The RET (rearranged-during-transfection protein) protooncogene triggers multiple intracellular signaling cascades regulating cell cycle progression and cellular metabolism. We therefore hypothesized that metabolic imaging could allow noninvasive detection of response to the RET inhibitor vandetanib in vivo. Methods: The effects of vandetanib treatment on the fullgenome expression and the metabolic profile were analyzed in the human medullary thyroid cancer cell line TT. In vitro, transcriptional changes of pathways regulating cell cycle progression and glucose, dopa, and thymidine metabolism were correlated to the results of cell cycle analysis and the uptake of 3 H-deoxyglucose, 3 H-3,4-dihydroxy-L-phenylalanine, and 3 H-thymidine under vandetanib treatment. In vivo, the tumor metabolism under vandetanib was monitored by small-animal PET of tumor-bearing mice. Results: Vandetanib treatment resulted in the transcriptional downregulation of various effector pathways with consecutive downregulation of cyclin expression and a G 0 /G 1 arrest. In vitro, vandetanib treatment resulted in the decreased expression of genes regulating glucose, 3,4-dihydroxy-L-phenylalanine, and thymidine metabolism, with a subsequent reduction in the functional activity of the corresponding pathways. In vivo, metabolic imaging with PET was able to assess changes in the tumoral glucose metabolism profile as early as 3 d after initiation of vandetanib treatment. Conclusion: We describe a metabolic imaging approach for the noninvasive detection of successful vandetanib treatment. Our results suggest that PET may be useful for identifying patients who respond to vandetanib early in the course of treatment. TheRET(rearranged-duri ng-transfection protein) protooncogene, located on chromosome 10q11.2, encodes for a tyrosine kinase of the cadherin superfamily that activates multiple intracellular signaling cascades regulating cell survival, differentiation, proliferation, migration, and chemotaxis (1). Gain-of-function mutations in the RET gene result in uncontrolled growth and cause human cancers and cancer syndromes, such as Hürthle cell cancer, sporadic papillary thyroid carcinoma, familial medullary thyroid carcinoma, and multiple endocrine neoplasia types 2A and 2B (2).The signaling pathways downstream of RET are activated by autophosphorylation of several tyrosine and serine residues (Fig. 1A) and regulate several genes involved in tumor progression (3). Among other effects, activated Rac (Ras-related C3 botulinum toxin substrate) (4), STAT3 (signal transducer and activator of transcription 3) (5), Src (v-src sarcoma [Schmidt-Ruppin A-2] viral oncogene homolog) (5), Ras (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (6), and PI3K (phosphatidylinositol-3-kinase) (7) each results in the upregulation of cyclin activity, which consequently leads to accelerated cell cycle progression (8). Growth factor receptor-bound proteins 7 and 10 (Grb7 and Grb10) presumably contribute to the invasive cell potential (9), whereas phospholipase Cg (PLCg...