一站式 [F]FDG 和 [Ga]Ga-DOTA-FAPI-04 全身 PET/CT 检查采用双低活度：一项可行性研究。
One-stop [F]FDG and [Ga]Ga-DOTA-FAPI-04 total-body PET/CT examination with dual-low activity: a feasibility study.
机构信息
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Institute of Nuclear Medicine, Fudan University, Shanghai, China.
出版信息
Eur J Nucl Med Mol Imaging. 2023 Jul;50(8):2271-2281. doi: 10.1007/s00259-023-06207-2. Epub 2023 Mar 27.
PURPOSE
Positron emission tomography/computed tomography (PET/CT) based on fibroblast activation protein inhibitors (FAPI) has shown complementary values to 2-[F]-fluoro-2-deoxy-D-glucose ([F]FDG) in cancer imaging. This study aimed to investigate the feasibility of a one-stop FDG-FAPI dual-tracer imaging protocol with dual-low activity for oncological imaging.
METHODS
Nineteen patients with malignancies underwent one-stop [F]FDG (0.37 MBq/kg) PET (PET) and dual-tracer PET 30-40 and 50-60 min (hereafter, PET and PET, respectively) after additional injection of [Ga]Ga-DOTA-FAPI-04 (0.925 MBq/kg), with a single diagnostic CT to generate the PET/CT. The lesion detection rate and tumor-to-normal ratios (TNRs) of tracer uptake were compared between PET/CT and PET/CT and between PET/CT and PET/CT. In addition, a visual scoring system was established to compare the lesion detectability.
RESULTS
The dual-tracer PET and PET/CT showed similar performance in detecting primary tumors but presented significantly higher lesion TNRs than PET. Significantly, more metastases with higher TNRs were identified on PET than PET (491 vs. 261, P < 0.001). The dual-tracer PET received significantly higher visual scores than single PET (111 vs. 10) in demonstrating both primary tumors (12 vs. 2) and metastases (99 vs. 8). However, these differences were not significant between PET and PET. These resulted in tumor upstaging in 44.4% patients taking PET/CT for initial assessment, and more recurrences (68 vs. 7) were identified in patients taking PET/CT for restaging, both on PET and PET, compared to PET. The reduced effective dosimetry per patient (26.2 ± 2.57 mSv) was equal to that of a single standard whole-body PET/CT.
CONCLUSION
The one-stop dual-tracer dual-low-activity PET imaging protocol combines the strengths of [F]FDG and [Ga]Ga-DOTA-FAPI-04 with shorter duration and lesser radiation and is thus clinically applicable.
目的
基于成纤维细胞激活蛋白抑制剂（FAPI）的正电子发射断层扫描/计算机断层扫描（PET/CT）在癌症成像中显示出与 2-[F]-氟-2-脱氧-D-葡萄糖（[F]FDG）互补的价值。本研究旨在探讨一种用于肿瘤成像的一站式 FDG-FAPI 双示踪剂双低活性的可行性。
方法
19 名恶性肿瘤患者在单次注射[Ga]Ga-DOTA-FAPI-04（0.925MBq/kg）后 30-40 分钟和 50-60 分钟（分别为 PET 和 PET）行一站式[F]FDG（0.37MBq/kg）PET（PET）和双示踪剂 PET，采用单次诊断 CT 生成 PET/CT。比较了 PET/CT 和 PET/CT、PET/CT 和 PET 之间的示踪剂摄取的病灶检出率和肿瘤与正常组织比值（TNR）。此外，建立了一个视觉评分系统来比较病灶的可探测性。
结果
双示踪剂 PET 和 PET/CT 在检测原发性肿瘤方面表现相似，但 TNR 明显高于 PET。值得注意的是，PET 比 PET 发现更多的转移灶，且 TNR 更高（491 比 261，P < 0.001）。双示踪剂 PET 在显示原发性肿瘤（12 比 2）和转移灶（99 比 8）时，比单 PET 获得了更高的视觉评分（111 比 10）。然而，在 PET 和 PET 之间，这些差异没有统计学意义。在对初始评估进行 PET/CT 检查的 44.4%患者中，肿瘤分期升高，在对 PET/CT 进行再次分期的患者中，无论在 PET 还是 PET 上，都发现了更多的复发（68 比 7）。与单次标准全身 PET/CT 相比，每位患者的有效剂量降低（26.2±2.57mSv）。
结论
一站式双示踪剂双低活性 PET 成像方案结合了[F]FDG 和[Ga]Ga-DOTA-FAPI-04 的优势，具有较短的检查时间、更低的辐射剂量，因此具有临床应用价值。
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