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China-Africa relations

China-Africa relations Explainer jon.wallace 18 January 2023

What are China’s objectives in Africa, how valid is the concept of ‘debt trap’ diplomacy, and what are China’s military ambitions in the region?

A brief history of China-Africa relations

Africa has been crucial to China’s foreign policy since the end of the Chinese civil war in 1947. China supported several African liberation movements during the Cold War, and for every year since 1950 bar one, the foreign minister of the People’s Republic of China (PRC) has first visited an African country.

China’s new foreign minister Qin Gang visited five African countries and the African Union in January 2023. Wang Yi, the former foreign minister, visited 48 African countries and premier Xi Jinping undertook 10 visits to Africa between 2014 and 2020.

China-Africa relations are the bedrock of China’s foreign policy.
 

Chinese foreign minister Qin Gang, speaking in December 2022

In 1971, the votes of African countries were instrumental in winning the PRC control of China’s seat in the UN General Assembly and Security Council – displacing representatives from Chinese nationalist forces, who had been defeated in the civil war and now governed Taiwan.

In the following decades, China’s focus in Africa switched to eliminating all remaining recognition for Taiwan’s government. Burkina Faso, Malawi, Liberia, Senegal and others all switched their recognition from Taiwan to the PRC. Eswatini is the only African nation still to recognize Taiwan’s government in 2023.

In 1999 China created its ‘Going Out’ strategy, which encouraged Chinese companies to invest beyond China.

The strategy was a statement of China’s growing economic might and created a new wave of Chinese engagement in Africa. It was also an important source of employment for Chinese citizens working on new infrastructure projects.

In November 2003 the first tri-annual Forum for China-Africa Cooperation (FOCAC) summit was held in Beijing. FOCAC was created to improve cooperation between China and African states and signalled China’s growing strategic initiative in Africa.

Chinese president Xi Jinping delivers his speech during the November 2021 China-Africa Cooperation (FOCAC) meeting in Dakar, Senegal, pledging to offer one billion COVID-19 vaccine doses to Africa. Photo by SEYLLOU/AFP via Getty Images.

In 2013, China’s Belt and Road Initiative (BRI) was launched by Xi Jinping, featuring an ambition to reinvigorate the old silk trading route along the East African coast. This should theoretically have seen Chinese investment concentrated in East Africa, but many other African states also sought opportunities through the BRI, making the initiative quickly expand in scope and ambition.

The BRI saw a huge number of signature infrastructure projects built across Asia and Africa, funded by Chinese loans whose size, nature and origin were often opaque. Some African countries became badly exposed to Chinese lending during this period. 

Chinese investment peaked around 2016. Since then, Chinese loans to African governments declined significantly, falling from $28.4 billion in 2016 to $1.9 billion in 2020 – partly due to changing priorities in domestic Chinese politics, and partly due to the apparent difficulty African countries had repaying loans.

China’s investment in Africa

China has taken a position contrary to Western governments in its African investment. It characterizes its loans as mutually beneficial cooperation between developing countries, promising not to interfere in the internal politics of those it loans to.

In this respect it presents itself in contrast to Western countries, who are accused by China and some African governments of arrogant, democratic posturing – often by former colonial powers that looted African resources during the 18th and 19th centuries.

China has learned by doing, and the reality of large-scale investments taught Chinese investors the limits of their approach. For instance, during the South Sudanese civil war, China had to deal with representatives of various forces opposed to the government to maintain the Greater Nile Oil Pipeline, operated by the China National Petroleum Corporation.

China has not made significant efforts to export communist ideology in Africa since the Cold War ended.

China has not made significant efforts to export communist ideology in Africa since the Cold War ended, claiming that Chinese communism could not be replicated outside of China.

However, ideological links exist between the Chinese Communist Party (CCP) and the rulers of a state like Ethiopia, whose Prosperity Party has origins in ‘revolutionary democracy’ and Marxist-Leninism.

China’s National People’s Congress has formal relations with 35 African parliaments and the CCP International Liaison Department (ILD) has relations with 110 political parties in 51 African countries.

Western politicians have increasingly voiced fears that China’s intentions in Africa are predatory, intended to create a network of African states that are obliged to service their debts by offering China access to resources, trade opportunities and locations for military bases.

