About

Zuzan Cayci, MD is a board certified Radiologist and Nuclear Medicine Physician, serving as a Professor of Radiology in the Department of Radiology at the University of Minnesota Medical School. Her clinical expertise includes nuclear medicine imaging, Theranostics, and neuroradiology imaging. Her clinical academic interests focus on oncological imaging, specifically head and neck cancer imaging, brain tumor imaging, and prostate cancer imaging. Additionally, she is an expert in dementia imaging and epilepsy imaging. Dr. Cayci is the Division Director of the Nuclear Medicine and Molecular Imaging Program and the Program Director of the Nuclear Radiology Fellowship. Her educational background includes medical training at Hacettepe University in Turkey, residency in Radiology at Istanbul University Cerrahpasa Medical Faculty, and fellowships in Nuclear Medicine, Neuroradiology, Body Imaging, and Vascular and Interventional Radiology at prestigious institutions such as NewYork-Presbyterian Hospital, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, and St. Luke's-Roosevelt Hospital. She holds certifications from the American Board of Radiology in Diagnostic Radiology with a subspecialty in Neuroradiology and from the American Board of Nuclear Medicine. Recognized as a Minnesota Monthly Top Doctor for multiple years, Dr. Cayci is actively involved in professional societies including the American Association for Woman Radiologists, American College of Radiology, and the Radiological Society of North America, among others.

Selected publications

• Serial proteomic characterization of plasma extracellular vesicles (EV) to identify changes that predict outcomes in metastatic castrate-resistant prostate cancer (mCRPC) patients receiving ¹⁷⁷ Lu-PSMA-617.

  Journal of Clinical Oncology · 2026-03-01

  article

  258 Background: Extracellular vesicles (EVs) in plasma offer a minimally invasive window into tumor biology. We hypothesized that deep proteomic profiling of plasma EVs can characterize dynamic molecular changes and predict outcomes in patients with mCRPC treated with 177 Lu-PSMA-617. Methods: Of 100 prospectively enrolled patients receiving 177 Lu-PSMA-617 (Arafa, et al. ASCO 2025), 58 men had serial (baseline and on-treatment) plasma samples. EVs were isolated using differential ultracentrifugation and analyzed by shotgun mass spectrometry. Protein expression patterns (e.g. PSMA, B7-H3) were categorized as undetected at both baseline and follow-up (U->U) or detectable at both timepoints (D->D). Relative protein expression changes were dichotomized as increasing (>10% increase) versus no change/decreasing (not a >10% increase). Surface protein changes were quantified and associations with overall survival (OS) were sought using log-rank tests. Pathway-level analysis was conducted using pre-ranked gene set enrichment analysis (GSEA) to identify pathways associated with outcomes. Results: A total of 6,306 proteins were identified, with about 20% mapping to key cell-surface markers including PSMA, B7-H3, Trop-2, and STEAP1. When patients were stratified by the detection of the key 4 surface proteins (0–1, 2, or 3–4); increasing numbers of detected proteins were associated with progressively shorter OS using both baseline and follow-up samples (p<0.0001 for both). Outcomes based on serial protein detection (D->D) or non-detection (U->U) patterns are shown in the Table. Increases in EV-derived PSMA (HR 2.7, 95% CI 1.3–5.9, p=0.002), Trop-2 (HR 4.8, 95% CI 1.5–15.7, p<0.0001), and STEAP1 (HR 5.7, 95% CI 1.6–20.2, p<0.0001) were associated with worse OS, with a similar trend for increasing B7-H3 (HR 1.7, 95% CI 0.8–3.4, p=0.16). In GSEA analysis, fatty acid metabolism (NES=1.8, q=0.004), Hedgehog signaling (NES=1.7, q=0.02), bile acid metabolism (NES=1.6, q=0.03), and MYC targets (NES=1.5, q=0.04) were enriched in on-treatment samples from progressors, while angiogenesis (NES=1.6, q=0.02) was enriched in on-treatment samples from responders. Conclusions: On-treatment persistent detection or upregulation of EV-derived surface proteins (PSMA, B7-H3, Trop-2, and STEAP1) was associated with inferior overall survival in mCRPC patients treated with 177 Lu-PSMA-617. These findings highlight the potential clinical utility of dynamic plasma EV proteomics for prognostic stratification and clinical trial selection. U->U (days) D->D (days) OS HR (difference) P PSMA 297 141 4.52 0.002 B7-H3 NR 175 7.3 p<0.0001 Trop-2 247 79 5.27 p<0.0001 STEAP1 268 79 10.76 p<0.0001

