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Maliha PG, Hotta M, Farolfi A, Grogan T, Alano R, Limon A, Lam E, Carlucci G, Bahri S, Salavati A, Benz M, Silverman D, Gupta P, Quon A, Allen-Auerbach M, Czernin J, Calais J. FAPI PET uptake patterns after invasive medical interventions: a single center retrospective analysis. Eur J Nucl Med Mol Imaging 2024; 51:3373-3385. [PMID: 38750372 DOI: 10.1007/s00259-024-06733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/24/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE Fibroblast activation protein (FAP)-inhibitor (FAPI)-PET tracers allow imaging of the FAP-expressing cancer associated fibroblasts (CAF) and also the normal activated fibroblasts (NAF) involved in inflammation/fibrosis that may be present after invasive medical interventions. We evaluated [68Ga]Ga-FAPI-46 uptake patterns post-medical/invasive non-systemic interventions. METHODS This single-center retrospective analysis was conducted in 79 consecutive patients who underwent [68Ga]Ga-FAPI-46 PET/CT. Investigators reviewed prior patient medical/invasive interventions (surgery, endoscopy, biopsy, radiotherapy, foreign body placement (FBP) defined as implanted medical/surgical material present at time of scan) and characterized the anatomically corresponding FAPI uptake intensity both visually (positive if above surrounding background) and quantitatively (SUVmax). Interventions with missing data/images or confounders of [68Ga]Ga-FAPI-46 uptake (partial volume effect, other cause of increased uptake) were excluded. Available correlative FDG, DOTATATE and PSMA PET/CTs were analyzed when available. RESULTS 163 medical/invasive interventions (mostly surgeries (49%), endoscopies (18%) and non-surgical biopsies (10%)) in 60 subjects were included for analysis. 43/163 (26%) involved FBP. FAPI uptake occurred in 24/163 (15%) of interventions (average SUVmax 3.2 (mild), range 1.5-5.1). The median time-interval post-intervention to FAPI-PET was 47.5 months and was shorter when FAPI uptake was present (median 9.5 months) than when absent (median 60.1 months; p = 0.001). Cut-off time beyond which no FAPI uptake would be present post-intervention without FBP was 8.2 months, with a sensitivity, specificity, positive predictive value and negative predictive value of 82, 90, 99 and 31% respectively. No optimal cutoff point could be determined when considering interventions with FBP. No significant difference was detected between frequency of [68Ga]Ga-FAPI-46 and [18F]FDG uptake in intervention sites. Compared to [68Ga]Ga-PSMA-11, [68Ga]Ga-FAPI-46 revealed more frequent and intense post-interventional tracer uptake. CONCLUSION [68Ga]Ga-FAPI-46 uptake from medical/invasive interventions without FBP appears to be time dependent, nearly always absent beyond 8 months post-intervention, but frequently present for years with FBP.
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Affiliation(s)
- Peter George Maliha
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
- Nuclear Medicine, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada.
- Nuclear Medicine Department, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Masatoshi Hotta
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Department of Nuclear Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Andrea Farolfi
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Rejah Alano
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Andrea Limon
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Ethan Lam
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Giuseppe Carlucci
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Shadfar Bahri
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Ali Salavati
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Matthias Benz
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Daniel Silverman
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Pawan Gupta
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Andrew Quon
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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Yuan H, Liu E, Zhang G, Lai C, Zhang Q, Shang Y, Cheng Z, Jiang L. Diagnostic efficacy of [ 68Ga]Ga-DOTA-GPFAPI-04 in patients with solid tumors in a head-to-head comparison with [ 18F]F-FDG: results from a prospective clinical study. Eur J Nucl Med Mol Imaging 2024; 51:3360-3372. [PMID: 38727829 DOI: 10.1007/s00259-024-06756-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/04/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE To identify the biodistribution and diagnostic performance of a novel fibroblast activation protein (FAP) targeted positron emission tomography (PET) tracer, [68Ga]Ga-DOTA-GPFAPI-04, in patients with solid tumors in a head-to-head comparison with [18F]F-FDG. METHODS Twenty-six patients histologically proven with cancers of nasopharyngeal (n = 5), esophagus (n = 