Research ArticleSupplement

Clinical Implementation of Total-Body PET in China

Yaping Wu, Tao Sun, Yee Ling Ng, Jianjun Liu, Xiaohua Zhu, Zhaoping Cheng, Baixuan Xu, Nan Meng, Yun Zhou and Meiyun Wang
Journal of Nuclear Medicine May 2024, 65 (Supplement 1) 64S-71S; DOI: https://doi.org/10.2967/jnumed.123.266977

Abstract

Total-body (TB) PET/CT is a groundbreaking tool that has brought about a revolution in both clinical application and scientific research. The transformative impact of TB PET/CT in the realms of clinical practice and scientific exploration has been steadily unfolding since its introduction in 2018, with implications for its implementation within the health care landscape of China. TB PET/CT’s exceptional sensitivity enables the acquisition of high-quality images in significantly reduced time frames. Clinical applications have underscored its effectiveness across various scenarios, emphasizing the capacity to personalize dosage, scan duration, and image quality to optimize patient outcomes. TB PET/CT’s ability to perform dynamic scans with high temporal and spatial resolution and to perform parametric imaging facilitates the exploration of radiotracer biodistribution and kinetic parameters throughout the body. The comprehensive TB coverage offers opportunities to study interconnections among organs, enhancing our understanding of human physiology and pathology. These insights have the potential to benefit applications requiring holistic TB assessments. The standard topics outlined in The Journal of Nuclear Medicine were used to categorized the reviewed articles into 3 sections: current clinical applications, scan protocol design, and advanced topics. This article delves into the bottleneck that impedes the full use of TB PET in China, accompanied by suggested solutions.

Clinical PET/CT scanners typically have an axial field of view of 15–30 cm, primarily determined by the need to encompass a single region. Short-axial-field-of-view scanners are characterized by suboptimal signal collection efficiency, because they collect less than 1% of the available signal (1). This issue can be addressed by extending the detector rings to cover the entire body, which is called total-body (TB) PET. The inaugural human TB PET system, with a remarkable 2-m length (uEXPLORER; United Imaging Healthcare), pioneered this concept in 2018 (1). Another commercially available system, the Siemens Biograph Vision Quadra, offers a 104-cm length (2). A prototype with scalable length is under development (3).

TB PET/CT has revolutionized molecular imaging in clinical and scientific domains. Long-axial-field-of-view PET systems have exhibited 40-fold enhancement in sensitivity, image quality, and the capabilities of molecular imaging compared with conventional PET/CT (4). The first human TB PET/CT images were reported in 2019, marking the inception of widespread clinical use. In China, the uEXPLORER PET/CT system found initial application at Zhongshan Hospital and was rapidly adopted by numerous hospitals across the country, totaling 16 installations as of September 2023. uEXPLORER use is expected to increase at a rate of 6–7 units per year in China.

TB PET/CT systems offer greatly improved sensitivity, detecting micrometastases, reducing injection dose, and shortening scan durations, all of which have substantial clinical implications. Moreover, a TB PET/CT system enables dynamic PET imaging of metabolic processes and tracer biodistribution throughout the body, promising advancements in drug development and clinical translation. However, TB PET/CT imaging presents challenges, including radiation exposure, acquisition and maintenance costs, the complexity of implementing dynamic scans, and the necessity for standardized protocols across various sites and settings.

With 16 TB PET scanners installed in China, this review explores clinical implementation studies of TB PET/CT in China and provides an overview of key findings. This review addresses the challenges encountered and offers perspectives into the future directions of TB PET research and its impact on health care.

CURRENT CLINICAL APPLICATIONS

18F-FDG Oncologic Imaging

18F-FDG is a well-established radiopharmaceutical agent that is widely used in TB PET/CT examinations for oncologic diseases and yields encouraging results (Fig. 1) (5). A consensus on oncologic 18F-FDG TB PET/CT imaging that used extensive clinical expertise has been published (6). In the realm of early tumor diagnosis, TB PET/CT demonstrates heightened sensitivity, particularly in detecting small or low-uptake lesions (7). This superiority is evident in colorectal cancer (8). In addition, TB PET/CT is used to assess neuroendocrine tumors, distinguish benign from malignant lymph nodes, and address issues of tumor recurrence and metastasis (9). Xie et al. (10) found that TB PET/CT aids in exploring potential correlations between lung cancer and brain metastases. TB PET/CT also aids in treatment planning by identifying immunotherapy-responsive patients (11) and evaluating pleural involvement in lung cancer, especially solid nodules (12). TB PET/CT detects and locates primary ectopic pheochromocytomas, facilitating early diagnosis and treatment (13).

