Li Xiang, Ma Wenhui, Wang Min, Quan Zhiyong, Zhang Mingru, Ye Jiajun, Li Guiyu, Zhou Xiang, Ma Taoqi, Wang Junling, Yang Weidong, Nie Yongzhan, Wang Jing, Kang Fei
Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
Mol Imaging Biol. 2023 Oct;25(5):857-866. doi: 10.1007/s11307-023-01835-4. Epub 2023 Jul 5.
This study aims to compare the diagnostic efficacy of Ga-FAPI-04 PET and F-FDG PET for detecting anastomotic recurrence in postoperative patients with gastrointestinal cancer, and to characterize the signal pattern over time at surgical wounds on both PET imaging.
Gastrointestinal cancer patients who planned to Ga-FAPI-04 and F-FDG PET/CT imaging for postoperative surveillance were involved. The SUV at surgical wounds were assessed. Endoscopic pathology confirmed anastomotic recurrence or it was ruled out by imaging and clinical follow-up. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of the two PET imaging in detecting anastomotic recurrence were compared. Relationships between tracer uptake at surgical wounds and postoperative time were also analyzed.
Compared with non-recurrent patients, the recurrent patients exhibited a significantly higher anastomotic SUV on Ga-FAPI-04 PET (SUV: 9.92 ± 4.36 vs. 2.81 ± 1.86, P = 0.002). Sensitivity, specificity, PPV, NPV, and accuracy of detecting anastomotic recurrence were 100.0%, 87.3%, 41.7%, 100.0%, and 88.3% for Ga-FAPI-04 PET, and 60.0%, 81.8%, 23.1%, 95.7%, and 80.0% for F-FDG PET, respectively. Although Ga-FAPI-04 PET signal at surgical wounds showed a slight trend to decrease with time, no statistical difference was observed over months post-surgery (P > 0.05).
Both tracers displayed high NPVs in identifying anastomotic recurrence with a higher sensitivity to Ga-FAPI-04. Tracer uptake at anastomotic sites does not decrease significantly over time, which results in low PPVs for both PET. Therefore, it is difficult to differentiate anastomotic recurrence from inflammation on either PET imaging.
本研究旨在比较镓标记的FAPI-04正电子发射断层显像（PET）与氟代脱氧葡萄糖（F-FDG）PET在检测胃肠道癌术后患者吻合口复发方面的诊断效能，并描述两种PET成像上手术切口处信号随时间的变化模式。
纳入计划接受镓标记的FAPI-04和F-FDG PET/CT成像进行术后监测的胃肠道癌患者。评估手术切口处的标准化摄取值（SUV）。通过内镜病理确诊吻合口复发，或经影像学及临床随访排除复发。比较两种PET成像检测吻合口复发的敏感性、特异性、阳性和阴性预测值（PPV和NPV）以及准确性。还分析了手术切口处示踪剂摄取与术后时间的关系。
与未复发患者相比，复发患者在镓标记的FAPI-04 PET上吻合口SUV显著更高（SUV：9.92±4.36 vs. 2.81±1.86，P = 0.002）。镓标记的FAPI-04 PET检测吻合口复发的敏感性、特异性、PPV、NPV和准确性分别为100.0%、87.3%、41.7%、100.0%和88.3%，F-FDG PET分别为60.0%、81.8%、23.1%、95.7%和80.0%。尽管镓标记的FAPI-04 PET在手术切口处的信号随时间呈轻微下降趋势，但术后数月未观察到统计学差异（P>0.05）。
两种示踪剂在识别吻合口复发方面均显示出较高的NPV，对镓标记的FAPI-04敏感性更高。吻合口部位的示踪剂摄取随时间无显著下降，导致两种PET的PPV均较低。因此，在任何一种PET成像上都难以将吻合口复发与炎症区分开来。