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• Plasma extracellular vesicle proteomics nominates candidate biomarkers of 177Lu-PSMA-617 outcomes in metastatic prostate cancer patients

  Cell Reports Medicine · 2026-04-20

  articleOpen access

  Lu-PSMA-617, using shotgun proteomics to profile plasma-derived extracellular vesicle (EV) proteins alongside PSMA-positive circulating tumor cell (CTC) enumeration. We identify 5,137 EV-derived proteins, including the cell-surface targets PSMA, B7-H3, Trop-2, and STEAP1, with high levels of these proteins associating with worse overall survival (OS). All four EV proteins positively correlate with molecular tumor volume on PSMA-PET imaging, serum PSA, and serum alkaline phosphatase. CTC subpopulations, including PSMA+/EpCAM+ and PSMA-/EpCAM+ cells, associate with worse progression-free survival (PFS) and OS. Pathway analysis reveals that p53 upregulation associates with poor PFS and OS, while an activated E2F pathway unexpectedly portends better PFS and OS. These findings support the integration of liquid biopsy proteomics into biomarker-driven mCRPC trials to improve patient stratification.

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• Clinical and <scp>MRI</scp> Correlates of β‐Amyloid Load Inconsistent With Its Presumed Neurotoxicity in Cognitively Healthy Ageing

  Journal of Neurochemistry · 2025-09-01

  articleOpen access

  Cognitively healthy ageing and its conceptual counterpart, dementia, have long garnered much interest in the research community, the broader public and regulatory bodies alike. Although β-amyloid deposition is widely regarded as the principal neuropathological hallmark of Alzheimer's disease, its precise role in the causal chain of cognitive decline remains under debate. Applying strict criteria to define neurocognitive health, a selection of 35 participants aged over 60 years was drawn from the Human Connectome Project-Ageing. The evaluation of both cognitive and physical fitness, and comprehensive magnetic resonance imaging (MRI) protocol, encompassing diffusion-weighted imaging, T1w/T2w ratio, resting-state functional MRI and arterial spin labelling, were combined with an additional 18F-florbetaben scan to evaluate β-amyloid load. Strikingly, β-amyloid load failed to adhere to the transcription patterns of amyloid precursor protein in all surveyed areas but the entorhinal cortex. Moreover, it was associated with either higher cognitive performance, general fitness, cerebral tissue integrity and cerebral perfusion, or had no discernible impact. This pilot study adds to the growing body of evidence that questions the significance attributed to β-amyloid build-up and the mechanisms of its accumulation in the ageing brain. The results invite a re-evaluation of established theories on β-amyloid build-up neurotoxicity at low concentrations as observed in this cohort. Future investigations should focus on recruiting larger populations to ascertain whether a specific threshold of β-amyloid build-up precipitates cognitive decline or whether β-amyloid accumulation, in fact, serves as a protective mechanism that ultimately fails.

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• The Immense Value Gained Through Positive Tau PET

  American Journal of Roentgenology · 2025-09-17

  letterSenior author
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• Case Report—An Unusual Presentation of Cervical Meningioma as a Carotid Body Mass Diagnosed by Fine Needle Aspiration Cytology

