头对头比较镓-DOTA-FAPI-04 与 F-FDG PET/MR 在鼻咽癌患者中的应用：一项前瞻性研究。
A head-to-head comparison of Ga-DOTA-FAPI-04 and F-FDG PET/MR in patients with nasopharyngeal carcinoma: a prospective study.
机构信息
Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
出版信息
Eur J Nucl Med Mol Imaging. 2021 Sep;48(10):3228-3237. doi: 10.1007/s00259-021-05255-w. Epub 2021 Feb 20.
PURPOSE
To conduct a head-to-head comparison of the diagnostic ability of Ga-DOTA-FAPI-04 (Ga-FAPI) and F-FDG PET/MR in nasopharyngeal carcinoma (NPC) patients.
METHODS
Patients diagnosed with NPC were prospectively enrolled. All patients underwent head-and-neck Ga-FAPI PET/MR and F-FDG PET/MR within 1 week. Primary tumor, lymph node numbers, and tracer uptake were compared by SUVmax and visual evaluation. The primary tumor volumes derived from Ga-FAPI, F-FDG PET, and MRI were also compared.
RESULTS
Fifteen patients were enrolled from June to August 2020. Both Ga-FAPI and F-FDG PET had 100% detection rate of the primary tumor. The Ga-FAPI SUVmax of primary tumors (13.87 ± 5.13) was lower than that of F-FDG (17.73 ± 6.84), but the difference was not significant (p = 0.078). Compared with F-FDG, Ga-FAPI PET improved the delineation of skull-base invasion in eight out of eight patients and intracranial invasion in four out of four patients. When 25%SUVmax of Ga-FAPI or 20%SUVmax of F-FDG was utilized as a threshold for determining tumor volume, it was highly consistent with MRI. F-FDG PET detected much more positive lymph nodes than Ga-FAPI (100 vs 48). The SUVmax of 48 paired lymph nodes was significantly lower on Ga-FAPI than F-FDG (8.67 ± 3.88 vs 11.79 ± 6.17, p < 0.001). Additionally, Ga-FAPI further detected four highly suspected small, distant metastases in three patients. Compared with F-FDG, Ga-FAPI changed overall staging in six of fifteen patients, with three patients being up-staged, and three down-staged.
CONCLUSION
Ga-FAPI outperforms F-FDG in delineating the primary tumor and detecting suspected distant metastases, particularly in the evaluation of skull-base and intracranial invasion, suggesting Ga-FAPI hybrid PET/MR has the potential to serve as a single-step staging modality for patients with NPC. However, its value regarding lymph node and distant metastases evaluation needs further study.
TRIAL REGISTRATION
NCT04554719. Registered September 8, 2020 - retrospectively registered, http://clinicaltrails.gov/show/NCT04554719.
目的
对头颈腺癌（NPC）患者进行 Ga-DOTA-FAPI-04（Ga-FAPI）与 F-FDG PET/MR 的直接对比研究。
方法
前瞻性招募被诊断为 NPC 的患者。所有患者在 1 周内接受 Ga-FAPI 和 F-FDG 的头颈部 PET/MR 检查。通过 SUVmax 和视觉评估比较原发性肿瘤、淋巴结数量和示踪剂摄取。还比较了源自 Ga-FAPI、F-FDG PET 和 MRI 的原发性肿瘤体积。
结果
2020 年 6 月至 8 月共纳入 15 例患者。Ga-FAPI 和 F-FDG 对原发性肿瘤的检出率均为 100%。Ga-FAPI 原发性肿瘤 SUVmax（13.87±5.13）低于 F-FDG（17.73±6.84），但差异无统计学意义（p=0.078）。与 F-FDG 相比，Ga-FAPI PET 改善了 8 例患者中的 8 例颅底侵犯和 4 例颅内侵犯的勾画。当 25%Ga-FAPI SUVmax 或 20%F-FDG SUVmax 被用作确定肿瘤体积的阈值时，其与 MRI 高度一致。F-FDG PET 检测到的阳性淋巴结数远多于 Ga-FAPI（100 比 48）。48 对配对淋巴结的 Ga-FAPI SUVmax 明显低于 F-FDG（8.67±3.88 比 11.79±6.17，p<0.001）。此外，Ga-FAPI 还在 3 例患者中进一步检测到 4 个高度可疑的小远处转移灶。与 F-FDG 相比，Ga-FAPI 在 15 例患者中有 6 例改变了总体分期，3 例升期，3 例降期。
结论
Ga-FAPI 在勾画原发性肿瘤和检测可疑远处转移方面优于 F-FDG，尤其是在评估颅底和颅内侵犯方面，提示 Ga-FAPI 混合 PET/MR 有可能成为 NPC 患者的单一分期方式。然而，其在淋巴结和远处转移评估方面的价值还需要进一步研究。
试验注册
NCT04554719。2020 年 9 月 8 日注册-回顾性注册，http://clinicaltrails.gov/show/NCT04554719。
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