FIGURE 1.
FIGURE 1.

Subjective overall image quality at various acquisition times using full dose, with ringlike 18F-FDG uptake lesion in liver shown in maximum intensity projection (A–F) and axial view (G–L) for 900- to 18-s groups. Overall image scores of 5, 4, 3, 2, and 1 were assigned to 180-, 120-, 60-, 30-, and 18-s groups, respectively. (Reprinted with permission of (5).)

Non–18F-FDG Oncologic Imaging

The clinical application of non–18F-FDG tracers in oncology is an active focus of TB PET/CT research in China. The radioligand 68Ga-N188 offers a noninvasive quantification of nectin-4 expression in advanced urothelial carcinoma. TB PET/CT may aid in selecting patients likely to respond to enfortumab vedotin and in predicting their response, optimizing targeted nectin-4 therapy (14). Dynamic 68Ga-fibroblast activation protein inhibitor (FAPI)-04 TB PET/CT imaging in pancreatic and gastric cancer enabled the study of 68Ga-FAPI-04 kinetics in normal organs and lesions. Research by Li et al. (15) suggests the potential of 11C-methionine–based TB PET/CT for monitoring multiple myeloma and stratifying risk. Parametric imaging proved to have superior quantification and enhanced lesion contrast compared with standard SUV images (16). In addition, using a half-dose of 68Ga-FAPI-04 in TB PET/CT imaging reduced acquisition time to 120 s while maintaining acceptable image quality and achieving a 100% tumor detection rate (17).68Ga-FAPI PET/CT may outperform 18F-FDG PET/CT in staging lung cancer (18). Evaluation of 18F-AlF-P-FAPI demonstrated specific uptake, rapid internalization, and low cellular efflux, showing results for primary tumors and lymph node metastases comparable to those of 18F-FDG (19). Recent studies have illustrated that the TB PET/CT, when coupled with 68Ga-prostate-specific membrane antigen (PSMA)-11, offers advanced insights into metabolic heterogeneity (20) and enhanced lesion detection in prostate cancer patients using TB parametric imaging (21), as well as highlighting the improved detection rate compared with conventional PET (22).

A HER2 molecular probe based on Affibody molecules (Affibody AB), 18F-AlF-RESCA-HER2-BCH, exhibits improved tumor uptake and renal clearance, reducing the renal absorbed dose and enhancing its clinical value for targeted radionuclide therapy (23). 18F-FAPI-42, a newly developed FAP-specific cancer imaging tracer, demonstrates optimal imaging 1 h after injection, displaying high uptake and clear lesion visualization (Fig. 2) (24). 68Ga-HNI01 has high specificity for carcinoembryonic antigen in vivo, which can effectively detect colorectal cancer lesions and identify small metastases, making it an ideal tool for selecting patients for anti–carcinoembryonic antigen therapy (Fig. 3) (25).

FIGURE 2.
FIGURE 2.

TB PET monitoring of biodistribution and optimization of acquisition time. (A) Maximum-intensity projection images of 18F-FAPI-42 at 5, 10, 15, 20, 65, and 120 min after injection in patient 21 (female). (B) Time–activity curves of 18F-FAPI-42 at various time points after injection. (C) Tumor SUVmax–to–organ SUVmean ratios at various time points after 18F-FAPI-42 injection, excluding tumor SUVmax–to–brain SUVmean ratio. (Reprinted with permission of (24).)

FIGURE 3.
FIGURE 3.

68Ga-HNI01 PET images in patients with colorectal cancer primary tumors. (A) Reconstructed dynamic whole-body PET/CT maximum-intensity projection (MIP) images of 68Ga-HNI01 in patient 10 (10 frames). (B) MIP images from 68Ga-HNI01 PET/CT (left) and 18F-FDG PET/CT (right) in patient 10 with abnormal intestinal activity uptake. (C) MIP images from 68Ga-HNI01 PET/CT (left) and 18F-FDG PET/CT (right) in patient 4 with normal intestinal activity uptake. (D) Time courses and fitting curves (fit spline or locally weighted scatterplot smoothing) of 68Ga-HNI01 uptake in normal tissues and tumors for 3 patients in terms of SUVmax. (E) Immunohistochemical staining for carcinoembryonic antigen in tumor samples from patients 1 and 4. A.U. = abnormal uptake; C = cecum; G.E.J. = gastroesophageal junction; K = kidney; p.i. = postinjection; T = tumor. (Reprinted with permission of (25).)