5), gastro-esophagus (n = 1), stomach (n = 7), liver (n = 3), and colorectum (n = 5) were recruited for [68Ga]Ga-DOTA-GPFAPI-04 and [18F]F-FDG PET/CT scans on consecutive days. The primary endpoint was the diagnostic efficacy, with the histological diagnosis and the follow-up results selected as the gold standard. The secondary endpoint was the background uptake pattern. Two experienced nuclear medicine physicians who were blinded to the gold standard results while having essential awareness of the clinical context reviewed the images and labeled lesions by consensus for subsequent software-assisted lesion segmentation. Additionally, background organs were automatically segmented, assisted by artificial intelligence. Volume, mean, and maximum standard uptake values (SUVmean and SUVmax) of all segmentations were recorded. P < 0.05 was deemed as statistically significant. RESULTS Significant glandular uptake of [68Ga]Ga-DOTA-GPFAPI-04 was detected in the thyroid, pancreas, and submandibular glands, while moderate uptake was observed in the parotid glands. The myocardium and myometrium exhibited 2-3 times higher uptake of the radiotracer than that of the background levels in blood and liver. A total of 349 targeted lesions, consisting of 324 malignancies and 25 benign lesions, were segmented. [68Ga]Ga-DOTA-GPFAPI-04 is more sensitive than [18F]F-FDG, especially for abdominopelvic dissemination (1.000 vs. 0.475, P < 0.001). Interestingly, [18F]F-FDG demonstrated higher sensitivity for lung metastasis compared to [68Ga]Ga-DOTA-GPFAPI-04 (0.845 vs. 0.682, P = 0.003). The high glandular uptake made it difficult to delineate lesions in close proximity and masked two metastatic lesions in these organs. CONCLUSION Despite prominent glandular uptake, [68Ga]Ga-DOTA-GPFAPI-04 demonstrates favorable diagnostic performance. It is a promising probe scaffold for further development of FAP-targeted tumor theranostic agents.
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Affiliation(s)
- Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Entao Liu
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Guojin Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Chaoquan Lai
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Yuxiang Shang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.
- Drug Discovery Shandong Laboratory, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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Karamian F, Sadeghi R, Aghaee A, Askari E, Roustaei H. Nonmalignant 68 Ga-FAPI-46 Uptake in 2 Cases of TENIS Syndrome : Comparison With 18 F-FDG. Clin Nucl Med 2024; 49:e213-e214. [PMID: 38465981 DOI: 10.1097/rlu.0000000000005160] [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: 03/12/2024]
Abstract
ABSTRACT The cancer specificity of fibroblast activation protein inhibitor (FAPI) uptake remains understudied topic, and several cases of false-positive FAPI PET/CT findings have been reported. We present 2 patients of differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy syndrome who underwent 68 Ga-FAPI PET/CT and 18 F-FDG PET/CT for evaluation of any possible sites for metastatic disease. Although no focus of metastatic disease was found in these patients, remarkable findings were noticed instead. Nonmalignant FAPI uptake was evident in the gallbladder, uterus, and degenerative changes, whereas these uptake were discordant or partially concordant with those in FDG's, also CT images showed no underlying abnormality.
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Affiliation(s)
- Farivash Karamian
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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4
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Unterrainer LM, Memarzadeh S, Moatamed NA, Benz MR, Czernin J, Calais J. [ 68Ga]Ga-FAPI-46 PET in a Borderline Ovarian Tumor. J Nucl Med 2024; 65:820-821. [PMID: 38212069 DOI: 10.2967/jnumed.123.266732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Lena M Unterrainer
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Sanaz Memarzadeh
- Jonsson Comprehensive Cancer Center, School of Dentistry and Medicine, UCLA, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, California
- Molecular Biology Institute, UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Neda A Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California; and
| | - Matthias R Benz
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
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Ebrahimi S, Lundström E, Batasin SJ, Hedlund E, Stålberg K, Ehman EC, Sheth VR, Iranpour N, Loubrie S, Schlein A, Rakow-Penner R. Application of PET/MRI in Gynecologic Malignancies. Cancers (Basel) 2024; 16:1478. [PMID: 38672560 PMCID: PMC11048306 DOI: 10.3390/cancers16081478] [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: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.
