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Chen H, Chen Y, Dong Y, Gou L, Hu Y, Wang Q, Li G, Li S, Yu J. 18F-FDG PET/CT Radiomics-Based Multimodality Fusion Model for Preoperative Individualized Noninvasive Prediction of Peritoneal Metastasis in Advanced Gastric Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-15631-z. [PMID: 38976160 DOI: 10.1245/s10434-024-15631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE This study was designed to develop and validate a machine learning-based, multimodality fusion (MMF) model using 18F-fluorodeoxyglucose (FDG) PET/CT radiomics and kernelled support tensor machine (KSTM), integrated with clinical factors and nuclear medicine experts' diagnoses to individually predict peritoneal metastasis (PM) in advanced gastric cancer (AGC). METHODS A total of 167 patients receiving preoperative PET/CT and subsequent surgery were included between November 2006 and September 2020 and were divided into a training and testing cohort. The PM status was confirmed via laparoscopic exploration and postoperative pathology. The PET/CT signatures were constructed by classic radiomic, handcrafted-feature-based model and KSTM self-learning-based model. The clinical nomogram was constructed by independent risk factors for PM. Lastly, the PET/CT signatures, clinical nomogram, and experts' diagnoses were fused using evidential reasoning to establish the MMF model. RESULTS The MMF model showed excellent performance in both cohorts (area under the curve [AUC] 94.16% and 90.84% in training and testing), and demonstrated better prediction accuracy than clinical nomogram or experts' diagnoses (net reclassification improvement p < 0.05). The MMF model also had satisfactory generalization ability, even in mucinous adenocarcinoma and signet ring cell carcinoma which have poor uptake of 18F-FDG (AUC 97.98% and 89.71% in training and testing). CONCLUSIONS The 18F-FDG PET/CT radiomics-based MMF model may have significant clinical implications in predicting PM in AGC, revealing that it is necessary to combine the information from different modalities for comprehensive prediction of PM.
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Affiliation(s)
- Hao Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yi Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ye Dong
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Longfei Gou
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanfeng Hu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Quanshi Wang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoxin Li
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Shulong Li
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, Guangdong, China.
| | - Jiang Yu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Dondi F, Bertagna F. Applications of 18F-Fluorodesoxyglucose PET Imaging in Leukemia. PET Clin 2024:S1556-8598(24)00053-1. [PMID: 38909010 DOI: 10.1016/j.cpet.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
The main finding that 18F-FDG PET imaging can reveal in patients with leukemias is the presence of bone marrow (BM) infiltration in both acute or chronic forms. This ability can influence and guide the use of BM biopsy but also assess to therapy response. Additionally 18F-FDG PET imaging has been reported as particularly useful for the diagnosis of leukemias in patients with non specific symptoms. In the case of acute leukemias it revealed also a role for the evaluation of extramedullary forms while in the case of chronic forms a role for the assessment of Richter transformation has been reported.
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Affiliation(s)
- Francesco Dondi
- Nuclear Medicine, Department of Medicine and Surgery, Università degli Studi di Brescia and ASST Spedali Civili di Brescia, Brescia, 25123, Italy.