  Cytopathology · 2025-08-21

  articleOpen access

  We describe an unusual case of cervical meningioma presenting as a carotid body tumour. This case emphasises the importance of cytoradiologic correlation in lesions with atypical imaging findings; and the crucial role of fine needle aspiration cytology in accurately diagnosing masses in precarious anatomic sites of the head and neck. Masses near the carotid artery bifurcation are rare occurrences and are commonly diagnosed as paragangliomas, schwannomas, enlarged lymph nodes, and rarely meningiomas. They are evaluated using ultrasound with Doppler, MRI (Magnetic Resonance Imaging), Computed Tomography (CT) or angiography, followed by imaging-guided FNA (Fine Needle Aspiration) or core biopsy for tissue diagnosis. We present the fascinating case of a carotid body mass considered to be a paraganglioma with unusual imaging that was diagnosed as a meningioma on cytopathology, highlighting the significance of cytologic diagnosis in cases with atypical imaging findings. Our patient is a 48-year-old woman who presented with a long-standing, slowly growing mass in the right side of her neck for 14 years. It was not initially associated with pain or other symptoms, but with its increasing size, she developed noticeable hoarseness of speech, occasional choking with ingestion of solids and liquids, and the feeling of something stuck in her throat. She denied difficulty breathing, facial flushing, or sweating. Clinical examination found ipsilateral vocal cord paresis causing hypernasal speech, neuropathy of the ipsilateral vagus and hypoglossal nerves, mass effect on the larynx, and pharyngeal narrowing. She also suffered from comorbidities including Type II Diabetes Mellitus, hypertension, obesity, and severe anxiety with frequent panic attacks. CT of the neck with contrast was performed, revealing an ill-defined, heterogeneous mass in the right carotid space measuring 4.5 × 3.5 cm. The mass showed areas of central, vascular-type contrast enhancement with slight increase in diffuse enhancement on delayed imaging (Figure 1A). There was smooth narrowing of the internal carotid artery and coarse calcifications at the cranial aspect of the mass, immediately below the skull base. The lesion encased but did not splay the carotid bifurcation and did not have any vascular pedicles feeding into it. Digital Subtraction Angiography (DSA) did not show early arterial enhancement but rather a tumour blush in the late capillary phase, which stayed on until the venous phase (Figure 1B). These features raised the possibility of a meningioma, schwannoma, or paraganglioma. MRI was deemed necessary to further define the lesion, but it was not possible due to the patient's severe claustrophobia. An ultrasound guided FNA was attempted given the lack of intense vascularity on imaging. Rapid On-Site Adequacy (ROSE) assessment was inadequate since the Diff Quik stained smears were paucicellular with abundant blood in the background. Four passes were obtained, with two taken directly into formalin for the cell block preparation. Cytologic smears showed sparse groups of epithelioid cells with poorly defined cytoplasmic borders, a moderate amount of pale blue wispy cytoplasm, central oval nuclei with fine chromatin, and occasional intranuclear pseudoinclusions (Figure 2A). The cell block showed a few cell clusters with papillary architecture, a vague whorling pattern, syncytial arrangement of cells, oval regular nuclei with nuclear streaming, and frequent intranuclear pseudoinclusions (Figure 2B). Immunohistochemistry (IHC) was performed, and the lesional cells showed patchy strong nuclear and weak cytoplasmic staining with S-100 (Figure 3A), but were negative for pancytokeratin, Epithelial Membrane Antigen (EMA) and neuroendocrine markers including synaptophysin and INSM-1. A second IHC panel, selected based on the morphologic features, revealed that the tumour cells were strongly positive for Progesterone Receptor (PR) (Figure 3B) and Somatostatin Receptor 2A (SSTR2A) consistent with meningothelial differentiation (Figure 3C). Based on the morphology and IHC, a diagnosis of meningothelial meningioma was suggested after intradepartmental consultation. This case was discussed in tumour board, and the imaging was revisited considering the cytology. The lack of intense arterial enhancement and splaying of the carotid bifurcation, the presence of calcifications near the skull base, and smooth vascular narrowing argued against a paraganglioma. A final integrated cytoradiologic diagnosis of meningioma was rendered, which likely originated from the skull base or the cervical spine and extended into