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Affiliation(s)
- Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elin Lundström
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
- Center for Medical Imaging, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Summer J. Batasin
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elisabeth Hedlund
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Eric C. Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vipul R. Sheth
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Negaur Iranpour
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Alexandra Schlein
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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6
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Zhang Z, Tao J, Qiu J, Cao Z, Huang H, Xiao J, Zhang T. From basic research to clinical application: targeting fibroblast activation protein for cancer diagnosis and treatment. Cell Oncol (Dordr) 2024; 47:361-381. [PMID: 37726505 DOI: 10.1007/s13402-023-00872-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE This study aims to review the multifaceted roles of a membrane protein named Fibroblast Activation Protein (FAP) expressed in tumor tissue, including its molecular functionalities, regulatory mechanisms governing its expression, prognostic significance, and its crucial role in cancer diagnosis and treatment. METHODS Articles that have uncovered the regulatory role of FAP in tumor, as well as its potential utility within clinical realms, spanning diagnosis to therapeutic intervention has been screened for a comprehensive review. RESULTS Our review reveals that FAP plays a pivotal role in solid tumor progression by undertaking a multitude of enzymatic and nonenzymatic roles within the tumor stroma. The exclusive presence of FAP within tumor tissues highlights its potential as a diagnostic marker and therapeutic target. The review also emphasizes the prognostic significance of FAP in predicting tumor progression and patient outcomes. Furthermore, the emerging strategies involving FAPI inhibitor (FAPI) in cancer research and clinical trials for PET/CT diagnosis are discussed. And targeted therapy utilizing FAP including FAPI, chimeric antigen receptor (CAR) T cell therapy, tumor vaccine, antibody-drug conjugates, bispecific T-cell engagers, FAP cleavable prodrugs, and drug delivery system are also introduced. CONCLUSION FAP's intricate interactions with tumor cells and the tumor microenvironment make it a promising target for diagnosis and treatment. Promising strategies such as FAPI offer potential avenues for accurate tumor diagnosis, while multiple therapeutic strategies highlight the prospects of FAP targeting treatments which needs further clinical evaluation.
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Affiliation(s)
- Zeyu Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jinxin Tao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jiangdong Qiu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhe Cao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hua Huang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianchun Xiao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Taiping Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Li T, Zhang J, Yan Y, Tan M, Chen Y. Applications of FAPI PET/CT in the diagnosis and treatment of breast and the most common gynecologic malignancies: a literature review. Front Oncol 2024; 14:1358070. [PMID: 38505595 PMCID: PMC10949888 DOI: 10.3389/fonc.2024.1358070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
The fibroblast activating protein (FAP) is expressed by some fibroblasts found in healthy tissues. However, FAP is overexpressed in more than 90% of epithelial tumors, including breast and gynecological tumors. As a result, the FAP ligand could be used as a target for diagnosis and treatment purposes. Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique commonly used to locate and assess the tumor's molecular and metabolic functions. PET imaging involves the injection of a radiotracer that tends to accumulate more in metabolically active lesions such as cancer. Several radiotracers have been developed to target FAP in PET/CT imaging, such as the fibroblast-activation protein inhibitor (FAPI). These tracers bind to FAP with high specificity and affinity, allowing for the non-invasive detection and quantification of FAP expression in tumors. In this review, we discussed the applications of FAPI PET/CT in the diagnosis and treatment of breast and the most common gynecologic malignancies. Radiolabeled FAPI can improve the detection, staging, and assessment of treatment response in breast and the most common gynecologic malignancies, but the problem with normal hormone-responsive organs remains insurmountable. Compared to the diagnostic applications of FAPI, further research is needed for future therapeutic applications.