Nononcologic Imaging

In nononcologic fields, TB PET/CT demonstrates high diagnostic potential, with heightened sensitivity in detecting early inflammation, particularly in vasculitis cases (26,27). It aids in gauging infection severity and assisting treatment strategy development. With its extensive detector coverage and sensitivity, TB PET/CT enables comprehensive assessments of TB glucose uptake and vascular wall lesions, yielding promising outcomes (28). Increased 18F-FDG uptake in the distal spinal cord has been identified in young individuals without diabetes or those with low fasting blood sugar levels (29). Yu et al. (30) used TB PET/CT to evaluate radiation accumulation within salivary glands, revealing that oral vitamin C effectively mitigates radiation-related adverse effects. A growing number of studies reveal the skeleton’s endocrine role in influencing glucose metabolism and human glucose homeostasis. Scientists used state-of-the-art TB PET/CT to investigate in vivo glucose uptake and distribution across the human skeleton, reinforcing its significance in regulating glucose metabolism and providing insights into age- and obesity-related factors (31).

Although 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl)tropane PET/CT is widely used for early Parkinson disease (PD) diagnosis, its short half-life and limited understanding of its biologic distribution pose challenges. TB PET/CT dynamic imaging confirms excellent systemic distribution, minimal internal radiation exposure, and high imaging quality for 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl)tropane, making it suitable for PD diagnosis in patients requiring multiple follow-up examinations (32). Similarly, uEXPLORER PET/CT can simultaneously measure the time–activity curve of 13N-ammonia in all body organs, providing more precise information about biologic distribution and radiation dose estimation (33).

SCAN PROTOCOL DESIGN

Short Scan Time

The high sensitivity of TB PET/CT allows data acquisition time to be curtailed without compromising image quality, thus optimizing clinical practice and benefiting patients (34). Reduced scan times enhance throughput and patient comfort even as they effectively minimize motion-induced artifacts. For full-dose (3.7 MBq/kg) TB PET/CT, a 2-min scan in oncologic patients yields satisfactory image quality (Fig. 1) (5) and matches conventional PET/CT in diagnostic performance (35). Even a 30- to 40-s TB PET/CT scan suffices for intolerant patients and provides image quality that rivals conventional PET/CT (36,37). Research confirms good image quality and diagnostic efficacy even at lower doses. In oncology patients, a 2-min TB PET/CT with half-dose (1.85 MBq/kg) 18F-FDG offers acceptable performance, whereas a 5- to 8-min scan aligns well with clinical practice needs (22,38–40). Ultralow (one tenth, 0.37 MBq/kg) 18F-FDG activity with an 8-min acquisition is clinically feasible (41), and a 2-min acquisition can achieve acceptable image quality (42). Image quality is contingent on factors such as tracer activity, acquisition time, and body mass. Research underscores the quadratic relationship between body mass index and injected activity (43) for oncology patients undergoing TB PET/CT imaging.

Reducing scan times helps minimize the impact of patient movement, especially during chest scans, where respiratory motion can cause image blurring. Respiration-gated imaging with a reduced scan time on TB PET/CT outperforms ungated imaging in terms of lesion detectability, offering promising clinical applications (44). If TB PET/CT’s ultrafast imaging capabilities are leveraged, a 20-s breath-hold acquisition will prove practical for reducing motion artifacts and shows potential for enhancing lesion detection, particularly in stage IA pulmonary adenocarcinoma (Fig. 4) (45).

FIGURE 4.
FIGURE 4.

Breath-hold (BH) acquisition in TB PET. Images of 59-y-old man with lung adenocarcinoma show solitary solid lung nodule in right lower lobe in axial, coronal, and sagittal chest CT (top row), PET (middle row), and PET/CT (bottom row). (A) Free-breathing (FB) PET/CT. (B) BH PET/CT. Blurred uptake area results from breathing artifacts in FB PET image. (Reprinted with permission of (45).)