Debt trap diplomacy

US commentators often describe Chinese policy in Africa as a ‘debt trap’, part of a deliberate strategy to loan unmanageable sums to African countries, draw them into China’s sphere of influence, and force unfair commitments upon them.

Some African nations do have extensive Chinese loans and are suffering from out-of-control debt, exacerbated by the COVID-19 pandemic, the invasion of Ukraine, and high interest rates. But their situations cannot be entirely blamed on Chinese loans. States including Kenya and Zambia have poorly managed their debt to all creditors, not only China.

Meanwhile, other African countries have created realistic, manageable debt arrangements with China without the tremendous risk and uncertainties that characterized some major BRI projects.

China also faces significant problems due to its extensive loans made during the BRI boom period, as it will struggle to force repayment while maintaining its image as a friend of developing nations.

BRI projects were largely uncoordinated and unplanned, with credit offered by competing Chinese lenders. This contradicts the idea of a coherent ‘debt trap’ policy by China.

However, the idea that China may use debt strategically, to expand its influence in the African content and secure access to resources, cannot be completely dismissed. China is an emerging superpower in strategic competition with the US. Building stronger economic relationships in Africa would be a logical step in its aspirations to be a global power.




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Africa’s strategic priorities and global role

Africa’s strategic priorities and global role 27 January 2023 — 1:00PM TO 2:00PM Anonymous (not verified) 18 January 2023 Chatham House and Online

At this hybrid event, HE John Dramani Mahama, former president of the Republic of Ghana, will discuss his ideas on the key economic and governance reforms required for economic stability and prosperity across Africa.

Ghana recently became the fourth country, after Chad, Ethiopia and Zambia, to seek debt treatment under the G20 Common Framework in January 2023 – reflecting the culmination of a series of internal and external shocks affecting the wider region, including extreme weather events, the COVID-19 pandemic and the Russia-Ukraine crisis.

Prospects for economic recovery and growth, nevertheless, remain positive in many parts of the continent, with the African Development Bank (AfDB), for example, reforecasting economic growth of 5.5 per cent in East Africa in 2023. Coordinated reforms can help to deepen regional integration and promote long-term economic prosperity, particularly in light of Africa’s evolving regional economic governance structures, notably the fledgling African Continental Free Trade Area (AfCFTA) headquartered in Accra.

At this hybrid event, HE John Dramani Mahama, former president of the Republic of Ghana, will discuss his ideas on the key economic and governance reforms required for economic stability and prosperity across Africa. He will also discuss priorities for regional integration and Africa’s role and responsibilities in global economic governance.




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Building carbon markets that work for Africa

Building carbon markets that work for Africa 31 January 2023 — 2:00PM TO 3:30PM Anonymous (not verified) 19 January 2023 Online

At this webinar, held in partnership with UNDP, speakers share experiences on carbon market advancement in Africa, highlighting challenges and obstacles.

Carbon finance offers a major opening towards meeting the goals of the Paris Agreement but progress across regions has been uneven, with the African continent accounting for just 15 per cent of voluntary carbon credits issued globally in 2021.

Harnessing the potential of carbon markets may offer one route towards closing the significant shortfall in climate financing for Africa, as well as accelerating transition in cooking and energy solutions and limiting deforestation.

Article 6 of the Paris Agreement requires significant adjustment of regulatory and policy frameworks at national level in order to align with emerging global imperatives within carbon markets. Various stakeholders, including the private sector, need to take these realities into considerations as they seek to meet commitments towards a more sustainable future.

Governments and the private sector alike need to address the obstacles that have held back Africa’s participation in carbon markets, and should explore all options including both the compliance and voluntary markets, and market-based alternatives such as emissions trading schemes and carbon taxes.

At this webinar, held in partnership with UNDP, speakers share experiences on carbon market advancement in Africa, highlighting challenges and obstacles. Speakers also explore in-country experiences and make proposals on how Africa might benefit from a functional global carbon market.




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Silencing the Guns in Africa by 2030: Lessons from Mozambique

Silencing the Guns in Africa by 2030: Lessons from Mozambique 17 February 2023 — 7:00AM TO 9:00AM Anonymous (not verified) 7 February 2023 Addis Ababa and online

A hybrid event in Addis Ababa reflecting on Mozambique’s 2019 peace agreement and the lessons it offers for the African Union’s ‘Silencing the Guns’ agenda by 2030.