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Affiliation(s)
- Tengfei Li
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Jintao Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yuanzhuo Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Min Tan
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
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8
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Caresia AP, Jo Rosales J, Rodríguez Fraile M, Arçay Öztürk A, Artigas C. PET/CT FAPI: Procedure and evidence review in oncology. Rev Esp Med Nucl Imagen Mol 2024; 43:130-140. [PMID: 38331248 DOI: 10.1016/j.remnie.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024]
Abstract
Neoplasms are composed of malignant tumor cells, which are surrounded by other non-tumor cellular elements, in what has been defined as the microenvironment or tumor stroma. Evidence on the importance of the tumor microenvironment has not stopped growing in recent years. It plays a central role in cell proliferation, tissue invasion, angiogenesis and cell migration. The paradigm is the family of new FAPI radiopharmaceuticals that show the density of the fibroblast activation protein (FAP) which is overexpressed in the cell membrane of activated cancer-associated fibroblasts (CAF), and its presence is related to poor prognosis. This educational document includes the procedure for performing PET/CT FAPI, biodistribution and the main potentially clinical applications in oncology to date.
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Affiliation(s)
- A P Caresia
- Servei e Medicina Nuclear, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - J Jo Rosales
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
| | - M Rodríguez Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Arçay Öztürk
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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9
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Al-Ibraheem A, Abdlkadir AS, Alalawi H, Badarneh M. 68 Ga-FAPI PET/CT Imaging : Unveiling the Hidden Pitfalls. Clin Nucl Med 2023; 48:965-966. [PMID: 37793179 DOI: 10.1097/rlu.0000000000004802] [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: 10/06/2023]
Abstract
ABSTRACT 68 Ga-FAPI has been introduced recently in many nuclear medicine centers. Many pitfalls have been discussed previously. However, not all pitfalls are currently addressed in the literature. To our knowledge, this is the first reported case to address nonspecific 68 Ga-FAPI expression at anorectal sphincter. A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. A 68 Ga-FAPI scan was performed after diagnostic workup and chemoradiotherapy. In addition to 68 Ga-FAPI-avid lesion at primary site, several nononcological ancillary findings have been observed. This includes unaddressed 68 Ga-FAPI-avid focus within anorectal sphincter. Moreover, the same noteworthy findings were observed in the musculoskeletal and gynecological systems.
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Affiliation(s)
| | | | - Hasan Alalawi
- From the Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center
| | - Mohannad Badarneh
- From the Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center
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10
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Bentestuen M, Al-Obaydi N, Zacho HD. FAPI-avid nonmalignant PET/CT findings: An expedited systematic review. Semin Nucl Med 2023; 53:694-705. [PMID: 36813670 DOI: 10.1053/j.semnuclmed.2023.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
Fibroblast activation protein inhibitor (FAPI) is a promising tracer in oncologic positron emission tomography/computed tomography (PET/CT). Numerous studies have demonstrated the superior sensitivity of FAPI PET/CT over fluorodeoxyglucose (FDG) PET/CT in several types of cancer. However, the cancer specificity of FAPI uptake remains understudied, and several cases of false-positive FAPI PET/CT findings have been reported. A systematic search of PubMed, Embase, and Web of Science was conducted for studies published prior to April 2022 reporting nonmalignant FAPI PET/CT findings. We included original peer-reviewed articles of studies in humans using FAPI tracers radiolabeled with 68Ga or 18F that were published in English. Papers without original data and studies with insufficient information were excluded. Nonmalignant findings were presented on a per-lesion basis and grouped according to the type of organ or tissue involved. The search identified a total of 1.178 papers, of which 108 studies were eligible. Eighty studies were case reports (74%), and the remaining 28 were cohort studies (26%). A total of 2.372 FAPI-avid nonmalignant findings were reported, with the most frequent being uptake in the arteries, e.g., related to plaques (n = 1178, 49%). FAPI uptake was also frequently related to degenerative and traumatic bone and joint lesions (n = 147, 6%) or arthritis (n = 92, 4%). For organs, diffuse or focal uptake was often seen in cases of inflammation, infection, fibrosis, and IgG4-related disease (n = 157, 7%). FAPI-avid inflammatory/reactive lymph nodes (n = 121, 5%) and tuberculosis lesions (n = 51, 2%) have been reported and could prove to be potential pitfalls in cancer staging. Periodontitis (n = 76, 3%), hemorrhoids (n = 47, 2%), and scarring/wound healing (n = 35, 2%) also presented as focal uptake on FAPI PET/CT. The present review provides an overview of the reported FAPI-avid nonmalignant PET/CT findings to date. A large number of benign clinical entities may show FAPI uptake and should be kept in mind when interpreting FAPI PET/CT findings in patients with cancer.
