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Following the previous part of the narrative review on artificial intelligence (AI) applications in positron emission tomography (PET) using tracers rather than 18F-fluorodeoxyglucose (18FF-FDG), in this part we review the impact of PET-derived radiomics data on the diagnostic performance of other PET radiotracers, 18F-O-(2-fluoroethyl)-L-tyrosine (18FF-FET), 18F-Fluorothymidine (18FF-FLT) and 11C-Methionine (11CC-MET). 18FF-FET-PET, using an artificial amino acid taken up into upregulated tumoral cells, showed potential in lesion detection and tumor characterization, especially with its ability to reflect glioma heterogeneity. 18FF-FET-PET-derived textural features appeared to have the potential to reveal considerable information for accurate delineation for guiding biopsy and treatment, differentiate between low-grade and high-grade glioma and related wild-type genotypes, and distinguish pseudoprogression from true progression. In addition, models built using clinical parameters and 18FF-FET-PET-derived radiomics features showed acceptable results for survival stratification of glioblastoma patients. 18FF-FLT-PET-based characteristics also showed potential in evaluating glioma patients, correlating with Ki-67 and patient prognosis. AI-based PET-volumetry using this radiotracer as a proliferation marker also revealed promising preliminary results in terms of guide-targeting bone marrow-preserving adaptive radiation therapy. Similar to 18FF-FET, the other amino acid tracer which reflects cellular proliferation, 11CC-MET, has also shown acceptable performance in predicting tumor grade, distinguishing brain tumor recurrence from radiation necrosis, and treatment monitoring by PET-derived radiomics models. In addition, PET-derived radiomics features of various radiotracers such as 18FF-DOPA, 18FF-FACBC, 18FF-NaF, 68GaGa-CXCR-4 and 18FF-FMISO may also provide useful information for tumor characterization and predict of disease outcome. In conclusion, AI using tracers beyond 18FF-FDG could improve the diagnostic performance of PET-imaging for specific indications and help clinicians in their daily routine by providing features that are often not detectable by the naked eye.
Eisazadeh et al. (Wed,) studied this question.