TB PET/CT’s potential for shorter scan times applies to exploring alternative radiotracers, such as 68Ga-PSMA and 68Ga-FAPI. Combining early dynamic 68Ga-PSMA PET (75–360 s) with static imaging at 60 min after injection can circumvent interference from urinary bladder activity, facilitating the detection of pathologic lesions with low PSMA uptake (46). Research indicates that TB 68Ga-FAPI-04 PET/CT images, obtained within a 30-s acquisition at 5 min after injection, yield diagnostic results similar to those of traditional scans conducted 60 min after injection with a 300-s acquisition. This reduction in waiting and acquisition times enhances patient throughput and comfort (47).

Low Injection Dose

The attractiveness of minimal TB PET doses lies in their reduction of radiation exposure (48). Studies demonstrated that half (22,38), one-tenth (8,48,49), or even one-thirtieth (50) doses potentially reduced the internal radiation effective dose in PET/CT examinations to 0.6–0.9 mSv. During the scanning process, CT plays a pivotal role in 3 stages: localization, attenuation correction, and diagnosis. A study on TB PET/CT for pediatric lymphoma reveals a 66.1% reduction in effective dose using low-dose CT, without compromising diagnostic accuracy and staging efficacy (51). Combining attenuation-corrected CT with artificial intelligence (AI) techniques empowers the reconstruction of ultra-low-dose CT scans as an alternative to diagnostic CT in specific scenarios (52). When the rich anatomic data from long-axial-field-of-view TB PET images are used as input, an AI application that uses a deep learning reconstruction algorithm can potentially enable the image reconstruction process without additional CT images for attenuation and scattering corrections (53). However, a drawback was the loss in converting 3-dimensional sinograms to 2 dimensions, which introduced noise, lost spatial information, and resulted in an incomplete recovery of details in the ground truth images. These low-dose methods hold promise for more efficient execution of multiple TB PET/CT scans.

Enhanced TB PET sensitivity offers significant advantages for pediatric patients, who are more susceptible to risk of radiation exposure from PET and CT scans. TB PET/CT can reduce the administered 18F-FDG dose to one-thirtieth while preserving image quality and lesion detectability. Optimal image quality is attainable with a one-tenth dose and a 10-min scan (Fig. 5) (50). Pediatric patients, receiving half the standard dose, require only 150 s of raw data to generate clear PET images displaying lesions.

FIGURE 5.
FIGURE 5.

Subjective overall image quality at different doses. 18F-FDG PET image of 1.9-y-old male patient, weighing 10 kg with Langerhans cell histiocytosis, is reconstructed at 600, 300, 60, 40, and 20 s and depicted in maximum-intensity projection and axial views (A–E), representing full, half, one-tenth, one-fifteenth, and one-thirtieth dose, respectively. Effective doses are shown in parentheses. (Reprinted with permission of (50).)

Dual Tracer Single Scan

Various radiotracers provide complementary insights into lesion characteristics, contributing to precise diagnosis. For instance, combining 68Ga-DOTATATE PET/CT with 18F-FDG PET/CT effectively diagnoses and evaluates neuroendocrine neoplasm heterogeneity (54). A streamlined approach proposes a single CT scan paired with a dual-tracer (18F-FDG and 68Ga-DOTA-FAPI-04) imaging protocol. This protocol effectively amalgamates the benefits of both tracers, ultimately enhancing diagnostic precision. It also significantly reduces both scan time and radiation exposure, making it clinically applicable (55). This protocol may serve as a supplementary approach to 18F-FDG PET/CT for suitable patients, broadening the scope of oncologic imaging using 68Ga-DOTA-FAPI-04 PET/CT.

OTHER ADVANCED TOPICS

Dynamic Imaging

TB PET/CT’s sensitivity and TB coverage provide unprecedented advantages for dynamic scanning. Its impressive temporal and spatial resolution forms a robust foundation for dynamic data analysis, essential for TB exploration of radiotracer biodistribution and kinetic parameters, whether using a full or reduced dose (48). For instance, dynamic scanning reveals variation in uptake and clearance among normal organ types, aiding assessment of tracer kinetics (41,56,57). Using dynamic frame reconstruction at 0.5-s intervals can demonstrate a pediatric patient’s movements during sleep (58). Dynamic scanning usually necessitates data collection exceeding 60 min; by leveraging the superior image quality provided by TB PET, acquisition times to 45 min may still obtain kinetic metrics for 18F-FDG (59). The clinical feasibility of ultra-low-dose 18F-FDG TB PET/CT imaging has been validated by dynamic imaging through both quantitative and qualitative analyses (41). Dynamic TB PET imaging also enables the attainment of comparable kinetic metrics (49) and tumor-to-background ratios in lung adenocarcinoma patients (48), which demonstrates that equivalency extends between normal and low-dose dynamic imaging.