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Affiliation(s)
- Morten Bentestuen
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, North Jutland Region, Denmark.
| | - Noor Al-Obaydi
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, North Jutland Region, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, North Jutland Region, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, North Jutland Region, Denmark
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Mokoala KMG, Lawal IO, Maserumule LC, Bida M, Maes A, Ndlovu H, Reed J, Mahapane J, Davis C, Van de Wiele C, Popoola G, Giesel FL, Vorster M, Sathekge MM. Correlation between [ 68Ga]Ga-FAPI-46 PET Imaging and HIF-1α Immunohistochemical Analysis in Cervical Cancer: Proof-of-Concept. Cancers (Basel) 2023; 15:3953. [PMID: 37568769 PMCID: PMC10417683 DOI: 10.3390/cancers15153953] [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: 06/02/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Hypoxia leads to changes in tumor microenvironment (upregulated CAFs) with resultant aggressiveness. A key factor in the physiological response to hypoxia is hypoxia-inducible factor-1alpha (HIF-1α). [68Ga]Ga-FAPI PET imaging has been demonstrated in various cancer types. We hypothesized that [68Ga]Ga-FAPI PET may be used as an indirect tracer for mapping hypoxia by correlating the image findings to pathological analysis of HIF-1α expression. The [68Ga]Ga-FAPI PET/CT scans of women with cancer of the cervix were reviewed and the maximum and mean standardized uptake value (SUVmax and SUVmean) and FAPI tumor volume (FAPI-TV) were documented. Correlation analysis was performed between PET-derived parameters and immunohistochemical staining as well as between PET-derived parameters and the presence of metastasis. Ten women were included. All patients demonstrated tracer uptake in the primary site or region of the primary. All patients had lymph node metastases while only six patients had distant visceral or skeletal metastases. The mean SUVmax, SUVmean, and FAPI-TV was 18.89, 6.88, and 195.66 cm3, respectively. The average FAPI-TV for patients with additional sites of metastases was higher than those without. Immunohistochemistry revealed varying intensities of HIF-1α expression in all tested samples. There was a positive correlation between the presence of skeletal metastases and staining for HIF-1α (r=0.80;p=0.017). The presence of skeletal metastasis was correlated to the HIF-1⍺ staining (percentage distribution). Furthermore, the FAPI-TV was a better predictor of metastatic disease than the SUVmax.
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Affiliation(s)
- Kgomotso M. G. Mokoala
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Ismaheel O. Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Letjie C. Maserumule
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Meshack Bida
- National Health Laboratory Services, Department of Anatomical Pathology, Pretoria 0001, South Africa;
| | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Katholieke University Leuven, 3000 Kortrijk, Belgium
| | - Honest Ndlovu
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Janet Reed
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Johncy Mahapane
- Department of Radiography, University of Pretoria, Pretoria 0028, South Africa;
| | - Cindy Davis
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Department of Diagnostic Sciences, University Ghent, 9000 Ghent, Belgium
| | - Gbenga Popoola
- Lincolnshire Partnership NHS Foundation Trust, St George’s, Lincoln, Lincolnshire LN1 1FS, UK;
| | - Frederik L. Giesel
- Department of Nuclear Medicine, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Kwazulu Natal, Durban 4001, South Africa;
| | - Mike M. Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
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Dendl K, Koerber SA, Watabe T, Haberkorn U, Giesel FL. Current Status of Fibroblast Activation Protein Imaging in Gynecologic Malignancy and Breast Cancer. PET Clin 2023; 18:345-351. [PMID: 37257985 DOI: 10.1016/j.cpet.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
68Ga-FAPI-PET/computed tomography (CT) is a novel PET/CT radiotracer particularly developed for oncologic imaging. Gynecologic malignancies comprise a broad spectrum of entities and, along with breast cancer, constitute cancers occurring exclusively or primarily, respectively, in women. Thus, a tracer designed not only for one but multiple malignancies has theoretic attractions. Even in comparison with 18F-FDG, the current standard oncologic tracer of nuclear medicine, 68Ga-FAPI, has demonstrated advantages in several tumors. As breast cancer, ovarian cancer, and cervical cancer are among the most common tumor types in women and are often accompanied by high morbidity as well as mortality rates, a reliable staging tool is paramount for optimal therapeutic management.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, Heidelberg, Germany; Deaprtment of Nuclear medicine, Geb. 13.55, Moorenstraße 5, 40225 Düsseldorf.