| | - Francesco Bertagna
- Nuclear Medicine, Department of Medicine and Surgery, Università degli Studi di Brescia and ASST Spedali Civili di Brescia, Brescia, 25123, Italy
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Wang T, Huang G, Zhao H, Li L, Shen Y, Lou W, Liu J. [ 68Ga]Ga-FAPI-04 PET/MR imaging strategy in management of Krukenberg tumors (KTs) from gastric signet-ring-cell carcinoma: to overcome limitation of [ 68Ga]Ga-FAPI-04 PET imaging in KTs. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06761-3. [PMID: 38767660 DOI: 10.1007/s00259-024-06761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To compare performance of whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging in the detection of Krukenberg tumors (KTs), primary site and extra-ovarian metastases of gastric signet-ring-cell carcinoma (GSRCC), and evaluate the value of [68Ga]Ga-FAPI-04 PET/MR imaging strategy and its potential impact on the management of KTs from GSRCC. METHODS Twelve patients with twenty-three KTs from GSRCC, who underwent both [68Ga]Ga-FAPI-04 pelvic PET/MR and whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging were retrospectively analyzed. [68Ga]Ga-FAPI-04 and [18F]FDG uptakes were compared by using Wilcoxon signed-rank test or paired t test. McNemar's test was used to compare lesion detectability between two modalities. Two-tailed P<0.05 was considered statistically significant. Immunohistochemistry staining was utilized to analyze the fibroblast activation protein (FAP) expression in KTs. RESULTS A total of 12 patients with 23 KTs from GSRCC (8 synchronous and 4 metachronous) were evaluated. [68Ga]Ga-FAPI-04 was superior to [18F]FDG PET in detecting primary sites of GSRCC (100% [11/11] vs. 18.2% [2/11], p = 0.002), involved lymph nodes (90.9% [10/11] vs. 54.5% [6/11], p = 0.046) and peritoneal metastases (100% [12/12] vs. 41.7% [5/12], p = 0.008), with higher SUVmax and TBR (all p < 0.005). Both tracers had limited value in identifying KTs, with 100% false negative rate on [68Ga]Ga-FAPI-04 PET and a low detection rate of 8.7% on [18F]FDG PET. Fap immunohistochemistry showed negative or slight FAP expression in neoplastic signet ring cells and ovarian stroma. [68Ga]Ga-FAPI-04 PET/MR imaging strategy greatly improved the detection rate of Krukenberg tumors (87%, 20/23). After adding diffusion-weighted imaging (DWI), the detection rate was further improved (87.5% vs. 100%, p = 0.083). [68Ga]Ga-FAPI-04 PET/MR imaging strategy either upgraded TNM staging or changed treatment management in twelve patients. CONCLUSIONS [68Ga]Ga-FAPI-04 PET outperformed [18F]FDG PET in detecting primary site and most extra-ovarian metastases of GSRCC, but both tracers had limited value in identifying Krukenberg tumors. Pelvis MRI should be applied to compensate the limitation of [68Ga]Ga-FAPI-04 PET imaging to identify Krukenberg tumours. The [68Ga]Ga-FAPI-04 PET/MR imaging strategy has the potential to impact treatment decisions for GSRCC patients with KTs.
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Affiliation(s)
- Tingting Wang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Gan Huang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Haitao Zhao
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Lianghua Li
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yanying Shen
- Department of Pathology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Weihua Lou
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Boschi A, Urso L, Uccelli L, Martini P, Filippi L. 99mTc-labeled FAPI compounds for cancer and inflammation: from radiochemistry to the first clinical applications. EJNMMI Radiopharm Chem 2024; 9:36. [PMID: 38695960 PMCID: PMC11065808 DOI: 10.1186/s41181-024-00264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND In recent years, fibroblast activating protein (FAP), a biomarker overexpressed by cancer-associated fibroblasts, has emerged as one of the most promising biomarkers in oncology. Similarly, FAP overexpression has been detected in various fibroblast-mediated inflammatory conditions such as liver