This event will explore opportunities for furthering the AU’s Silencing the Guns agenda by 2030 to assist Africa’s transformative development, highlighting lessons learnt from Mozambique’s experience.

The ‘Silencing the Guns in Africa’ agenda, a flagship initiative of the African Union’s (AU) Agenda 2063, aspires to end all wars and conflict, prevent genocide, and stop gender-based violence.

The 2019 peace agreement in Mozambique and the subsequent disarmament, demobilization and reintegration process supported by the United Nations (UN) but implemented by Mozambique’s government and institutions, provides experience and learning for other continental conflicts that have recently ended or resumed.

Mozambique is seeking to break from the cyclical ‘conflict trap’ where once a country experiences one civil war, it is significantly more likely to experience additional episodes of violence.

Since the end of Mozambique’s civil war in 1992, targeted armed conflict by RENAMO resumed in 2013 and ended through the new agreement in August 2019. The final reintegration into civilian life of former Mozambican combatants of opposition RENAMO will be completed in 2023.

Mozambique and Switzerland – a key supporter of successive Mozambican peace processes – have become non-permanent members of the UN Security Council for the first time in their respective histories.

At a moment when old vulnerabilities and new threats are apparent on the African continent, this seminar, held by Chatham House in partnership with the United Nations Development Programme (UNDP), explores opportunities to furthering the AU’s Silencing the Guns agenda by 2030 to assist Africa’s transformative development, as outlined by the UNDP in a report published in February 2022.

This hybrid event is held in partnership with the African Union Commission and the United Nations Development Programme (UNDP).

This event will also be broadcast live via the Africa Programme Facebook page.




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Africa Aware: Towards just transition in Africa

Africa Aware: Towards just transition in Africa Audio NCapeling 1 March 2023

African countries face collective climate and job creation-related challenges, yet policymaking often remains regionally siloed.

This podcast reflects on the key policy messages from the Africa programme’s series on Towards just transition: Connecting green financing and sustainable job creation in Africa.

African countries face collective climate and job creation-related challenges. Yet policymaking often remains regionally siloed according to differing political, energy sector and ecological realities.

This output is part of a stream of work supported by the Chatham House Sustainability Accelerator and the United Nations Development Programme (UNDP). 




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A critical juncture for Sudan’s democratic transition

A critical juncture for Sudan’s democratic transition Expert comment LJefferson 28 March 2023

International pressure is essential to reach an agreement that establishes a credible civilian government.

The signing of the Framework Agreement (FA) on 5 December 2022 between Sudan’s military leaders and its leading pro-democracy parties is a major step to reversing the damage done by the disastrous military coup in October 2021.

The FA removes any formal role for the military in Sudan’s politics. A civilian head of state and prime minister will select the cabinet and chair the Defence and Security Council. The armed forces will be prohibited from non-military business activities and security sector reform will lead to a unified, professional and non-partisan national army. Elections are due to take place at the end of a two-year transitional period. 

Signatories included General Abdel Fatah Al Burhan, chair of the Sovereign Council and head of the Sudanese Armed Forces (SAF), General Mohamed Hamdan Dagalo (known as Hemedti), his deputy and Commander of the paramilitary Rapid Support Forces (RSF) and more than 40 civilian entities, including the Forces of Freedom and Change- Central Council (FFC-CC), a few other political parties, former armed movements, civil society organizations and professional associations. However, the agreement has faced criticism from the street for not being sufficiently radical, has been overshadowed at times by heightened tension between the two military leaders, and has seen sabotage attempts by supporters of the Bashir regime.

Building consensus on the Framework Agreement

The agreement meets most of the demands of the anti-coup camp, at least on paper. Yet doubts persist as to whether the military are genuine about handing over power, particularly among the neighbourhood-based resistance committees – the heart of the youth-led mobilization that forced the military to recognize the failure of their power grab. Peaceful protests against the coup have seen 125 killed and over 8,000 injured by government security forces. Many want to see Burhan and Hemedti held accountable.

Doubts persist as to whether the military are genuine about handing over power, particularly among the neighbourhood-based resistance committees.