| | - Stefan A Koerber
- Department of Radiooncology and Radiation Therapy, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86 93049 Regensburg, Germany; Department of Radiooncology and Radiation Therapy, University Hospital Heidelberg
| | - Tadashi Watabe
- Department of Nuclear Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Uwe Haberkorn
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, Heidelberg, Germany; Deaprtment of Nuclear medicine, Geb. 13.55, Moorenstraße 5, 40225 Düsseldorf
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Abstract
ABSTRACT A 60-year-old woman diagnosed with clear cell endometrial carcinoma received neoadjuvant chemotherapy. However, the patient was inoperable and referred to our clinic to evaluate the extent of the disease. The patient underwent 18FDG PET/CT and 68Ga-FAPI (fibroblast activated protein inhibitor)-04 PET/CT scans. 68Ga-FAPI-04 PET/CT outperformed 18FDG PET/CT demonstrating higher uptake in the metastatic lesions.
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Zhang X, Song W, Qin C, Lan X. Different displays of 13N-NH 3 myocardial perfusion and cardiac 68Ga-FAPI PET in immune checkpoint inhibitor-associated myocarditis-induced heart failure. Eur J Nucl Med Mol Imaging 2023; 50:964-965. [PMID: 36322188 DOI: 10.1007/s00259-022-06018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Xiao Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Wenyu Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chunxia Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China.
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Wegen S, Roth KS, Weindler J, Claus K, Linde P, Trommer M, Akuamoa-Boateng D, van Heek L, Baues C, Schömig-Markiefka B, Schomäcker K, Fischer T, Drzezga A, Kobe C, Köhler C, Marnitz S. First Clinical Experience With [68Ga]Ga-FAPI-46-PET/CT Versus [18F]F-FDG PET/CT for Nodal Staging in Cervical Cancer. Clin Nucl Med 2023; 48:150-155. [PMID: 36607364 PMCID: PMC9835656 DOI: 10.1097/rlu.0000000000004505] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION In several solid tumors, fibroblast activation protein (FAP) is overexpressed by cancer-associated fibroblasts in the tumor microenvironment. Preliminary evidence suggests that detection and staging are feasible with PET/CT imaging using [68Ga]-radiolabeled inhibitors of FAP also in cervical cancer (CC). Our study aims to explore the accuracy of [68Ga]Ga-fibroblast activation protein inhibitor (FAPI)-46 PET/CT and [18F]F-FDG PET/CT compared with histopathological results of surgical lymph node (LN) staging before primary chemoradiation. METHODS Seven consecutive women with treatment-naive and biopsy-proven locally advanced CC underwent both whole-body [68Ga]Ga-FAPI-46- and [18F]F-FDG PET/CT, for imaging nodal staging before systematic laparoscopic lymphadenectomy of the pelvic and para-aortic region. Location and number of suspicious LNs in PET imaging were recorded and compared with the results of histopathological analysis, including immunohistochemical staining for FAP. RESULTS All 7 patients had focal uptake above background in their tumor lesions in [68Ga]Ga-FAPI-46 PET/CT. [68Ga]Ga-FAPI-46 PET/CT showed a higher tumor-to-background ratio (TBR) in primary tumor as well as in LN metastasis. Median TBRmax values using liver were 32.02 and 5.15 for [68Ga]Ga-FAPI-46 PET/CT and [18F]F-FDG PET/CT, respectively. Median TBRmax using blood pool was 18.45 versus 6.85 for [68Ga]Ga-FAPI-46 PET/CT and [18F]F-FDG PET/CT, respectively. Higher TBR also applies for nodal metastasis: TBRmax was 14.55 versus 1.39 (liver) and 7.97 versus 1.8 (blood pool) for [68Ga]Ga-FAPI-46 PET/CT and [18F]F-FDG PET/CT, respectively. Overall, [68Ga]Ga-FAPI-46 PET/CT detected more lesions compared with [18F]F-FDG PET/CT. Following surgical staging, a total of 5 metastatic LNs could be pathologically confirmed, of which 2 and 4 were positive by [18F]F-FDG PET/CT and [68Ga]Ga-FAPI-46 PET/CT, respectively. CONCLUSION [68Ga]Ga-FAPI-46 PET/CT seems useful to improve detection of nodal metastasis in patients with CCs. Future studies should aim to compare [68Ga]Ga-FAPI-46 PET/CT to surgical staging of pelvic and para-aortic LNs in patients with locally advanced CC.
