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Over the past years, we have observed the appearance of unclassifiable, doughnut-shaped bone lesions in patients under immunotherapy. Our study aims to characterize these lesions under the hypothesis they may represent osseous PP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 714 patients under immune-checkpoint inhibitor (ICI) therapy, targeted therapy, chemotherapy or local radiotherapy (RT) for either malignant melanoma (mM), lung cancer (LC), oropharyngeal or nasopharyngeal cancer with annular bone lesions, who underwent\n                      <jats:sup>18<\/jats:sup>\n                      F-fluorodeoxyglucose positron emission tomography \/ computed tomography (\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG-PET\/CT) at the University Hospital Zurich between January 2010 and November 2023. Characteristics of annular bone lesions, including\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG-PET\/CT metrics, were recorded. A descriptive analysis was carried out.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six of the 714 patients demonstrated a new onset of\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG-avid doughnut-shaped bone lesions on\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG-PET\/CT. Five patients were under ICI therapy and one patient was under RT. All lesions were transient and resolved on follow-up imaging. In two of six patients, histopathology samples were obtained and excluded malignancy. All ICI-treated patients demonstrated high\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG uptake of the lesions without corresponding abnormalities on computed tomography (CT). The mean time to lesion appearance after therapy initiation was 10.0\u2009\u00b1\u20098.1 months, and mean resolution occurred 7.7\u2009\u00b1\u20092.4 months after detection. All patients under ICI therapy exhibited additional immune-related changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      New, metabolically active doughnut-shaped bone lesions without clear CT correlates on\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG-PET\/CT in patients receiving immunotherapy (or local RT) likely represent benign manifestations within the spectrum of PP rather than metastatic disease.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12149-026-02168-2","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:28:31Z","timestamp":1770892111000},"page":"676-686","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Doughnut-shaped bone lesions on 18F-FDG-PET\/CT may indicate pseudoprogression under immuno(radio)therapy"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8344-314X","authenticated-orcid":false,"given":"Nathan D.","family":"Aeschbacher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Beintner-Skawran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Messerli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert-Ram","family":"Sah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp A.","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Holzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Meerwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Bankel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Rordorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolaus","family":"Andratschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Balermpas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Guckenberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Mangana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Mihic-Probst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.","family":"Huellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"8","key":"2168_CR1","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1056\/NEJMoa1003466","volume":"363","author":"FS Hodi","year":"2010","unstructured":"Hodi FS, O\u2019Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. 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AJR Am J Roentgenol. 2017;208(5):960\u201370.","journal-title":"AJR Am J Roentgenol"}],"container-title":["Annals of Nuclear Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12149-026-02168-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12149-026-02168-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12149-026-02168-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:03:26Z","timestamp":1792087406000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12149-026-02168-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":45,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2168"],"URL":"https:\/\/doi.org\/10.1007\/s12149-026-02168-2","relation":{},"ISSN":["0914-7187","1864-6433"],"issn-type":[{"value":"0914-7187","type":"print"},{"value":"1864-6433","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"assertion":[{"value":"10 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article was originally published under the subscription model but it is now published under an Open Access license.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"No potential conflicts of interest directly related to the current work were disclosed. A.M. received speaker honoraria from Jansen Pharmaceutica N.V unrelated to the current work. S.B. reports an advisory role for Novartis, Switzerland, unrelated to the current work. J.M. has intermittent project focused consultant\/advisory relationships or has received speaker fees from Merck Sharp & Dohme, Novartis, Janssen, Bristol Myers Squibb and Pierre Fabre and has received travel support from Sunpharma, L\u2019Or\u00e9al, Merck Sharp & Dohme, Bristol Myers and Squibb und Pierre Fabre outside of the submitted work. M.H. received grants and speaker honoraria from GE HealthCare, a fund by the Alfred and Annemarie von Sick legacy and a grant from the clinical research priority program (CRPP) Artificial Intelligence in Oncological Imaging Network of the University of Zurich. All other authors declare no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Open access funding provided by University of Zurich.","order":2,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Declarations"}}]}}