For precise early activity measurement, shorter frame durations are essential, albeit at the cost of a reduced signal-to-noise ratio. Conventional denoising methods, such as the nonlocal mean method, often address individual frames or slices (60). Adjacent frames exhibit an anticipated pattern in voxel activity, allowing the use of interframe information to enhance image quality through pixel-level time–activity curve correction (61). Motion correction is also vital in maintaining image quality in dynamic TB PET imaging. It effectively reduces the impact of random body movements on dynamic images and may prove beneficial for comprehensive TB assessment, such as brain–gut axis and systemic disease imaging (62).

A closely related topic to dynamic imaging is dosimetry, which is vital for radiation protection, dose optimization, image quality enhancement, and workflow simplification. Traditional PET struggles with precise internal dose assessment because of limited axial coverage. TB PET/CT’s dynamic scanning enables detailed voxel-based radiation dose calculations, ensuring accurate total internal dosimetry (63). This approach applies to tracers such as 68Ga-PSMA-11 (64), 68Ga-FAPI-04 (64), 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl)tropane (32), and 13N-ammonia (33), offering insights for optimizing dose and workflow in future clinical settings (64).

Kinetic Modeling

The widely adopted SUV from a single time frame suffices for many clinical purposes. Nevertheless, dynamic scans using multiple time frames offer more comprehensive metabolic insights. Parametric imaging, facilitated by appropriate kinetic models, generates quantitative images and parameters with diverse applications in advanced diagnosis, treatment assessment, therapy management, and drug or tracer development (65). A study of healthy volunteers revealed significant variations in kinetic and metabolic rates of 18F-FDG across organs (66). TB dynamic PET imaging using ultralow injected activity achieved pertinent kinetic metrics for 18F-FDG and maintained image contrast comparable to that of full-activity imaging (49). Wu et al. (67) performed qualitative and quantitative comparisons between metabolic rate images from dynamic 18F-FDG imaging and delayed images. The clinical values in improved lesion detection and differential diagnosis were evaluated for the same group of patients. The Patlak model is increasingly favored for 18F-FDG TB PET dynamic imaging because of its simplicity (60) and predictive value in immunochemotherapy response (68).

Scanning protocols have emerged to shorten the total imaging time (Fig. 6) (59,60,69). The derived Ki and K1 values from a protocol with dual time windows, comprising a 10-min early scan and a 5-min late scan, showed strong agreement with the results from a full 60-min dynamic scan (69). An dual-injection protocol, involving an initial scan 50–60 min after injection followed by a second injection at 56 min, reduces TB Ki imaging time to 10 min with a single CT scan, enabling the incorporation of parametric imaging into clinical practice (70). In addition, K1 images can be estimated using only data from the first 90 s after injection with a 1-tissue compartment model (71). When it comes to non–18F-FDG tracers, researchers are also interested in their kinetic information and effect in clinics. Analyzing dynamic data for 68Ga-PSMA-11 (20) and 68Ga-FAPI-04 (72) establishes a strong correlation between the mean tumor-to-blood ratio and the total distribution volume, which would be the preferred measurement tool for semiquantitative assessment of tumor uptake and treatment response evaluation. In addition, 11C-methionine TB PET scans capture dynamic changes in myeloma metabolism by tracking radiotracer distribution in vivo. This approach unveils the metabolic process of 11C-methionine in multiple myeloma through kinetic modeling and found that risk stratification in multiple myeloma based on the k4 value holds promise (15).

FIGURE 6.
FIGURE 6.

Ki images with various settings. These 16 schemes use different durations (40, 30, 20, and 16 min), input functions (image-derived input function [IDIF] and population-based input function [PBIF]), and application with or without nonlocal means (NLM) filter. Arrow indicates lesion. (Reprinted from (60).)