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Affiliation(s)
- Simone Wegen
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | - Katrin Sabine Roth
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Jasmin Weindler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Karina Claus
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | - Philipp Linde
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | - Maike Trommer
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | - Dennis Akuamoa-Boateng
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | - Lutz van Heek
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Christian Baues
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
| | | | - Klaus Schomäcker
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Thomas Fischer
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne
- Institute of Neuroscience and Medicine (INM-2), Molecular Organization of the Brain, Forschungszentrum Jülich
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Simone Marnitz
- From the Department of Radiation Oncology, Cyberknife and Radiotherapy, University Hospital Cologne
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Qi N, Wang H, Wang H, Ren S, You Z, Chen X, Guan Y, Xie F, Hua F, Zhao J. Non-tumoral uptake of 68Ga-FAPI-04 PET: A retrospective study. Front Oncol 2022; 12:989595. [PMID: 36531015 PMCID: PMC9751966 DOI: 10.3389/fonc.2022.989595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/18/2022] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVE Fibroblast activation protein (FAP)-targeting radiopharmaceutical based on the FAP-specific inhibitor (FAPI) is considered as a potential alternative agent to FDG for tumor-specific imaging. However, FAP is also expressed in normal adult tissues. The aim of this study was to explore the image features of non-tumoral regions with high uptake of 68Ga-FAPI-04 in positron emission tomography (PET) imaging and to reveal the physiological mechanisms of these regions. MATERIAL A total of 137 patients who underwent whole-body 68Ga-FAPI-04 PET/MR (n=46) or PET/CT (n=91) were included in this retrospective study. Three experienced nuclear medicine physicians determined the non-tumoral regions according to other imaging modalities (CT, MRI, 18F-FDG PET, or ultrasound), clinical information, or pathological results. The regions of interest (ROIs) were drawn manually, and the maximum standardized uptake value (SUVmax) was measured. RESULTS A total of 392 non-tumoral uptake regions were included in this study. The included physiological regions were uterus (n=38), submandibular gland (n=118), nipple (n=37), gingiva (n=65), and esophagus (n=31). The incidence of 68Ga-FAPI-04 uptake in physiological regions was independent of age, the tracer uptakes in the gingiva and esophagus were more common in male patients (p=0.006, 0.009), while that in the nipple was more common in female patients (p < 0.001). The included benign regions were inflammatory lymph node (n =10), pneumonia (n=13), atherosclerosis (n=10), pancreatitis (n=18), osteosclerosis (n=45), and surgical scar (n=7). No significant difference was observed in SUVmax between physiological and benign regions. CONCLUSIONS A number of organs exhibit physiological uptakes of 68Ga-FAPI-04. Our study showed that regions with high 68Ga-FAPI-04 uptake did not necessarily represent malignancy. Being familiar with physiological and typical benign 68Ga-FAPI-04 uptake regions can be helpful for physicians to interpret images and to make an accurate diagnosis.
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Affiliation(s)
- Na Qi
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Haiyan Wang
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuhua Ren
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiwen You
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xing Chen
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Xie
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengchun Hua
- Department of Nuclear Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Kaghazchi F, Divband G, Amini H, Adinehpour Z, Akbarian Aghdam R. 68 Ga-FAPI-46 and 18 F-FDG in Advanced Metastatic Pancreatic Cancer. Clin Nucl Med 2022; 47:e666-e669. [PMID: 35714370 DOI: 10.1097/rlu.0000000000004316] [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: 11/25/2022]
Abstract
ABSTRACT Recently imaging with new PET radiotracers that act as fibroblast activation protein inhibitors (FAPIs) showed promising results in oncology and even nononcology imaging. Here we report a case of advanced pancreatic adenocarcinoma, imaged with both 18 F-FDG and 68 Ga-FAPI-46 PET/CT scans. The result indicated that imaging with 68 Ga-FAPI-46 showed significant improvement in detection of metastases as well as local malignancy recurrence. Moreover, the intensity and SUVs of the lesions were higher in 68 Ga-FAPI-46 scan compared with 18 F-FDG.