the carotid space. However, there was no obvious evidence of skull base erosion, and a head CT was never performed given the initial radiologic suspicion for a paraganglioma; thus, the exact origin of the tumour could not be defined. The patient was asked to follow up for surgical planning, but she has unfortunately not kept her scheduled appointments with the provider. Masses detected in and around the carotid artery bifurcation are uncommon and can have a wide spectrum of pathologies. They are commonly diagnosed as extra-adrenal paragangliomas, benign nerve sheath tumours such as schwannomas, lipomas, pathologies of the cervical lymph node chain, and rarely, cervical extensions of intracranial or dura-based neoplasms such as meningiomas [1, 2]. Due to the complex anatomy of this region and its intimate relationship with large vascular channels, imaging with contrast enhanced CT (CECT), DSA and/or MRI is the first step in their evaluation. MRI is considered the imaging modality of choice given its high soft tissue resolution and non-ionising nature; but long imaging wait time, high costs and limited availability often make CECT the first choice for the work-up of neck masses. Ga68-Dotatate-PET CT is complementary to conventional imaging for local staging of paragangliomas and to look for metastatic involvement [1]. Meningiomas with extension into the neck have been reported in literature by at least 9 authors [3]. They are typically seen in women in the 3rd to 5th decade, presenting as slow-growing masses with neck fullness, hoarseness of voice, or dysphagia due to mass effect. Complete surgical resection is the treatment of choice, with radiotherapy as an adjunct; since all published cases are individual case reports, long-term follow-up for these patients was not available in the literature [3]. Imaging guided FNA is of immense help in the precise diagnosis of carotid bifurcation masses. Cytologically, paragangliomas show clusters of moderately pleomorphic cells with eosinophilic granular cytoplasm, round to oval nuclei with stippled chromatin and transgressing vessels with scattered bare nuclei in the background [4, 5]. Lesional cells are strongly positive for synaptophysin, chromogranin, CD56 and INSM-1, with spindly sustentacular cells staining with S-100. Meningiomas typically contain round to oval cells in syncytial groups or papillary arrangements with fine nuclear chromatin, abundant intranuclear pseudoinclusions and may show psammomatous calcifications [6, 7]. Meningothelial cells typically stain strongly and diffusely with PR and SSTR2A in ~70% of cases, show strong albeit patchy staining with EMA, and may show patchy S-100 positivity but are negative for pancytokeratin, desmin and synaptophysin. Diagnosis may be challenging in scantly cellular specimens or those with a predominantly spindly morphology without evidence of pathognomic morphologic features such as calcifications or whorls; SOX-10 may be helpful here since nerve sheath tumours are typically positive for SOX-10 while meningiomas are negative. Cell blocks are instrumental in the evaluation of neck masses and even in scenarios like ours with limited tissue quantity, they allow IHC analysis to provide confirmation of diagnosis and appropriate clinical management without the need for repeat sampling or core biopsy. This case highlights the significance of morphologic and radiologic correlation, especially when it comes to atypical imaging findings of lesions in anatomically risky regions of the head and neck. Fine needle aspiration with cell block preparation is a safe, quick, and valuable modality for morphologic evaluation of such challenging lesions and can help define the underlying pathology by allowing for ancillary workup. A wide range of morphologic differentials must be considered when evaluating carotid body masses since dura-based neoplasms may rarely extend into the neck, adding to the complexity in diagnosis [3]. Poorva Singh: conceptualization (lead), writing – original draft (lead), writing – review and editing (lead). Liam Chen: writing – review and editing (equal). Zuzan Cayci: writing – review and editing (equal), supervision (equal). Khalid Amin: writing – original draft (equal), writing – review and editing (equal), supervision (lead). Statement of eligibility for the mina desai early career investigator award: POORVA SINGH, the first and corresponding author, is currently a pathology fellow (Molecular Genetic Pathology) and is eligible for this award. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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• A Novel Approach to Parametric Studies in Nuclear Medicine

