F-18 标记成纤维细胞激活蛋白抑制剂（FAPI）在肺腺癌原发分期中的临床应用：一项前瞻性研究。
Clinical Utility of F-18 Labeled Fibroblast Activation Protein Inhibitor (FAPI) for Primary Staging in Lung Adenocarcinoma: a Prospective Study.
机构信息
Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
出版信息
Mol Imaging Biol. 2022 Apr;24(2):309-320. doi: 10.1007/s11307-021-01679-w. Epub 2021 Nov 23.
PURPOSE
The purpose of this study was to compare the primary staging of F-18 labeled fibroblast activation protein inhibitor ([F]F-FAPI) with that of F-18 labeled fluordesoxyglucose positron emission tomography/computed tomography ([F]F-FDG PET/CT) in patients with lung adenocarcinoma (LAD).
PROCEDURES
We prospectively analyzed the images of LAD patients who underwent [F]F-FAPI and [F]F-FDG PET/CT between May 2020 and August 2021. [F]F-FAPI and [F]F-FDG uptakes were compared using the paired samples t test, and lesion numbers were compared using the Wilcoxon signed-rank test.
RESULTS
Thirty-four LAD patients were evaluated. Patients showed high [F]F-FAPI uptake in primary lesions (SUVmax 12.54 ± 3.77). Both [F]F-FAPI and [F]F-FDG had 100% detection rates for primary tumors. However, [F]F-FAPI showed higher SUV than [F]F-FDG in lesions of the lymph nodes, pleura, bones, and other tissues (all P ≤ 0.05). Although the absolute uptake values of [F]F-FAPI in brain lesions were lower than those of [F]F-FDG (1.56 ± 2.19 vs.7.34 ± 3.54, P < 0.0001), the tumor-to-background (T/B) ratios were significantly higher than those of [F]F-FDG (9.53 ± 12.07 vs.1.01 ± 0.49, P < 0.0001). Generally, [F]F-FAPI PET/CT could visualize more total lesions than [F]F-FDG (554 vs.464, P = 0.003), especially in lymph nodes (258 vs.229, P = 0.039), the brain (34 vs.9, P = 0.002), and pleura (56 vs.30, P = 0.041). However, contrast-enhanced brain magnetic-resonance imaging (MRI) showed more brain lesions than [F]F-FAPI PET/CT (56 vs.34, P = 0.002). Compared with the [F]F-FDG-based TNM stage, the [F]F-FAPI-based TNM stage was upgraded in six patients (17.6%).
CONCLUSIONS
[F]F-FAPI PET/CT showed a very high detection rate for primary LAD. In addition, F-FAPI PET/CT demonstrated clearer tumor delineation and more lesions than [F]F-FDG PET/CT, especially in lymph nodes, the brain, and pleura. Therefore, [F]F-FAPI had an advantage over [F]F-FDG for primary staging of LAD. However, brain MRI could identify more and smaller lesions than [F]F-FAPI PET/CT.
目的
本研究旨在比较 F-18 标记的成纤维细胞激活蛋白抑制剂（[F]F-FAPI）与 F-18 标记的氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（[F]F-FDG PET/CT）在肺腺癌（LAD）患者中的初步分期。
程序
我们前瞻性分析了 2020 年 5 月至 2021 年 8 月间接受 [F]F-FAPI 和 [F]F-FDG PET/CT 的 LAD 患者的图像。采用配对样本 t 检验比较 [F]F-FAPI 和 [F]F-FDG 的摄取情况，采用 Wilcoxon 符号秩检验比较病灶数量。
结果
34 例 LAD 患者进行了评估。原发性病变（SUVmax 12.54 ± 3.77）中患者表现出高 [F]F-FAPI 摄取。[F]F-FAPI 和 [F]F-FDG 对原发性肿瘤的检测率均为 100%。然而，[F]F-FAPI 在淋巴结、胸膜、骨骼和其他组织的病变中显示出比 [F]F-FDG 更高的 SUV（均 P ≤ 0.05）。尽管脑病变中 [F]F-FAPI 的绝对摄取值低于 [F]F-FDG（1.56 ± 2.19 比 7.34 ± 3.54，P ＜0.0001），但肿瘤与背景（T/B）比值明显高于 [F]F-FDG（9.53 ± 12.07 比 1.01 ± 0.49，P ＜0.0001）。通常，[F]F-FAPI PET/CT 可以比 [F]F-FDG 更清楚地显示更多的总病变（554 比 464，P = 0.003），特别是在淋巴结（258 比 229，P = 0.039）、脑（34 比 9，P = 0.002）和胸膜（56 比 30，P = 0.041）。然而，增强对比脑磁共振成像（MRI）比 [F]F-FAPI PET/CT 显示更多的脑病变（56 比 34，P = 0.002）。与基于 [F]F-FDG 的 TNM 分期相比，基于 [F]F-FAPI 的 TNM 分期在 6 名患者中升级（17.6%）。
结论
[F]F-FAPI PET/CT 对原发性 LAD 的检出率非常高。此外，F-FAPI PET/CT 比 [F]F-FDG PET/CT 更清晰地显示肿瘤轮廓和更多的病变，特别是在淋巴结、脑和胸膜。因此，[F]F-FAPI 在 LAD 的初步分期方面优于 [F]F-FDG。然而，脑 MRI 可以比 [F]F-FAPI PET/CT 识别更多和更小的病变。
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