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Advances in Radiotherapy
& Nuclear Medicine Role of PET/CT in exploring tumor heterogeneity

of secondary malignancies, particularly in younger to provide metabolic and molecular insights, plays a
patients. 13,15 crucial role in assessing tumor heterogeneity and guiding
(iv) Availability of radiopharmaceuticals and trained personalized treatment strategies. However, multiple PET/
personnel: The production and distribution of CT scans are coupled with multiple challenges which must
radiopharmaceuticals are complex and require be carefully considered. Despite these challenges, PET/CT
specialized facilities. Many regions lack the remains a powerful tool in diagnosing heterogeneity and
infrastructure to produce these tracers, thereby limiting cancer management. Future developments in radiomics,
availability. In addition, the interpretation of PET/CT AI, and novel tracers hold great promise for overcoming
scans requires highly trained personnel, including these challenges and improving patient outcomes.
nuclear medicine physicians and radiologists, which
may not be available in all healthcare settings. 13,15 Acknowledgments
(v) False positives and specificity: PET tracers can None.
display false positivity in inflammatory and benign
conditions, leading to potential misinterpretation Funding
and overdiagnosis. For example, F-FDG, the most
18
commonly used tracer, can accumulate in areas of None.
infection or inflammation, mimicking malignant Conflict of interest
lesions. This lack of specificity can complicate treatment
decisions and lead to unnecessary interventions. 13,17 The authors declare that they have no competing interests.
(vi) Ethical considerations and over-reliance on imaging:
There is a growing concern about the over-reliance Author contributions
on imaging in cancer management, which may lead Conceptualization: Anjali Jain
to overtreatment or unnecessary interventions. Writing – original draft: Anjali Jain, Subhash Kheruka
Ethical considerations, such as the balance between Writing – review & editing: Sharjeel Usmani, Khulood Al
the benefits of early detection and the risks of Riyami, Asiya Al Busaidi, Sumit Bichpuria, Rashid Al
overdiagnosis, need to be carefully weighed. In Sukaiti
addition, the psychological impact of frequent
imaging and the potential for false positives should be Ethics approval and consent to participate
considered in patient management. 13,17
(vii) PET/CT images have limited spatial resolution, Not applicable.
and other factors, including scatter and attenuation Consent for publication
artifacts, may lead to noisy images that adversely
affect image analysis, even with AI. PET tracer uptake Not applicable.
variability, due to various factors, including breathing
artifacts, misregistrations, and truncation artifacts, Availability of data
may also be added to the challenges. 13 Not applicable.

11. Future directions References
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improving the specificity of PET tracers. Advances in AI gov/books/NBK9963 [Last accessed on 2024 Dec 24].
and radiomics may also help streamline the interpretation 2. Anderson NM, Simon MC. The tumor microenvironment.
process, reducing the reliance on highly specialized Curr Biol. 2020;30:921-925.
personnel. Furthermore, efforts to standardize protocols doi: 10.1016/j.cub.2020.06.081
and improve access to PET/CT technology in underserved
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Tumor heterogeneity is a complex and dynamic doi: 10.7150/ijbs.72534
phenomenon that poses significant challenges for cancer 4. Zhu L, Jiang M, Wang H, et al. A narrative review of tumor
diagnosis and treatment. PET/CT imaging, with its ability heterogeneity and challenges to tumor drug therapy. Ann

Volume 3 Issue 2 (2025) 12 doi: 10.36922/ARNM025040005