McDonald Sam, Keane Kevin G, Gauci Richard, Hayne Dickon
Urology Department, South Metropolitan Health Service, Murdoch, WA, 6150, Australia.
UWA Medical School, University of Western Australia, Crawley, WA 6009, Australia.
Cancers (Basel). 2025 Jan 13;17(2):232. doi: 10.3390/cancers17020232.
: The role of molecular imaging in urothelial cancer is less defined than other cancers, and its utility remains controversial due to limitations such as high urinary tracer excretion, complicating primary tumour assessment in the bladder and upper urinary tract. This review explores the current landscape of PET imaging in the clinical management of urothelial cancer, with a special emphasis on potential future advancements including emerging novel non-F FDG PET agents, PET radiopharmaceuticals, and PET-MRI applications. : We conducted a comprehensive literature search in the PubMed database, using keywords such as "PET", "PET-CT", "PET-MRI", "FDG PET", "Urothelial Cancer", and "Theranostics". Studies were screened for relevance, focusing on imaging modalities and advances in PET tracers for urothelial carcinoma. Non-English language, off-topic papers, and case reports were excluded, resulting in 80 articles being selected for discussion. : F FDG PET-CT has demonstrated superior sensitivity over conventional imaging, such as contrast-enhanced CT and MRI, for detecting lymph node metastasis and distant disease. Despite these advantages, FDG PET-CT is limited for T-staging of primary urothelial tumours due to high urinary excretion of the tracer. Emerging evidence supports the role of PETC-CT in assessing response to neoadjuvant chemotherapy and in identifying recurrence, with a high diagnostic accuracy reported in several studies. Novel PET tracers, such as Ga-labelled FAPI, have shown promising results in targeting cancer-associated fibroblasts, providing higher tumour-to-background ratios and detecting lesions missed by traditional imaging. Antibody-based PET tracers, like those targeting Nectin-4, CAIX, and uPAR, are under investigation for their diagnostic and theranostic potential, and initial studies indicate that these agents may offer advantages over conventional imaging and FDG PET. Molecular imaging is a rapidly evolving field in urothelial cancer, offering improved diagnostic and prognostic capabilities. While F FDG PET-CT has shown utility in staging, further prospective research is needed to establish and refine standardised protocols and validate new tracers. Advances in theranostics and precision imaging may revolutionise urothelial cancer management, enhancing the ability to tailor treatments and improve patient outcomes.
分子成像在尿路上皮癌中的作用不如在其他癌症中那样明确，并且由于诸如高尿示踪剂排泄等限制，其效用仍存在争议，这使得对膀胱和上尿路原发性肿瘤的评估变得复杂。本综述探讨了PET成像在尿路上皮癌临床管理中的现状，特别强调了潜在的未来进展，包括新兴的新型非F-FDG PET显像剂、PET放射性药物和PET-MRI应用。我们在PubMed数据库中进行了全面的文献检索，使用了“PET”、“PET-CT”、“PET-MRI”、“FDG PET”、“尿路上皮癌”和“治疗诊断学”等关键词。筛选研究的相关性，重点关注尿路上皮癌的成像方式和PET示踪剂的进展。排除非英语语言、离题论文和病例报告，最终选择了80篇文章进行讨论。F-FDG PET-CT在检测淋巴结转移和远处疾病方面已显示出优于传统成像（如对比增强CT和MRI）的敏感性。尽管有这些优点，但由于示踪剂的高尿排泄，FDG PET-CT在原发性尿路上皮肿瘤的T分期方面存在局限性。新出现的证据支持PET-CT在评估新辅助化疗反应和识别复发方面的作用，几项研究报告其诊断准确性很高。新型PET示踪剂，如镓标记的FAPI，在靶向癌症相关成纤维细胞方面已显示出有前景的结果，提供了更高的肿瘤与背景比值，并检测到传统成像遗漏的病变。基于抗体的PET示踪剂，如靶向Nectin-4、CAIX和uPAR的示踪剂，正在研究其诊断和治疗诊断潜力，初步研究表明这些药物可能比传统成像和FDG PET具有优势。分子成像在尿路上皮癌中是一个快速发展的领域，具有改进的诊断和预后能力。虽然F-FDG PET-CT在分期方面已显示出效用，但需要进一步的前瞻性研究来建立和完善标准化方案并验证新的示踪剂。治疗诊断学和精准成像的进展可能会彻底改变尿路上皮癌的管理，增强定制治疗方案和改善患者预后的能力。
