☆ 4.7 Article

Comparison of PET imaging of activated fibroblasts and 18F-FDG for diagnosis of primary hepatic tumours: a prospective pilot study

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING (2021)

Journal

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

Volume 48, Issue 5, Pages 1593-1603

Publisher

SPRINGER

DOI: 10.1007/s00259-020-05070-9

Keywords

Ga-68-FAPI-04; F-18-FDG; Fibroblast activating protein; Hepatic nodule; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma

Funding

National Natural Science Foundation of China [81571713]
Fundamental Research Funds for the Central Universities [3332020011]
CAMS Innovation Fund for Medical Sciences [2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001]

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Abstract

This study compared the performance of Ga-68-labelled fibroblast activating protein inhibitor (FAPI) PET and F-18-FDG PET for imaging of hepatic tumours, finding that Ga-68-FAPI PET-CT has superior potential in the detection of primary hepatic malignancy compared to F-18-FDG.

Purpose This study aimed to compare the performance of Ga-68-labelled fibroblast activating protein inhibitor (FAPI) PET and F-18-FDG PET for imaging of hepatic tumours. Methods We prospectively assessed 20 patients with suspected intrahepatic lesions. Tumour radiological features, pathology, or follow-up examinations were assessed as ground truth in correlation with PET scans. Semiquantitative analysis was additionally performed by measuring the standardised uptake value (SUV). Tumour-to-liver background ratios (TBR) were calculated and compared between Ga-68-FAPI PET and F-18-FDG PET. FAPI expression was assessed by immunochemistry in samples obtained from 7 patients with hepatocellular carcinomas (HCC)/intrahepatic cholangiocarcinoma (ICC) or granulomas. Results Primary intrahepatic tumours, including 16 HCC in 14 patients and 4 ICC in 3 patients with extrahepatic metastases, were determined by histology (n = 14) and clinical examinations (n = 3). Based on visual analysis, 17 patients presented elevated Ga-68-FAPI uptake (sensitivity: 100%, specificity: 100%), while 7 patients presented F-18-FDG avid tumours (sensitivity: 58.8%, specificity: 100%). Ga-68-FAPI PET/CT identified 17 extrahepatic metastases vs. 13 in F-18-FDG PET/CT in 2 ICC patients. Three benign liver nodules in three patients showed negligible uptake in dual-PET scans. The SUVmax_HCC = 8.47 +/- 4.06 and TBRmax_HCC = 7.13 +/- 5.52, and SUVmax_ICC = 14.14 +/- 2.20 TBRmax_ICC = 26.46 +/- 4.94 in Ga-68-FAPI-04 PET/CT were significantly higher than the F-18-FDG uptake presenting SUVmax_HCC = 4.86 +/- 3.58 and TBRmax_HCC = 2.39 +/- 2.21, and SUVmax_ICC = 9.19 +/- 3.60 and TBRmax_ICC = 2.39 +/- 2.21 (all p values < 0.05). ICC patients showed higher levels of FAPI uptake in the primary hepatic lesions compared to extrahepatic metastases, TBRmax_ICC = 15.18 +/- 5.80 (p = 0.04). Conclusions Ga-68-FAPI PET-CT has superior potential in the detection of primary hepatic malignancy compared to F-18-FDG.

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Comparison of [Ga-68]Ga-DOTA-FAPI-04 and [F-18]FDG Uptake in Esophageal Cancer

Huipan Liu, Zhi Hu, Xiao Yang, Tianyang Dai, Yue Chen

Summary: The study found that [Ga-68]Ga-DOTA-FAPI-04 PET/CT has better diagnostic performance in detecting primary and metastatic lesions of esophageal cancer compared to [F-18]FDG PET/CT. The technology showed higher accuracy in detecting lesions in treatment-naive patients and had higher sensitivity for primary tumors, lymph nodes, and bone and visceral metastases.

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