The activity of immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma is often monitored using fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans. However, distinguishing disease progression (PD) from pseudoprogression (PsPD), where increased FDG uptake might reflect immune cell activity rather than tumor growth, remains a challenge. This prospective study compared the efficacy of dual-time point (DTP) FDG-PET/CT with modified response criteria (PERCIMT) in differentiating PsPD from PD. From July 2017–January 2021, 41 patients suspected to have PsPD on an evaluation scan were prospectively included (29 evaluable). A subsequent DTP FDG-PET/CT scan was conducted within 14 days, followed by a confirmatory FDG-PET/CT scan. Additionally, PERCIMT were applied. DTP FDG-PET/CT identified 24% with PsPD and 76% with PD. Applying PERCIMT criteria, 69% showed PsPD, while 31% had PD. On follow-up, 10 patients (34%) demonstrated confirmed PsPD, while 19 (66%) exhibited PD. The sensitivity and specificity of DTP FDG-PET/CT were 20% and 74%, respectively, and for PERCIMT this was 80% and 37%, respectively. Our findings suggest limited efficacy of DTP FDG-PET/CT in distinguishing PsPD from PD in ICI-treated patients with metastatic melanoma. The use of PERCIMT could complement clinical assessment and be incorporated in multidisciplinary team conferences for enhanced decision-making.

We present the ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) findings in a 57-year-old woman with post-menopausal bleeding diagnosed with hepatoid adenocarcinoma (HAC) with a primary tumour in the uterine corpus and a highly elevated level of serum-α-fetoprotein (S-AFP) at presentation. HAC is a variant of adenocarcinoma with hepatic differentiation representing a heterogeneous group of neoplasms that morphologically and immunphenotypically resemble hepatocellular carcinoma (HCC) but are of extrahepatic origin. Microscopically, they are usually poorly differentiated adenocarcinomas proliferating in solid sheets or in a trabecular or cord-like arrangement. Primary uterine HAC is exceedingly rare with a general poor prognosis, and data is sparse and limited to case reports, making the clinical management challenging. Various primary anatomical sites have been reported in the literature, with the stomach being the most common primary site. ¹⁸F-FDG PET/CT plays an important role in staging and follow-up in many gynecological malignancies including uterine corpus cancer. To the best of our knowledge, this is the first report describing a primary uterine hepatoid adenocarcinoma with metastases to bone, vagina and lymph nodes on ¹⁸F-FDG PET/CT. By utilizing the ability of PET to detect early metabolic changes prior to visible structural changes on conventional imaging, this case illustrates a potential role of ¹⁸FDG-PET/CT in the staging of primary endometrial HAC by depicting distant metastasis that is not readily identifiable on CT alone.

[¹¹C]Choline ([¹¹C]CHO) has reemerged as a radiopharmaceutical tracer for positron emission tomography (PET) diagnostics and optimized synthesis setups are thus needed to meet the increased demand, often on existing production lines. Originally, [¹¹C]CHO has experienced a decline in use for PET diagnostics, particularly in prostate cancer imaging due to radiopharmaceuticals with higher target specificity. However, recent studies have demonstrated superior sensitivity and diagnostic accuracy of [¹¹C]CHO for localizing autonomous adenomas in primary hyperparathyroidism (PHPT) compared to conventional ⁹⁹ᵐTc-sestamibi scintigraphy. The PET-scan is used prior to surgery, but not for the diagnosis of PHPT. The patient compliance is high due to the relatively short time in the scanner. With this renewed clinical relevance, optimization of [¹¹C]CHO synthesis is warranted, as standard production protocols typically yield only 2.5–3.0 GBq. In this study, three critical steps in the synthesis process on a TracerMaker module were systematically evaluated and optimized. (1) Extending the irradiation time from 25 to 42 minutes produced no significant increase in radiochemical yield (RCY). (2) Increasing the precursor, dimethylaminoethanol (DMAE) loading volume to 150 µL divided across two serially connected Sep-Pak Accell CM Plus Light cartridges resulted in a twofold RCY increase but also elevated residual DMAE levels in the final product. (3) Increasing washing volumes of ethanol and water did not improve purification efficiency; however, replacing the two stacked cartridges (2 × 130 mg) with a single cartridge containing a higher sorbent mass (360 mg) achieved effective DMAE removal while maintaining high RCY. These findings demonstrate a practical route for optimizing [¹¹C]CHO synthesis to meet the growing clinical demand of [¹¹C]CHO for imaging of PHPT.

Positron emission tomography (PET) using [¹¹C]choline has recently gained clinical importance for localizing autonomous adenomas in primary hyperparathyroidism (PHPT), offering superior diagnostic accuracy and sensitivity compared to conventional [^99mTc]sestamibi scintigraphy. To meet rising clinical demand using existing infrastructure, this study evaluated three key parameters to optimize the in-house [¹¹C]choline synthesis on a TracerMaker module using [¹¹C]CH₄ as the radioactive precursor, which originally yielded 3.19 ± 0.69 GBq at end of synthesis (EOS). Three critical synthesis steps were systematically evaluated: (1) cyclotron irradiation time, (2) precursor (dimethylaminoethanol, DMAE) loading volume across Sep-Pak Accell CM cartridges, and (3) purification wash volumes. Extending irradiation time from 25 to 42 min produced no significant increase in EOS yield. Increased DMAE loading volumes up to 300 µL across 1–3 serially connected 130 mg sorbent cartridges doubled the EOS yield but elevated residual DMAE levels in the final product. Increased wash volumes of ethanol and water failed to improve purification efficiency; however, substituting the multi-cartridge system with a single higher-mass sorbent cartridge (360 mg) achieved effective DMAE removal while maintaining high EOS yield (6.46 ± 0.31 GBq). These findings demonstrate a practical route for [¹¹C]choline synthesis optimization to meet the growing clinical demand for PET imaging of PHPT.