Total-Body PET/CT Metabolic Response in Esophageal Squamous Cell Carcinoma

Runjun Yang; Xinyi Lu; Wenxin Tang; Lorenzo Nardo; Yunze Xie; Akram Al-Ibraheem; Lichao Zhang; Wenjin Zhao; Axel Rominger; Lijie Tan; Han Tang; Ida Nur Syafinaz Binti Muhammad Fuad; Subapriya Suppiah; Eric Cruz; Yu Lin; Haojun Yu; Hongcheng Shi

doi:10.1053/j.semnuclmed.2025.11.010

Total-Body PET/CT Metabolic Response in Esophageal Squamous Cell Carcinoma

Semin Nucl Med. 2025 Nov 29:S0001-2998(25)00162-X. doi: 10.1053/j.semnuclmed.2025.11.010. Online ahead of print.

Authors

Runjun Yang¹, Xinyi Lu¹, Wenxin Tang¹, Lorenzo Nardo², Yunze Xie¹, Akram Al-Ibraheem³, Lichao Zhang¹, Wenjin Zhao¹, Axel Rominger⁴, Lijie Tan⁵, Han Tang⁵, Ida Nur Syafinaz Binti Muhammad Fuad⁶, Subapriya Suppiah⁷, Eric Cruz⁸, Yu Lin⁹, Haojun Yu¹, Hongcheng Shi¹⁰

Affiliations

¹ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Institute of Medical Imaging, Shanghai, 200032, China; Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China; Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
² Department of Radiology, University of California, Davis, Sacramento, CA, 95817, USA.
³ Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Queen Rania Street Al Jubeiha, Amman, 11941, Jordan.
⁴ Department of Nuclear Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
⁵ Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁶ Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
⁷ Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
⁸ Department of Nuclear Medicine and Theranostics, St. Luke's Medical Center, Quezon City, Philippines.
⁹ Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou 350001, China; Fujian Research Institute of Nuclear Medicine, Fuzhou 350001, China.
¹⁰ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Institute of Medical Imaging, Shanghai, 200032, China; Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China; Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. Electronic address: shi.hongcheng@zs-hospital.sh.cn.

PMID: 41320614
DOI: 10.1053/j.semnuclmed.2025.11.010

Abstract

Esophageal squamous cell carcinoma (ESCC) exhibits heterogeneous responses to neoadjuvant therapy, necessitating early and accurate assessment. [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) PET/CT enables quantitative assessment of tumor glucose metabolism, correlating with pathological remission and long-term outcomes, while [¹⁸F] or [⁶⁸Ga]Ga-labeled fibroblast activation protein inhibitor (FAPI) PET/CT evaluates stromal metabolism, providing complementary information. Total-body PET/CT (uEXPLORER, United Imaging Healthcare Co.Ltd., Shanghai, China) with 194-cm long-axial field-of-view (LAFOV) offers long axial coverage, up to 68-fold higher sensitivity than conventional systems. It enables low-dose, rapid imaging, dynamic whole-body parametric imaging, and improves detection of small, low-uptake lesions as well as metastatic lesions in the distal upper or lower extremities in a single bed position. Delayed and dual-time imaging protocols, alone and/or combined with deep learning-based synthetic CT, further improve lesion detectability while minimizing radiation exposure. This narrative review summarizes evidence from conventional PET/CT studies, highlights the technical and clinical advantages of total-body PET/CT, and discusses its feasibility, quantitative capabilities, and potential to guide response-adapted management in ESCC based on our institutional experience.

Publication types

Review