  Molecular Imaging · 2025-08-01

  articleOpen access

  Finding the rate constants (rates of transition) of radiopharmaceuticals between organs or different regions of interest (ROIs) in nuclear medicine quickly and accurately provides rich physiological data that is essential for determining drug dosages and performing precise radiation dosimetry. This article describes a novel exact analytical approach to achieving this goal. This can be done in a very short time period at the beginning of treatment with application of tracer levels of radiopharma, and using activities in the ROIs construct the rate constants. Here, using randomly chosen rate constants, time activity curves (TACs) for a four-compartment model are created, and using different sampling regimens of these TACs, the rate constants are reconstructed in a large number of simulations. The least square error (LSE) and relative LSE in the reconstructed parameters are shown to be better than <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mn>1</mml:mn> <mml:mo>×</mml:mo> <mml:msup> <mml:mn>10</mml:mn> <mml:mrow> <mml:mo>−</mml:mo> <mml:mn>4</mml:mn> </mml:mrow> </mml:msup> </mml:math> . While studies based on optimization methods have been described previously, this paper achieves the rate constants accurately and robustly using analytical methods, thus improving on the clinical applicability of these methods.

  PublisherDOI

• Integrated CTC- and EV-based detection of PSMA protein and efficacy of ¹⁷⁷ Lu-PSMA-617 radioligand therapy.

  Journal of Clinical Oncology · 2025-05-28 · 1 citations

  article

  5083 Background: Blood-based predictive biomarkers of sensitivity to 177 Lu-PSMA-617 are lacking, and may facilitate clinical decisions. Here, we studied whether integrated PSMA protein detection in circulating tumor cells (CTCs) and extracellular vesicles (EVs) is associated with outcomes in patients receiving 177 Lu-PSMA therapy. Methods: We enrolled 100 metastatic castrate-resistant prostate cancer (mCRPC) pts who were candidates for 177 Lu-PSMA into a prospective biomarker trial. Blood samples were collected for CTC and EV analysis at baseline, at the time of response, and at progression. Baseline characteristics included serum PSA, alkaline phosphatase (ALP), hemoglobin, albumin, and radiographic tumor burden. PSMA+ CTCs were enumerated using an AI-empowered holographic imaging platform combined with in-flow protein marker analysis (Astrin Biosciences, St. Paul, MN); PSMA protein was quantified in plasma EVs using shotgun proteomics via mass spectrometry (Arafa et al., Cancers 2024; 16: 4261). We assessed the impact of PSMA+ CTCs and EV-derived PSMA protein on PSA 50 responses, PFS, and OS. Multivariable Cox regressions were used to adjust for baseline PSA, ALP, and hemoglobin. Exploratory analyses of other EV-derived proteins were also conducted. Results: Of 100 enrolled pts, 47% had Gleason sum 9-10, 62% had &gt;10 bone mets, 12% had visceral mets, 72% had received ≥3 prior systemic therapies, and median PSA was 57 (range 1.5–5,000) ng/mL. High PSMA+ CTC counts (&gt; median) were associated with shorter overall survival (OS) (HR 2.71, 95%CI 1.18–6.21, p=0.02). PSA 50 response rates were similar for those with high and low PSMA+ CTC counts (39% vs 42%, p=0.8). Shotgun proteomics from plasma EV samples identified &gt;11 000 unique proteins, of which 12% represented the cell surfaceome. EV-PSMA protein correlated with baseline PSA, ALP, and tumor burden (all p&lt;0.05). High EV-PSMA protein (&gt; median) was associated with worse OS (1.81, 95%CI 0.97–3.35, p=0.06). PSA 50 response rates were similar for those with high and low EV-PSMA protein (48% vs 42%, p=0.5). After multivariate adjustment, nonsignificant trends for shorter OS persisted for pts with high PSMA+ CTCs (HR 1.71, 95%CI 0.72–4.05) and high EV-PSMA levels (HR 1.49, 95%CI 0.78–2.84). Worse OS was also observed in pts with high EV levels of B7-H3 (HR 2.85, 95%CI 1.58–5.14, p=0.002), Trop-2 (HR 2.23, 95%CI 1.22–4.05, p=0.008), and STEAP1 (HR 1.69, 95%CI 0.93–3.06, p=0.08) proteins. Conclusions: In mCRPC pts receiving 177 Lu-PSMA, high PSMA+ CTC counts and high EV-derived PSMA levels portended poor survival. PSMA protein may be a novel blood-based biomarker of 177 Lu-PSMA sensitivity, facilitating treatment decisions, with relevance for other PSMA-targeting strategies. The robust detection and prognostic impact of additional cell-surface proteins ( e.g. B7-H3, Trop-2, STEAP1) may fuel the development of alternative novel therapeutics.

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• Feasibility of using toroidal transceivers for acquiring intraoperative MR images around deep brain stimulation electrodes