Recognizing the need to expand popular support, FFC-CC leaders have been reaching out to other pro-democracy forces to build a united civilian front. They report increased buy-in from some resistance committees in the last few months, recognizing that street protests alone were not sufficient to overthrow the coup, and that engagement with the military is necessary to find a way out of the impasse.

The FA offers the only currently available path to embedding civilian politics in Sudan and has received active diplomatic support from UNITAMS, AU and IGAD (who form the Tripartite Mechanism), the Troika of the US, UK and Norway, alongside the EU, as well as Saudi Arabia and the UAE (who are members of ‘the Quad’ with the US and UK).

Broader public participation has also been developed through a series of conferences, facilitated by the Tripartite Mechanism, on five contentious issues – dismantling the old regime, the Juba Peace Agreement, Eastern Sudan, Transitional Justice and Security Sector Reform. Recommendations will be incorporated in a final political agreement. 

In a significant breakthrough, both sides have agreed to draft the final agreement and transitional constitution, with the aim of forming a civilian government by 11 April. 

The political process has been overshadowed by increasingly visible tension between Burhan and Hemedti, seen in parallel foreign visits, conflicting public statements, and a heavy military presence in Khartoum. But concerns that SAF and the RSF were heading towards confrontation appear to have been assuaged thanks to international pressure and preliminary agreements reached between military and civilian signatories of the FA on security sector reform and integration. In a significant breakthrough, both sides have now agreed to draft the final agreement and transitional constitution, with the aim of forming a civilian government by 11 April.  

Potential spoilers and interests from Sudan’s regions

Progress has been made, but significant challenges remain, notably from supporters of the former Bashir regime in ‘the deep state’ and from Sudan’s historically marginalized peripheries. Old regime elements have been intensifying social media campaigns to derail the agreement and drive a wedge between the SAF and RSF, and have been accused of deliberately inciting instability in the peripheries to undermine the democratic transition. 

The Popular Defence Forces, established by the National Islamic Front in the 1990s, have been reactivated under different names in several parts of the country and there are reports of mobilization and recruitment of armed militias in Darfur. The recent public appearance of Ali Karti, the Secretary-General of the Islamic Movement, who has close relations with Islamists in SAF, has also caused renewed concern.

Two Darfuri armed movement leaders who signed the October 2020 Juba Peace Agreement (JPA) and are members of the current military-led government, have not signed the FA, allegedly due to concerns about their representation in the next government.

Despite intensive efforts to bring them on board, there is continuing disagreement over the inclusion of other members of ‘the Democratic Bloc’, a political alliance backed by Sudan’s influential neighbour Egypt, which is reportedly angry at being excluded from the Quad. The FFC-CC say that the door is open for the two Darfuri leaders and some other political parties, but they will not allow the agreement to be ‘diluted’ with political forces who intend to torpedo the transition, including by imposing a weak prime minister.

Supporters of the pro-democracy movement outside Khartoum, particularly the resistance committees, recognize the organic link between peace and democracy.

Both Burhan and Hemedti have courted support from the regions. Burhan used the 2020 SAF takeover of Al Fashaga in the contested eastern border region with Ethiopia to boost his national standing and secure backing from local tribal leaders; while Hemedti has sought to position himself as a champion of the peripheries, particularly in his Darfur heartlands, while simultaneously advancing his business interests.

Competition between them in building domestic powerbases, as well as alliances with neighbouring states, risks reigniting tensions, particularly given deep grievances and contrasting ambitions between and among Sudan’s diverse regional leaders and communities.




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Africa Aware: Supply chains, land contestation, conflict

Africa Aware: Supply chains, land contestation, conflict Audio NCapeling 30 March 2023

This episode examines relations between Ethiopia and Sudan as part of an XCEPT project mini-series.

The war in northern Ethiopia since November 2020, and subsequent conquest of disputed farmlands in Al-Fashaga by the Sudanese army on the Ethiopia-Sudan border, has brought into focus the importance of agricultural commodities such as sesame as a potential driver of land contestation and conflict.  The panel discusses the interrelation of commodity and conflict supply chains, land contestation, and boundary disputes in the Horn of Africa, with a particular focus on the regions of Wolkait/Western Tigray in northwest Ethiopia and Al Fashaga in eastern Sudan. This podcast was produced with support from the Cross-Border Conflict Evidence, Policy and Trends (XCEPT) project, funded by UK Aid from the UK government.




