The bibliometric analysis reveals that positron emission tomography/computed tomography research in skeletal metastasis has shifted from diagnostic validation toward theranostic integration and multi-target precision imaging.
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Research Article
The bibliometric analysis reveals that positron emission tomography/computed tomography research in skeletal metastasis has shifted from diagnostic validation toward theranostic integration and multi-target precision imaging.
Skeletal metastasis is a common complication of advanced malignancies, and positron emission tomography/computed tomography (PET/CT) plays an increasingly important role in its diagnosis and management. Given the rapid evolution of this field over the past decade, a timely bibliometric assessment is warranted to delineate its research landscape and emerging trends. This study aimed to comprehensively analyze the global research landscape of PET/CT in skeletal metastasis from 2016 to 2025. Publications were retrieved from the Web of Science Core Collection on April 6, 2026, using a topic search strategy. After screening, 1,154 articles and reviews in English were included. Bibliometric analyses were performed using VOSviewer, CiteSpace, and Scimago Graphica. Annual publication output showed a fluctuating growth trend, peaking in 2025 with 137 papers. China ranked first in publication volume (297 papers), followed by the United States (230 papers) and Germany (150 papers). In terms of citation impact, the United States had the highest total citations (7,628), while the Netherlands achieved the highest average citations per paper (56.7). The European Journal of Nuclear Medicine and Molecular Imaging was the most productive and most cited journal. International collaboration was strongest among the United States, Germany, and the United Kingdom. The included literature covered a broad range of PET tracers, including prostate-specific membrane antigen (PSMA)-targeted agents, choline analogs, fibroblast activation protein inhibitor (FAPI), and somatostatin receptor (SSTR)-targeted tracers. Research hotspots evolved from early validation of novel tracers (68Ga-PSMA, 18F-choline) to PSMA-targeted theranostics and multi-target precision imaging, and more recently to FAPI-based imaging, neuroendocrine tumors, whole-body assessment, and treatment efficacy monitoring. Emerging topics include clinical translation of novel probes, cross-cancer applications, quantitative radiomics, and international collaboration. This evolution indicates that PET/CT research in skeletal metastasis has been moving steadily toward multi-target, cross-cancer, integrated theranostic precision medicine.
Skeletal metastasis is a common complication of advanced malignancies, especially breast, prostate, lung, and thyroid cancers1,2,3,4,5. It often leads to skeletal-related events, including pathological fractures, spinal cord compression, hypercalcemia, and intractable pain, which impair quality of life and reduce survival6,7,8,9,10. Positron emission tomography/computed tomography (PET/CT) has emerged as a powerful molecular imaging modality that integrates functional metabolic information with anatomical localization11,12,13,14,15. Compared with conventional techniques such as bone scintigraphy, computed tomography (CT), or magnetic resonance imaging (MRI), PET/CT offers superior sensitivity and specificity for detecting bone metastases16,17,18,19,20. Commonly used tracers like 18F‑FDG, 18F‑NaF, and 68Ga‑FAPI have broadened diagnostic capabilities across different clinical scenarios21,22. In particular, prostate-specific membrane antigen (PSMA)-targeted PET and somatostatin receptor (SSTR)-targeted PET have shown significant value in detecting skeletal metastases in prostate cancer and neuroendocrine tumors, respectively, further expanding the clinical utility of PET/CT in this field23. Over the past two decades, a rapidly growing body of literature has investigated the application of PET/CT in skeletal metastasis, covering diagnostic accuracy, prognostic value, treatment response assessment, tracer development, and comparisons with other modalities24.
Despite this wealth of publications, the rapid expansion and wide dispersion of the literature make it difficult for researchers and clinicians to systematically grasp the overall structure, evolution, and emerging frontiers of the field. Bibliometric analysis provides a quantitative and visual approach to map knowledge landscapes by examining publication outputs, citation networks, co‑authorship, keyword co‑occurrence, and collaboration patterns25,26. Through quantitative analysis of publication volume, citation relationships, and author collaborations, this method can objectively and systematically identify research hotspots, highly influential works, and core collaboration networks in a given field27. To date, no comprehensive bibliometric study has specifically focused on the role of PET/CT in skeletal metastasis. Therefore, this study aims to conduct a bibliometric analysis of global research on PET/CT in skeletal metastasis, including annual trends, productive countries, institutions, journals, and authors, research hotspots, temporal evolution of frontiers, and visualized knowledge maps, thereby guiding future investigations in this field.
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Data source and retrieval strategy
The data for this study were retrieved from the Web of Science Core Collection database on April 6, 2026. The following Core Collection indexes were searched: Science Citation Index Expanded (SCI-EXPANDED) and Social Sciences Citation Index (SSCI). An advanced search was conducted, limiting the search scope to the topic field of the literature. The specific search query was constructed as follows: TS=(“bone metast” OR “skeletal metast” OR “osseous metast”) AND TS=(“Positron Emission Tomography Computed Tomography” OR “CT PET” OR “CT PET Scan” OR “PET CT Scan” OR “PET/CT” OR “PET/CT Scan” OR “Positron Emission Tomography-Computed Tomography”). The retrieval period was set from January 1, 2016, to December 31, 2025, to capture the most recent decade of research activity in this rapidly evolving field, as the past ten years have witnessed substantial advances in PET/CT technology, novel tracer development, and clinical applications in skeletal metastasis, making this timeframe most representative of the current research landscape.