  NeuroImage · 2024-11-01 · 1 citations

  articleOpen access

  INTRODUCTION: Magnetic resonance imaging (MRI) provides excellent soft tissue contrast for visualizing of deep brain stimulation (DBS) targets, allowing validation of the electrode placement, and assessing complications such as microhemorrhage and edema. However, the presence of the electrodes can introduce challenges such as radiofrequency (RF) induced current artifacts and excessive heating of the electrode contacts. Additionally, extended procedure times are also considered a disadvantage when using MRI as an intraoperative imaging modality following DBS electrode placement. METHOD: We propose a novel approach of using toroidal resonators to inductively couple the shaft of the electrode to the scanner's transmit-receive chain thereby utilizing it as a localized imaging antenna. The small extent of the field generated by the electrode antenna allows fast imaging with smaller field-of-views (FOVs) spanning only a few centimeters. Furthermore, we present a fast and accurate safety monitoring strategy that can be used to predict the temperature increase at the electrical contacts of the electrode. RESULTS AND DISCUSSION: Imaging with the toroidal transceiver yields a higher signal-to-noise ratio (SNR) efficiency in proximity to the electrodes. This approach reduced the RF induced current artifacts around the electrode which enhanced the visibility of the shaft and improved electrode localization. Moreover, the limited sensitivity around the electrode can be exploited to perform fast scans with small FOVs. The predicted heating around DBS contacts was in quantitative agreement with the experimental heating in swine studies with a normalized root-mean-square error (NRMSE) ≤ 0.09.

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• Different Grey Matter Microstructural Patterns in Cognitively Healthy Versus Typical Ageing

  NMR in Biomedicine · 2024-12-12 · 1 citations

  articleOpen access

  Ageing is a complex phenomenon affecting a wide range of coexisting biological processes. The homogeneity of the studied population is an essential parameter for valid interpretations of outcomes. The presented study capitalises on the MRI data available in the Human Connectome Project-Aging (HCP-A) and, within individuals over 55 years of age who passed the HCP-A section criteria, compares a subgroup of 37 apparently neurocognitively healthy individuals selected based on stringent criteria with 37 age and sex-matched individuals still representative of typical ageing but who did not pass the stringent definition of neurocognitively healthy. Specifically, structural scans, diffusion weighted imaging and T1w/T2w ratio were utilised. Furthermore, data of 26 HCP-A participants older than 90 years as notional 'super-agers' were analysed. The relationship of age and several microstructural MRI metrics (T1w/T2w ratio, mean diffusivity, intracellular volume fraction and free water volume fraction) differed significantly between typical and healthy ageing cohort in areas highly relevant for ageing such as hippocampus, prefrontal and temporal cortex and cerebellum. However, the trajectories of the healthy ageing population did not show substantially better overlap with the findings in people older than 90 than those of the typical population. Therefore, caution must be exercised in the choice of adequate study group characteristics relevant for respective ageing-related hypotheses. Contrary to typical ageing group, the healthy ageing cohort may show generally stable levels of several MRI metrics of interest.

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• Quantitative SPECT/CT Metrics in Early Prediction of [¹⁷⁷Lu]Lu-DOTATATE Treatment Response in Gastroenteropancreatic Neuroendocrine Tumor Patients

  Journal of Nuclear Medicine · 2024-09-12 · 8 citations

  articleOpen accessSenior author

  Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [¹⁷⁷Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. <b>Methods:</b> Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [¹⁷⁷Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (ΔTBS) and changes in normalized peak count (ΔnPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. <b>Results:</b> Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in ΔTBS_second-first, ΔTBS_third-first, and ΔTBS_fourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [¹⁷⁷Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. −0.049, 0.08 vs. −0.116, and 0.109 vs. −0.123 [<i>P</i> = 0.023, <i>P</i> = 0.002, and <i>P</i> &lt; 0.001], respectively). ΔnPC_second-first showed significant group differences (mean, −0.107 vs. −0.282; <i>P</i> = 0.033); ΔnPC_third-first and ΔnPC_fourth-first did not reach statistical significance (mean, −0.122 vs. −0.312 and −0.183 vs. −0.405 [<i>P</i> = 0.117 and 0.067], respectively). At the optimal threshold, ΔTBS_fourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. ΔTBS_second-first and ΔTBS_third-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. ΔnPC_second-first, ΔnPC_third-first, and ΔnPC_fourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. <b>Conclusion:</b> ΔTBS and ΔnPC can predict [¹⁷⁷Lu]Lu-DOTATATE response by the second treatment session.

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Awards & honors

• Minnesota Monthly Top Doctor, 2018
• Minnesota Monthly Top Doctor, 2019
• Minnesota Monthly Top Doctor, 2021
• Minnesota Monthly Top Doctor, 2022
• Minnesota Monthly Top Doctor, 2023