SPECT-based radiomics in oncology: current evidence, technical challenges, and future directions

Purpose This mini-review provides an updated overview of SPECT-based radiomics in oncology, summarizing clinical applications, highlighting SPECT-specific technical considerations, and identifying priorities for future research. Methods A structured search of MEDLINE and Scopus was performed using the terms “SPECT,” “radiomics,” and “oncology.” Only original clinical studies published in English within the last five years were included. Eligible articles were screened and grouped by oncologic topic. Results Eleven studies met the inclusion criteria. The reported applications included differentiation of metastatic versus benign bone lesions using bone SPECT/CT, prediction of survival in neuroblastoma with 123I-mIBG SPECT/CT, and characterization of indeterminate renal masses with 99mTc-sestamibi. Early work in radiodosiomics showed potential for estimating absorbed doses during peptide receptor radionuclide therapy and predicting response to selective internal radiation therapy. Conclusions SPECT radiomics and radiodosiomics show promise for quantitative oncologic imaging, but the evidence base remains limited by small, retrospective, single-center studies and the complete absence of external validation. Standardizing acquisition and reconstruction protocols, and multicenter studies are essential to enable translation of SPECT-based radiomics into routine clinical practice.