Inclusion and exclusion criteria
To minimize bias in subsequent analyses, a rigorous screening process was applied. The inclusion criteria were: peer-reviewed original articles or reviews; published in English; published between 2016 and 2025. The exclusion criteria were: conference abstracts, conference papers, editorials, book chapters, and retracted publications; non-English publications; duplicate records. Preclinical studies, simulation studies, case reports, and case series were excluded from the final analysis, as the present bibliometric study focused on peer-reviewed original research and review articles that provide systematic evidence and comprehensive overviews of the field. Duplicate records were identified by comparing author names, titles, journal names, publication years, and DOIs using the “Find Duplicates” function in the bibliometric software and manual verification. Identified duplicates were removed prior to further analysis.
Data export and preprocessing
Full records and cited references of the literature meeting the inclusion criteria were exported from the database in plain text format. The exported data included core metadata fields such as author names, article titles, source publications, abstracts, keywords, reference lists, and citation counts. The exported data files were archived on local storage devices for subsequent reading and visualization by bibliometric software.
Data analysis and visualization tools
For the obtained literature dataset, multiple specialized software tools and online platforms were used collaboratively to complete the bibliometric analysis and scientific mapping. The specific analysis process was as follows: Basic bibliometric indicators were compiled and organized using Excel. Scientific knowledge maps were primarily constructed using VOSviewer and CiteSpace. For VOSviewer analysis, the full counting method was adopted. For the country collaboration network, the maximum number of displayed nodes was set to 25; for institution, journal, and author collaboration networks, it was set to 50. For iournal co-citation analysis, the minimum number of citations was set to five. The clustering resolution parameter was maintained at the default value of 1.0. VOSviewer was used for network analysis and cluster visualization of journal co-citation, country collaboration, institutional collaboration, and author co-authorship. For CiteSpace analysis, the time slicing parameter was set to 1 year per slice. The Top N per slice was set to 10. The pathfinder algorithm was adopted for network pruning, combined with the pruning sliced networks option, and all other parameters followed the software’s default recommendations. CiteSpace was employed for keyword burst detection, keyword co-occurrence time-zone evolution analysis, and reference co-citation network construction and interpretation. For the spatial visualization of country collaboration relationships, Scimago Graphica was used to generate geospatial maps to intuitively display the intensity of academic collaboration between different countries or regions. Additionally, chord diagrams illustrating country collaboration links were generated using an online bibliometric analysis platform. Journal evaluation data, including journal impact factors and Journal Citation Reports (JCR) quartile rankings, were obtained by querying and manually verifying information on the Journal Citation Reports (JCR) website. This multi-tool integrated analysis process ensured the comprehensiveness and accuracy of the analysis of research structure, hotspot evolution, and collaboration patterns in this field. The research process of this study is shown in Figure 1.
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Annual trends in publication and citation counts
Using the above retrieval strategy, an initial set of 1,478 records was obtained from the Web of Science Core Collection database. After refining by document type (excluding conference abstracts, conference papers, editorial materials, book chapters, and retracted articles), a total of 1,182 original articles and reviews were retained. Following further restrictions to English-language publications, 1,154 records were ultimately included for bibliome...
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Skeletal metastasis is one of the most common complications of advanced malignancies and severely impairs patients' quality of life and survival28,29. The most common primary tumors that metastasize to bone are breast, lung, prostate, kidney, and thyroid cancers, which account for the vast majority of skeletal metastatic lesions30. As a molecular imaging technique, PET/CT plays an increasingly important role in the diagnosis, staging, ...
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The authors declare no conflicts of interest.
No artificial intelligence tools were used in the preparation of this manuscript, including the writing, data analysis, or figure generation. All work was performed independently by the authors.
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| Bibliometric Online Analysis Platform | bibliometric.com | https://bibliometric.com | Used for generating chord diagrams illustrating country/regional collaboration networks. |
| CiteSpace | Chaomei Chen, Drexel University | version 6.4.R1; https://citespace.podia.com/ | Used for keyword burst detection, co-citation analysis, and time-zone evolution analysis. |
| Journal Citation Reports (JCR) | Clarivate Analytics | https://jcr.clarivate.com | Used for obtaining journal impact factors and JCR quartile rankings. |
| Microsoft Excel | Microsoft Corporation | Microsoft 365; https://www.microsoft.com/microsoft-365/excel | Used for descriptive statistical analysis and data management. |
| Scimago Graphica | SCImago Lab | version 1.0.25; https://graphica.scimago.es/ | Used for geospatial visualization of country/regional collaboration networks. |
| VOSviewer | Centre for Science and Technology Studies (CWTS), Leiden University | version 1.6.19; https://www.vosviewer.com/ | Used for constructing and visualizing co-authorship, co-occurrence, and collaboration networks. |
| Web of Science Core Collection | Clarivate Analytics | https://www.webofscience.com | Literature database used for data acquisition and search strategy. |
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