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Fighting over ‘white gold’: Sesame in Ethiopia and Sudan

Fighting over ‘white gold’: Sesame in Ethiopia and Sudan Expert comment LJefferson 3 April 2023

The supply chain of a seemingly innocuous cash crop – sesame – has intersected with transnational conflict dynamics, exacerbating tensions between Ethiopia and Sudan.

Late 2020 saw the beginning of the devastating war in Tigray and the occupation of a disputed region on the Ethiopia–Sudan border – Al Fashaga – by the Sudanese army. These shocks disrupted settled patterns of land ownership and control in both Ethiopia’s volatile north and Sudan’s borderlands, historically the heart of the sesame and oilseed production that is economically vital to both countries.

These seemingly harmless cash crops are now embedded in local, subnational and national political contestations in both countries. Sesame value chains are being reshaped, with power and profits being used to entrench the grip of political and armed actors who are reinforcing new patterns of land control and driving informal and illicit trade – impacting the coping mechanisms of local communities and threatening to fuel further conflict.

Regional rivalries drive contestation over the Ethiopia supply chain

Internal borders between most of Ethiopia’s regions are marked by boundary disputes, which often degenerate into violent conflict. The most important is between the Tigray and Amhara regions. Since the war began in 2020, the Amhara region has annexed vast areas of western and southern Tigray, which the Amhara region claims were taken from them by Tigray 30 years ago, after the Tigray People’s Liberation Front (TPLF) dominated ethnic coalition came to power.

Conflict has exacerbated a steady decline in formal revenues from sesame exports, dropping over $115 million from 2016 to 2021.

Ethiopia’s exports of spices, oilseeds and pulses brought in over half a billion dollars in 2021, roughly a quarter of the country’s total export revenues and second only to coffee. The sector has been rocked by the war in the north, which accounted for much of Ethiopia’s sesame production, with an estimated 500,000 hectares of sesame fields taken out of cultivation during the 2021 growing season. Conflict has exacerbated a steady decline in formal revenues from sesame exports, dropping over $115 million from 2016 to 2021.

Alongside falling production, the previously integrated value chain has been disrupted and decentralized by political fragmentation and land competition between Amharas and Tigrayans. Before the war, the agricultural sector in Western Tigray/Welkait was dominated by Tigrayan business interests, through the TPLF’s regional endowment fund EFFORT, a business conglomerate including subsidiaries such as Guna Trading House, and Hiwot Agricultural Mechanization.

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Two-minute video explainer: Supply chains, land contestation and conflict in the Horn of Africa

The taking of the area by Amhara forces in late 2020 saw the control over agricultural supply chains shift to actors from the Amhara region, amid contestation between regional officials, businessmen and security actors, backed by political elites. Thousands of displaced ethnic Tigrayan inhabitants of the area have been replaced by ethnic Amharas, enticed to settle there by the Amhara regional government’s offer of grants and leases for land which promise better livelihoods. The sesame they farm is now largely exported through informal and illicit channels, with profits used to reinforce de facto regional control.    

But there is also contestation within the Amhara region over the land and sesame supply chain between sub-regional elites from Gojjam, Gondar and indigenous Welkaites. Welkaites, who were marginalized under TPLF rule, believed that by aligning themselves with powerful Amharas they would reclaim land and influence. But this has not been fully realized, with the local administration reliant on Amhara region subsidies, rather than the federal budget. With little support from the federal government, local Welkait officials are strengthening their ties with Eritrea.

The Ethiopian government’s pursuit of peace with Tigray may lead it to turn away from the Amhara region, which could result in a renewed showdown between Amhara and Tigrayan forces.

At the national level, regional contestation over the control over Western Tigray/Welkait feeds into shifting political alliances between the Amhara, Tigrayans and Oromo which threaten the sustainability of the peace agreement struck between the federal government and TPLF in November 2022 – despite efforts by the government to defer the thorny issue.

While the constitutional return of the land to Tigray remains unlikely anytime soon, there is a feeling that Amhara control over Western Tigray/Welkait is no longer certain. The Ethiopian government’s pursuit of peace with Tigray may lead it to turn away from the Amhara region, despite their alliance during and before the war, which could result in a renewed showdown between Amhara and Tigrayan forces.