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Dendl K, Koerber SA, Tamburini K, Mori Y, Cardinale J, Haberkorn U, Giesel FL. Advancement and Future Perspective of FAPI PET/CT In Gynecological Malignancies. Semin Nucl Med 2022; 52:628-634. [PMID: 35842334 DOI: 10.1053/j.semnuclmed.2022.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 01/18/2023]
Abstract
Fibroblast activation protein (FAP) is ubiquitously present in healthy tissue, and additionally upregulated by cancer associated fibroblasts (CAFs) leading to high levels of FAP. Thus, neoplastic tissue, which is containing CAFs, characterized by a high presence of FAP. Moreover, in more than 90% of all epithelial tumors this phenomenon seems to occur, including many gynecological tumors, providing the foundation for a successful application of FAP-ligands. However, FAP upregulation, can also be initiated by benign conditions such as inflammation, hormonal-influence, and wound healing. Gynecological cancers seem to represent a field of interest for the utilization of FAPI-PET/CT to potentially improve staging, restaging and therapeutic management. First highly promising investigations demand further research in order to validate these preliminary findings.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany; Department of Nuclear Medicine, Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Duesseldorf Germany.
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Germany
| | | | - Yuriko Mori
- Department of Nuclear Medicine, Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Duesseldorf Germany
| | - Jens Cardinale
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany; Department of Nuclear Medicine, Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Duesseldorf Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany; Department of Nuclear Medicine, Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Duesseldorf Germany
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PET Imaging of Estrogen Receptors for Gynecological Tumors. Clin Nucl Med 2022; 47:e481-e488. [PMID: 35675139 DOI: 10.1097/rlu.0000000000004258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In the past few decades, PET with 18F-FDG has been used for the diagnosis of gynecological malignancies and is considered to be superior to conventional imaging methods in diagnostic accuracy for detecting metastatic lesions and local recurrence and in evaluating the treatment response. On the other hand, several gynecological tumors, such as endometrial cancer and leiomyoma, and breast cancer are estrogen-dependent, in which estrogen is essential for their development and progression. 18F-FES is an 18F-labeled compound of estradiol, the most bioactive type of estrogen, and 18F-FES PET has been well-established for diagnosis, staging, and posttherapeutic follow-up in patients with estrogen receptor-positive breast cancer. Compared with in vitro assessment of tumor biopsy material, PET imaging has the advantages of being able to measure in vivo tumor behavior, characterize the entire tumor burden, and capture the heterogeneity of the tumor phenotype. In this article, we review the phenotyping of estrogen-related gynecological tumors other than breast cancer using 18F-FES PET and demonstrate the additional value of 18F-FES PET to 18F-FDG PET in their diagnosis and prognostication. Moreover, promising PET tracers other than 18F-FES and 18F-FDG for the evaluation of estrogen-related gynecological tumors are introduced.
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Lipid-Poor Renal Angiomyolipoma Mimicking Renal Cell Carcinoma on 68Ga-FAPI-04 PET/CT. Clin Nucl Med 2022; 47:991-993. [PMID: 35619202 DOI: 10.1097/rlu.0000000000004297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT FAPI PET/CT findings of renal tumors have been rarely reported. We describe 68Ga-FAPI-04 PET/CT findings in 1 case with lipid-poor renal angiomyolipoma and 1 case with high-grade clear cell renal cell carcinoma. Both tumors showed intense 68Ga-FAPI-04 uptake. These 2 cases indicate that lipid-poor renal angiomyolipoma should be included in the differential diagnosis of FAPI-avid renal tumors.
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Clinical summary of fibroblast activation protein inhibitor-based radiopharmaceuticals: cancer and beyond. Eur J Nucl Med Mol Imaging 2022; 49:2844-2868. [DOI: 10.1007/s00259-022-05706-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/23/2022] [Indexed: 02/06/2023]
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