cirrhosis and idiopathic pulmonary fibrosis. Along this trajectory, FAP-targeted positron emission tomography (PET), utilizing FAP inhibitors (FAPi) labeled with positron emitters, has gained traction as a powerful imaging approach in both cancer and inflammation. However, PET represents a high-cost technology, and its widespread adoption is still limited compared to the availability of gamma cameras. To address this issue, several efforts have been made to explore the potential of [99mTc]Tc-FAPi tracers as molecular probes for imaging with gamma cameras and single photon emission computed tomography (SPECT). MAIN BODY Several approaches have been investigated for labeling FAPi-based compounds with 99mTc. Specifically, the mono-oxo, tricarbonyl, isonitrile, and HYNIC strategies have been applied to produce [99mTc]Tc-FAPi tracers, which have been tested in vitro and in animal models. Overall, these labeling approaches have demonstrated high efficiency and strong binding. The resulting [99mTc]Tc-FAPi tracers have shown high specificity for FAP-positive cells and xenografts in both in vitro and animal model studies, respectively. However, the majority of [99mTc]Tc-FAPi tracers have exhibited variable levels of lipophilicity, leading to preferential excretion through the hepatobiliary route and undesirable binding to lipoproteins. Consequently, efforts have been made to synthesize more hydrophilic FAPi-based compounds to improve pharmacokinetic properties and achieve a more favorable biodistribution, particularly in the abdominal region. SPECT imaging with [99mTc]Tc-FAPi has yielded promising results in patients with gastrointestinal tumors, demonstrating comparable or superior diagnostic performance compared to other imaging modalities. Similarly, encouraging outcomes have been observed in subjects with gliomas, lung cancer, breast cancer, and cervical cancer. Beyond oncological applications, [99mTc]Tc-FAPi-based imaging has been successfully employed in myocardial and idiopathic pulmonary fibrosis. CONCLUSIONS This overview focuses on the various radiochemical strategies for obtaining [99mTc]Tc-FAPi tracers, highlighting the main challenges encountered and possible solutions when applying each distinct approach. Additionally, it covers the preclinical and initial clinical applications of [99mTc]Tc-FAPi in cancer and inflammation.
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Affiliation(s)
- Alessandra Boschi
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Via L. Borsari, 46, 44121, Ferrara, Italy
| | - Luca Urso
- Department of Translational Medicine, University of Ferrara, Via Fossato di Mortara, 70 c/o viale Eliporto, 44121, Ferrara, Italy
- Nuclear Medicine Unit, Ferrara Hospital, Via A. Moro, 8, 44124, Ferrara, Italy
| | - Licia Uccelli
- Department of Translational Medicine, University of Ferrara, Via Fossato di Mortara, 70 c/o viale Eliporto, 44121, Ferrara, Italy.
- Nuclear Medicine Unit, Ferrara Hospital, Via A. Moro, 8, 44124, Ferrara, Italy.
| | - Petra Martini
- Department of Environmental and Prevention Sciences, University of Ferrara, Via L. Borsari, 46 44121, Ferrara, Italy.
| | - Luca Filippi
- Nuclear Medicine Unit, Department of Oncohaematology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
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Kiran MY, Ercan LD, Karatay E, Has Simsek D, Sanli Y. Unusual Metastasis of Signet-Ring Cell Gastric Cancer That Could Not Be Detected With 18 F-FDG PET But With 68 Ga-FAPI PET/CT. Clin Nucl Med 2024; 49:e215-e216. [PMID: 38537207 DOI: 10.1097/rlu.0000000000005154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT A 70-year-old man who was scheduled for surgery because of the recurrence of gastric cancer was referred to our clinic preoperatively. The patient underwent a comprehensive evaluation through 18 F-FDG and 68 Ga-FAPI ( 68 Ga-labeled FAP inhibitors) PET/CT scans. The 68 Ga-FAPI PET/CT scan was particularly valuable in this case because of its ability to detect recurrent mass lesions and identify unusual metastatic sites compared with the 18 F-FDG PET/CT scan.
