhibited LNI following ePLND. These findings suggest that untraceable sLNs may correlate with an extremely low probability of nodal invasion and could serve as a criterion for safely omitting ePLND in selected patients.