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Historically, response evaluation relied primarily on anatomical imaging criteria derived from tumor size changes on computed tomography (CT), most notably the Response Evaluation Criteria in Solid Tumors (RECIST) and its adaptations. However, advances in molecular imaging, particularly positron emission tomography (PET) using [18F]-2-fluoro-2-deoxyglucose ([18F]FDG) and other radiopharmaceuticals, have introduced new biomarkers capable of detecting tumor response earlier than structural changes. Molecular imaging-based criteria, including EORTC, PERCIST, immune-adapted PET frameworks, and disease-specific systems such as Lugano, RANO, ENETS SSTR-PeRForm, and RECIP, provide quantitative assessment of tumor burden and may better reflect biologic response to therapy. This review discusses the rationale behind molecular imaging response criteria, outlines the principles of CT-based and PET-based evaluation systems, and highlights the clinical relevance of integrating metabolic imaging into tumor response.<\/jats:p>","DOI":"10.1093\/bjr\/tqag241","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:22:55Z","timestamp":1791973375000},"source":"Crossref","is-referenced-by-count":0,"title":["The importance of molecular imaging response criteria: rationale and overview"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9732-1094","authenticated-orcid":false,"given":"Egesta","family":"Lopci","sequence":"first","affiliation":[{"name":"Nuclear-Medicine Unit, IRCCS\u2014Humanitas Research Hospital , Rozzano (Milan), 20089,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arben","family":"Dhima","sequence":"additional","affiliation":[{"name":"Department of Radiology, \u201cMedicare\u201d Diagnostic Center, University Hospital \u201cMother Teresa\u201d, Tirana , 1001, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe M","family":"Deroose","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, University Hospitals Leuven , Leuven, 3000,","place":["Belgium"]},{"name":"Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven , Leuven, 3000,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric E","family":"Lecouvet","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Universit\u00e9 Catholique de Louvain (UCL) , Brussels, 1200,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"2026102311514910500_tqag241-B1","doi-asserted-by":"publisher","first-page":"e70064","DOI":"10.1002\/cncr.70064","article-title":"The legend of the response evaluation criteria in solid tumors: a historical overview","volume":"131","author":"Smesseim","year":"2025","journal-title":"Cancer"},{"key":"2026102311514910500_tqag241-B2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s00259-017-3687-3","article-title":"Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments","volume":"44","author":"Pinker","year":"2017","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026102311514910500_tqag241-B3","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/1097-0142(19810101)47:1&lt;207::AID-CNCR2820470134&gt;3.0.CO;2-6","article-title":"Reporting results of cancer treatment","volume":"47","author":"Miller","year":"1981","journal-title":"Cancer"},{"key":"2026102311514910500_tqag241-B4","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1200\/JCO.1999.17.4.1244","article-title":"Report of an international workshop to standardize response criteria for non-Hodgkin\u2019s lymphomas. 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