The prospect of losing territory could also heighten Amhara nationalist claims on Al Fashaga – the loss of which was partly offset by gaining Western Tigray/Welkait – leading to renewed conflagration with Sudan, outside of federal direction. Eritrea’s presence and alliance with Amhara militias remains a concern, given Asmara’s demonstrable ability to inflame tensions.  

Sudan’s securocrats battle over resources to entrench political power

The war in northern Ethiopia was also used opportunistically by the Sudanese Armed Forces (SAF) to take control of the fertile Al Fashaga borderland. This roughly 250 sq km area had been awarded to Sudan when the boundary was initially demarcated by the British in 1903, a ruling that remained contested by Ethiopia. An uneasy truce had seen Ethiopian farmers cultivate the land under nominal Sudanese administration; a settlement that collapsed in 2020 when thousands of predominantly Amhara farmers were evicted.

Local Sudanese farmers have also lost out – with some not compensated for the loss of lands to their own military, with land given to people from other parts of the country, and through lost relationships with Ethiopian farmers, labourers and investors.

The Sudanese military now allegedly controls more than 90 per cent of the disputed areas and security-linked companies and investors have moved into the lucrative sesame sector, re-routing the supply chain, which used to flow largely through Ethiopian markets. These companies are connected to Sudan’s Military Industrial Corporation, a vast conglomerate of business subsidiaries controlled by SAF – which is headed by General Abdel Fattah al-Burhan.

Competition between Sudanese security actors fuels volatile political rivalries, and further entrenches military control of economic resources.

The commander of the paramilitary Rapid Support Forces, General Mohamed Hamdan Dagolo (or Hemedti), also has interests in agriculture, through his family business Al-Junaid. Both sit at the top of Sudan’s Sovereign Council. Hemedti’s competition with Burhan has seen him develop relations with Ethiopia’s prime minister – counter-balanced by recent rapprochement between Abiy and Burhan – as well as senior Amhara leaders, including over business activities.

Moreover, competition between Sudanese security actors fuels volatile political rivalries, and further entrenches military control of economic resources, undermining civilians at a time when pro-democracy forces are seeking to restore a reform-minded government. One of the key challenges for a new civilian government will be to quickly build up a domestic revenue base to compete with the economic heft of the country’s prominent security institutions, which will demand taking on military-controlled holdings in civic sectors such as agriculture, including sesame.

Informal and illicit trade reinforces conflict dynamics

This context has driven the informalization of trade, with cash crops such as sesame increasingly exported outside of formal channels and connected to other illicit cross-border activities between Ethiopia and Sudan. Indications are that sesame production in Western Tigray/Welkait has recovered significantly during the current 2022/23 harvest season. However, rather than contributing much needed currency to soften Ethiopia’s forex crisis, the Amhara elite-controlled supply chain is primarily being used to secure a variety of regional interests.




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Guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An Information Statement from ASNC and SNMMI




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Impact of the ISCHEMIA Trial on Stress Nuclear Myocardial Perfusion Imaging




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Humana and 18F-FDG PET/CT: Another Sequel to the Injustice of Being Judged by the Errors of Others




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The added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in patients with castration-resistant prostate cancer

Purpose: The 68Ga-PSMA PET/CT is a commonly used imaging modality in prostate cancers. However, few studies have compared the diagnostic efficiency between 68Ga-PSMA and 18F-FDG PET/CT and evaluated whether a heterogeneous metabolic phenotype (especially PSMA-FDG+ lesions) exists in patients with castration-resistant prostate cancer (CRPC). We determined the added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in CRPC patients and identified CRPC patients who may benefit from additional 18F-FDG PET/CT. Methods: Data of 56 patients with CRPC who underwent both 68Ga-PSMA and 18F-FDG PET/CT from May 2018 to February 2021 were retrospectively analysed. Patients were classified into two groups with or without PSMA-FDG+ lesions. The differences in patient characteristics between the two groups and predictors of patients who having at least one PSMA-FDG+ lesion were analysed. Results: Although both the detection rate (75.0% vs. 51.8%, P = 0.004) and positive lesion number (135 vs. 95) of 68Ga-PSMA PET/CT were higher than 18F-FDG PET/CT, there were still 13/56 (23.2%) patients with at least one PSMA-FDG+ lesion. The prostate-specific antigen (PSA) and Gleason score were both higher in the patients with PSMA-FDG+ lesions than in those without PSMA-FDG+ lesions (P = 0.04 and P<0.001, respectively). Multivariate regression analysis showed that the Gleason score (≥8) and PSA (≥7.9 ng/mL) were associated with the detection rate of patients who had PSMA-FDG+ lesions (P = 0.01 and P = 0.04, respectively). The incidences of having PSMA-FDG+ lesions in low-probability (Gleason score<8 and PSA<7.9 ng/mL), medium-probability (Gleason score≥8 and PSA<7.9 ng/mL or Gleason score<8 and PSA≥7.9 ng/mL), and high-probability (Gleason score≥8 and PSA≥7.9 ng/mL) groups were 0%, 21.7%, and 61.5%, respectively (P<0.001). Conclusion: Gleason score and PSA are significant predictors for PSMA-FDG+ lesions, and CRPC patients with high Gleason score and PSA may benefit from additional 18F-FDG PET/CT.