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Affiliation(s)
| | | | - Ecem Karatay
- Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Lee H, Hwang KH. Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by? World J Clin Cases 2024; 12:1885-1899. [PMID: 38660550 PMCID: PMC11036514 DOI: 10.12998/wjcc.v12.i11.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Since the inception of fluorine-18 fluorodeoxyglucose (F-18 FDG), positron emission tomography/computed tomography (PET/CT) utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology, with global prevalence in clinical practice. Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh, the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon. Numerous investigations have been undertaken to delineate the distinctive features of these findings, yet the outcomes have proven inconclusive. The incongruent results of these studies present a challenge for physicians, leaving them uncertain about the appropriate course of action. This article provides a succinct overview of the characteristics of fluorodeoxyglucose, followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs. In conclusion, while the prevalence of unrecognized malignancy varies across organs, malignancies account for a substantial proportion, ranging from approximately one-third to over half, of incidental focal uptake. In light of these rates, physicians are urged to exercise vigilance in not disregarding unexpected uptake, facilitating more assured clinical decisions, and advocating for further active evaluation.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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7
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Zhao M, Zhang A, Zu M, Ma Y, Ding S, Zhang W. Comparison of 18 F-FDG and 18 F-FAPI PET/CT Findings of Signet-Ring Cell Carcinoma of the Stomach. Clin Nucl Med 2024; 49:e139-e140. [PMID: 38271264 DOI: 10.1097/rlu.0000000000005024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT A 66-year-old man with gastric signet-ring cell carcinoma underwent both 18 F-FDG and 18 FAl-NOTA-FAPI PET/CT imaging. There was no abnormal FDG activity in the stomach, but there was diffuse intense 18 FAl-NOTA-FAPI uptake in the known lesion and an adjacent metastasis.
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Affiliation(s)
| | | | | | - Yanpeng Ma
- General Surgery, Peking University Third Hospital, Beijing, China
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8
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Dondi F, Antonelli A, Suardi N, Guerini AE, Albano D, Lucchini S, Camoni L, Treglia G, Bertagna F. PET/CT and Conventional Imaging for the Assessment of Neuroendocrine Prostate Cancer: A Systematic Review. Cancers (Basel) 2023; 15:4404. [PMID: 37686680 PMCID: PMC10486674 DOI: 10.3390/cancers15174404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuroendocrine prostate cancer (NEPC) is a rare neoplasm, and the role of both conventional imaging (CI) and positron emission tomography/computed tomography (PET/CT) for its assessment has not been clearly evaluated and demonstrated. The aim of this systematic review was to analyze the diagnostic performances of these imaging modalities in this setting. METHODS A wide literature search of the PubMed/MEDLINE, Scopus, and Web of Science databases was made to find relevant published articles about the role of CI and PET/CT for the evaluation of NEPC. RESULTS 13 studies were included in the systematic review. PET/CT imaging with different radiopharmaceuticals has been evaluated in many studies (10) compared to CI (3 studies), which has only a limited role in NEPC. Focusing on PET/CT, a study used [18F]FDG, labeled somatostatin analogs were used in 5 cases, a study used [68Ga]Ga-FAPI-04, [68Ga]Ga-PSMA-11 was evaluated in a single case, and two works used different tracers. CONCLUSION Published data on the role of PET/CT for the assessment of NEPC are limited. At present, it is still uncertain which tracer performs best, and although [18F]FDG has been evaluated and seems to offer some advantages in availability and clinical staging, other tracers may be more useful to understand tumor biology or identify targets for subsequent radioligand therapy. Further research is therefore desirable. In contrast, data are still limited to draw a final conclusion on the role and the specific characteristics of CI in this rare form of neoplasm, and therefore, more studies are needed in this setting.
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Affiliation(s)
- Francesco Dondi
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | | | - Nazareno Suardi
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Domenico Albano
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Silvia Lucchini
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Luca Camoni
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Treglia
- Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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Abstract
Like other major cancers, gastric cancer expresses fibroblast activation protein (FAP) in cancer-associated fibroblasts. Many recent studies have reported the utility and superiority of FAP inhibitor (FAPI)-PET over [18F]fluorodeoxyglucose (FDG)-PET in gastric cancers, from initial staging to recurrence detection. FAPI-PET shows higher accumulation in primary sites and metastatic lesions than does FDG-PET, especially for the detection of peritoneal carcinomatosis. In the case of gastric signet ring cell carcinoma, FAPI-PET showed excellent performance, as uptake is usually weak on FDG-PET in this cohort.
