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Sixty-nine? No—59 patients underwent baseline scans measuring SUVmax, SUVmean, SUVpeak, metabolic tumor volume (MTV) and total lesion CXCR4 expression (TLC). Severe myelosuppression showed higher splenic uptake and TLC. 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Cancer Imaging (2026) 26:60 [https://doi.org/10.1186/s40644-026-01024-w](https://doi.org/10.1186/s40644-026-01024-w)  \nCancer Imaging  \nRESEARCH Open Access  \n[ 18 F]AlF-NOTA-QHY-04 uptake in spleen before anti-tumor therapy may predict degree of myelosuppression for patients with small cell lung cancer  \nSiyu Cai1†, Jingru Liu1†, Kai Cheng1,2, Xinzhi Zhao1, Shengnan Xu1, Jinli Pei1, Shijie Wang1, Kunlong Zhao1, Jinming Yu1*, Wanhu Li2* and Jie Liu1,3,4*  \nAbstract  \nBackground The aim of this study was to assess the value of C-X-C motif chemokine receptor 4 (CXCR4) targeted positron emission tomography/computed tomography ([ 18 F]AlF-NOTA-QHY-04 PET/CT) imaging in spleen for prediction of degree of myelosuppression in patients with small cell lung cancer (SCLC) before therapy.  \nMethods 59 patients with SCLC underwent [ 18 F]AlF-NOTA-QHY-04 PET/CT scanning before treatment. The maximum, mean, and peak standard uptake value (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV) and total lesion CXCR4 expression (TLC) of spleen at baseline were acquired. Chemotherapy-based treatment was administered for limited-stage and extensive-stage SCLC. The most severe degree of myelosuppression during the treatment was recorded. Patients were identified as mild and severe myelosuppression. Potential predictors were identified and validated through intergroup difference analysiis, ROC curve assessment, and ordinal regression analysis.  \nResults Patients with severe myelosuppression exhibited significantly higher splenic uptake values (SUVmax, SUVmean, SUVpeak and TLC) compared to those with mild myelosuppression (all p \u003C 0. 05) . Regions of interest (ROI) curve analysis identified that higher metabolic parameters, including SUVmax (AUC = 0 . 853, p \u003C 0. 0001), SUVmean (AUC = 0 . 885, p \u003C 0. 0001), SUVpeak (AUC = 0 . 821, p \u003C 0. 0001), TLC (AUC = 0 . 753, p = 0 . 0016), were significantly associated with more severe myelosuppression. Multivariate analysis identified SUVmax (p = 0 . 007) and age (p = 0 . 005) as significant independent predictors of treatment-related myelosuppression severity.  \n†Siyu Cai and Jingru Liu contributed equally to this work.  \n*Correspondence: Jinming Yu[sdyujinming@163.com](sdyujinming@163.com)[ ](sdyujinming@163.com)Wanhu Li[lwhvzg@126.com](lwhvzg@126.com)[ ](lwhvzg@126.com)Jie Liu [liujie@sdfmu.edu.cn](liujie@sdfmu.edu.cn)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.)  \nCai et al. Cancer Imaging (2026) 26:60 Page 2 of 10  \nConclusions Our findings suggest that baseline splenic [ 18 F]AlF-NOTA-QHY-04 PET/CT parameters, particularly SUVmax, may help identify patients with small cell lung cancer who are at high risk of severe treatment-related myelosuppression, with older age serving as an additional clinical risk factor.  \nKey points  \nQuestion Can ","cbCaimcVVWRCj3Ca","https://ap.wps.com/l/cbCaimcVVWRCj3Ca","pdf",2577722,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusions\n# Key points\n## Question\n## Findings\n## Clinical relevance statement\n# Keywords\n# Background","[{\"question\":\"What was the aim of this study in SCLC patients?\",\"answer\":\"To evaluate the value of CXCR4-targeted [18 F]AlF-NOTA-QHY-04 PET/CT imaging of the spleen for predicting the degree of myelosuppression before therapy.\"},{\"question\":\"How were baseline splenic PET/CT parameters obtained and which metrics were assessed?\",\"answer\":\"Patients underwent [18 F]AlF-NOTA-QHY-04 PET/CT before treatment, and splenic SUVmax, SUVmean, SUVpeak, MTV and total lesion CXCR4 expression (TLC) were measured.\"},{\"question\":\"Which factors were identified as independent predictors of treatment-related myelosuppression severity?\",\"answer\":\"Multivariate analysis identified SUVmax and age as significant independent predictors of severity.\"}]","[18 F]AlF-NOTA-QHY-04 uptake in spleen before anti-tumor therapy may predict degree of myelosuppression in patients with small cell lung cancer | PDF",1790150901,25]