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The Annual Journal Impact Factor Saga




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The Translation of Dosimetry into Clinical Practice: What It Takes to Make Dosimetry a Mandatory Part of Clinical Practice




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Challenges with 177Lu-PSMA-617 Radiopharmaceutical Therapy in Clinical Practice




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Pattern of Failure in Patients with Biochemical Recurrence After PSMA Radioguided Surgery

Visual Abstract




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Theranostics for Meningioma on the Rise: New EANM/EANO/RANO/SNMMI Guidelines Pave the Way to Improved Patient Outcomes Using Radiolabeled Somatostatin Receptor Ligands




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Impact of 18F-FDG PET/MRI on Therapeutic Management of Women with Newly Diagnosed Breast Cancer: Results from a Prospective Double-Center Trial

Visual Abstract




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Diagnostic Radiopharmaceuticals: A Sustainable Path to the Improvement of Patient Care




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One Bite from the Apple, One Bite from the Orange in the PRECISE-MDT Study




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Reply: One Bite from the Apple, One Bite from the Orange in the PRECISE-MDT Study and Limitations of Retrospective Study Design and Potential Bias in the PRECISE-MDT Study




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SNMMI Procedure Standard/EANM Practice Guideline for Brain [18F]FDG PET Imaging, Version 2.0

PREAMBLE

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine.

The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.

Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized.

These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, both the SNMMI and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines.

The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment.

Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.




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Limitations of Retrospective Study Design and Potential Bias in the PRECISE-MDT Study




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Improved Localization of Insulinomas Using 68Ga-NODAGA-Exendin-4 PET/CT

Visual Abstract




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MIRD Pamphlet No. 31: MIRDcell V4--Artificial Intelligence Tools to Formulate Optimized Radiopharmaceutical Cocktails for Therapy

Visual Abstract




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Modeling PET Data Acquired During Nonsteady Conditions: What If Brain Conditions Change During the Scan?

Researchers use dynamic PET imaging with target-selective tracer molecules to probe molecular processes. Kinetic models have been developed to describe these processes. The models are typically fitted to the measured PET data with the assumption that the brain is in a steady-state condition for the duration of the scan. The end results are quantitative parameters that characterize the molecular processes. The most common kinetic modeling endpoints are estimates of volume of distribution or the binding potential of a tracer. If the steady state is violated during the scanning period, the standard kinetic models may not apply. To address this issue, time-variant kinetic models have been developed for the characterization of dynamic PET data acquired while significant changes (e.g., short-lived neurotransmitter changes) are occurring in brain processes. These models are intended to extract a transient signal from data. This work in the PET field dates back at least to the 1990s. As interest has grown in imaging nonsteady events, development and refinement of time-variant models has accelerated. These new models, which we classify as belonging to the first, second, or third generation according to their innovation, have used the latest progress in mathematics, image processing, artificial intelligence, and statistics to improve the sensitivity and performance of the earliest practical time-variant models to detect and describe nonsteady phenomena. This review provides a detailed overview of the history of time-variant models in PET. It puts key advancements in the field into historical and scientific context. The sum total of the methods is an ongoing attempt to better understand the nature and implications of neurotransmitter fluctuations and other brief neurochemical phenomena.




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