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Affiliation(s)
- Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Institute for Radiation Sciences, Osaka University.
| | - Frederik L Giesel
- Institute for Radiation Sciences, Osaka University; Department of Nuclear Medicine, University Hosptial Duesseldorf (UKD), Geb. 13.52.01.50, Moorenstrasse 5D-40225 Düsseldorf, Germany
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10
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Liu H, Yang X, Liu L, Qu G, Chen Y. Comparison of 18 F-FDG and 68 Ga-FAPI-04 Uptake in Postoperative Re-evaluation of Gastric, Duodenal, and Colorectal Cancers. Clin Nucl Med 2023; 48:304-308. [PMID: 36800254 DOI: 10.1097/rlu.0000000000004604] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To compare the potential efficacy of 68 Ga-FAPI-04 PET/CT with that of 18 F-FDG PET/CT for detecting tumor recurrence and nodal and distant metastases in gastric, duodenal, and colorectal cancers. METHODS This single-center retrospective clinical study was performed at the Affiliated Hospital of Southwest Medical University between January 2020 and June 2022. Participants with gastric, duodenal, and colorectal cancers after curative resection underwent both 68 Ga-FAPI-04 and 18 F-FDG PET/CT. Histopathologic examination, morphologic imaging, and/or follow-up imaging served as the reference standards. The SUV max of the tumor recurrence and nodal and distant metastases between 18 F-FDG and 68 Ga-FAPI-04 PET/CT were compared using the paired-sample t test. RESULTS Forty-one participants with gastric, duodenal, and colorectal cancers were enrolled in the study (median age, 51 years; range, 19-75 years). The sensitivity of 68 Ga-FAPI-04 PET/CT was higher than that of 18 F-FDG PET/CT for detecting tumor recurrence (6 of 6 [100%] vs 4 of 6 [67%]), nodal metastases (92 of 92 [100%] vs 31 of 92 [34%]), and distant metastases (28 of 30 [93%] vs 20 of 30 [67%]). CONCLUSION 68 Ga-FAPI-04 PET/CT for tumor re-evaluation showed potential for more accurate performance of gastric, duodenal, and colorectal cancers, thereby improving treatment decision-making.
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Affiliation(s)
| | - Xiao Yang
- Department of Nuclear Medicine, Second People's Hospital of Yibin City, Yibin, Sichuan, People's Republic of China
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11
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Zheng W, Liu L, Feng Y, Wang L, Chen Y. Comparison of 68 Ga-FAPI-04 and fluorine-18-fluorodeoxyglucose PET/computed tomography in the detection of ovarian malignancies. Nucl Med Commun 2023; 44:194-203. [PMID: 36472415 PMCID: PMC9907692 DOI: 10.1097/mnm.0000000000001653] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, fluorine-18-fluorodeoxyglucose ( 18 F-FDG) is the most frequently used diagnostical radiotracer for PET/computed tomography (PET/CT) in ovarian malignancies. However, 18 F-FDG has some limitations. The fibroblast activation protein inhibitor (FAPI) previously demonstrated highly promising results in studies on various tumor entities and 68 Ga-labeled FAPI presents a promising alternative to 18 F-FDG. This study aimed to compare the performance of 68 Ga-FAPI and 18 F-FDG PET/CT for imaging of ovarian malignancies. METHODS A total of 27 patients were included in this retrospective study conducted at the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022. The 18 F-FDG and 68 Ga-FAPI uptakes of tumors, lymph nodes, and distant metastases were quantified using the maximum standardized uptake values, and the tumor-to-background ratios were also evaluated and calculated by using the Wilcoxon signed-rank test. RESULTS Twenty-one patients with suspected ( n = 11) and previously treated ovarian malignancies ( n = 10) were in statistical analysis finally. For detecting tumors, 68 Ga-FAPI PET/CT was more sensitive than 18 F-FDG PET/CT [14 of 14 (100%) vs. 11 of 14 (78%)], lymph node metastases [75 of 75 (100%) vs. 60 of 75 (80%)] and superior to 18 F-FDG PET/CT in terms of the peritoneal and pleural metastases [9 of 9 (100%) vs. 5 of 9 (56%)]. For four of the newly diagnosed patients ( n = 11), 68 Ga-FAPI PET/CT upstaged the clinical stage compared to 18 F-FDG PET/CT. CONCLUSION 68 Ga-FAPI PET/CT has superior potential in the detection of ovarian cancers, especially in peritoneal carcinomatosis. 68 Ga-FAPI PET/CT may be a promising supplement for staging and follow-up of ovarian malignancies.