Connectome Analysis

TB PET’s exceptional sensitivity enables high-temporal-resolution TB dynamic imaging, facilitating the study of organ connectomes to comprehend human physiology and pathology. This capability allows measurement of simultaneous or delayed signal changes in different organs, paving the way for causal relationships that hold promise for medical interventions (73). Maintaining health relies on the stability of interorgan interactions for homeostasis. Metabolic abnormalities in certain organs can disrupt this equilibrium, potentially causing diseases. Consequently, using organ networks as diagnostic tools offers a systemic perspective to identify individual metabolic abnormalities (Fig. 7) (74). When investigating the brain–gastrointestinal relationships in PD through dynamic 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl)tropane TB PET/CT imaging of dopamine transporters, the results suggest a loss of interactions between gastrointestinal organs and PD-related brain nuclei in PD patients (75). Moreover, studying metabolic interactions between organs in overweight and obese patients using TB PET underscores the significance of understanding organ connectivity for a comprehensive assessment of health and disease (76). Exploiting the advantages of TB PET low-dose imaging expands its application to health assessments and treatment efficacy evaluations.

FIGURE 7.
FIGURE 7.

Abnormal metabolic connectivity between organs. (A–C) Metabolic connectivity plots show 2 abnormal subjects and control, with middle images displaying coronal SUV slices and side plots showing network connections between organs. Abnormal subjects demonstrated denser connectivity and higher strength at relevant nodes than did control network, marked with red arrows for SUV uptake. CER = cerebellum; Covid-19 = coronavirus disease 2019; CSF = cerebrospinal fluid; GI = gastrointestinal; LV = left ventricle; SF = frontal cortex; WM = white matter. (Reprinted from (74).)

AI Application

AI is an effective tool that enhances image quality in TB PET studies. High-quality TB PET images can serve as training labels when training deep learning models for denoise (77) and enhance contrast (78) in PET images from conventional devices, as well as improving the quality of low-dose (79) or ultrafast acquisition (80) TB PET images. AI methods also facilitate the reconstruction and synthesis of parametric images (81). A deep learning–driven approach has demonstrated its capacity to create superior direct Patlak Ki images without necessitating an input function (82), which may mitigate the challenge posed by protracted scan times of dynamic PET. AI-based image quality control enables automated generation of comprehensive and intricate image quality assessment reports (83). Lesion segmentation is time-consuming, and automatic segmentation performance is often unsatisfactory. By harnessing the high contrast provided by TB PET parametric images, the accuracy of automatic lesion segmentation can be significantly improved, integrating Ki parametric images with PET and CT images (84).

SUMMARY

Over the years, TB PET/CT has achieved sensitivity and capabilities that advanced the realm of molecular imaging. This article encapsulates the key findings of TB PET in China, covering both oncologic and nononcologic applications and delving into advanced topics such as dynamic parametric imaging, component analysis, and AI. It is evident that TB PET is making significant strides in clinical applications in China, promising to enhance clinical efficiency.

Despite the achievements, the application of TB PET in China encounters challenges. From an economic standpoint, the purchase and maintenance costs of TB PET are higher than those of conventional PET. In China, the price of a TB scan is about ¥6,000–¥9,000 (∼$832.72–$1,250.57), which is the same or slightly higher than that of a conventional full-body scan from eye to thigh. Many hospitals in China have a large patient population and limited space for equipment installation. The high throughput of TB PET can effectively alleviate this problem. Furthermore, beyond its clinical value, TB PET may be more important as a scientific platform to enhance research capabilities, potentially outweighing economic concerns. The legal and regulatory frameworks are incomplete, and non–18F-FDG radiotracers lack approval. Meanwhile, the discipline of PET started relatively late in China, resulting in a shortage of expertise. In addition, limited familiarity with PET technology and its applications in other disciplines hinders multidisciplinary collaboration in clinical applications. For example, application and research in nononcologic disease are relatively limited compared with oncologic disease. However, efforts have been initiated to formulate a long-term plan that encourages the development of nuclear medicine, and we believe that TB PET will play an important role in Chinese clinical practice.

DISCLOSURE

This work was partially supported by the National Key R&D Program of China (2023YFC2414200), National Natural Science Foundation of China (82371934), and Joint Fund of Henan Province Science and Technology R&D Program (225200810062). Yee Ling Ng and Yun Zhou are employed by United Imaging Healthcare. No other potential conflict of interest relevant to this article was reported.

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  • Received for publication November 4, 2023.
  • Revision received February 13, 2024.
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