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Affiliation(s)
- Wenlu Zheng
- Faculty of Chinese Medicine, Macau University of Science and Technology
- State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Macau
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Lin Liu
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Yue Feng
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Li Wang
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Yue Chen
- Faculty of Chinese Medicine, Macau University of Science and Technology
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
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Chen H, Pang Y, Li J, Kang F, Xu W, Meng T, Shang Q, Zhao J, Guan Y, Wu H, Xie F, Wang J, Sun L. Comparison of [ 68Ga]Ga-FAPI and [ 18F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study. Eur Radiol 2023; 33:1329-1341. [PMID: 35976396 DOI: 10.1007/s00330-022-09084-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we investigated the role of [68Ga]Ga-FAPI PET imaging in the detection of primary and metastatic gastric signet-ring-cell carcinoma (GSRCC) and compared with [18F]FDG PET. METHODS This retrospective multicenter analysis included 34 patients with histologically confirmed GSRCCs from four medical centers. The maximum standard uptake value (SUVmax), tumor-to-background ratio (TBR), and diagnostic accuracy were compared between the two modalities. [18F]FDG and [68Ga]Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. McNemar's test was used to compare the diagnostic accuracy between the two techniques. RESULTS Data were analyzed from 27 paired PET/CT and 7 paired PET/MRI scans for 34 GSRCC patients (16 men and 18 women) who had a median age of 51 years (range: 25-85 years). [68Ga]Ga-FAPI PET showed higher SUVmax and TBR values than did [18F]FDG PET in the primary tumors (SUVmax: 5.2 vs. 2.2, p = 0.001; TBR: 7.6 vs. 1.3, p < 0.001), involved lymph nodes (SUVmax: 6.8 vs. 2.5, p < 0.001; TBR: 5.8 vs. 1.3, p < 0.001), and bone and visceral metastases (SUVmax: 6.5 vs. 2.4, p < 0.001; TBR: 6.3 vs. 1.3, p < 0.001). In diagnostic performance, [68Ga]Ga-FAPI PET exhibited higher sensitivity than [18F]FDG PET for detecting primary tumors (73% [16/22] vs. 18% [4/22], p < 0.001), local recurrences (100% [7/7] vs. 29% [2/7], p = 0.071), lymph node metastases (77% [59/77] vs. 23% [18/77], p < 0.001), and distant metastases (93% [207/222] vs. 39% [86/222], p < 0.001). CONCLUSION The results from this multicenter retrospective analysis justify the clinical use of [68Ga]Ga-FAPI tracers for GSRCC diagnosis and staging. KEY POINTS • [68Ga]Ga-FAPI PET/CT is a promising imaging modality for the detection of primary and metastatic disease and has implications for TNM staging in GSRCC. • In this multicenter study of 34 patients with GSRCC, [68Ga]Ga-FAPI PET exhibited greater radiotracer uptake, tumor-to-background ratios, and diagnostic accuracy than [18F]FDG PET for detecting primary/recurrent tumors and metastatic lesions.
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Affiliation(s)
- Haojun Chen
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Yizhen Pang
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Junpeng Li
- Department of PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weizhi Xu
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Tinghua Meng
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qihang Shang
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yihui Guan
- Department of PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua Wu
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Fang Xie
- Department of PET Center, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Long Sun
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Perirenal Infiltration of Signet Ring Cell Colon Carcinoma Shown by 68Ga-FAPI PET/CT. Clin Nucl Med 2022; 47:e509-e512. [DOI: 10.1097/rlu.0000000000004166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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