Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin, China.
Department of Medical Instruments, Second Hospital of Harbin, Harbin, China.
Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):4051-4063. doi: 10.1007/s00259-023-06351-9. Epub 2023 Aug 5.
The radiopharmaceutical [F]AlF-NOTA-FAPI-04 presents a promising alternative to Ga-FAPI owing to its relatively longer half-life. This study aimed to evaluate the clinical usefulness of [F]AlF-NOTA-FAPI-04 PET/CT for the diagnosis of primary and metastatic lesions in various types of gastrointestinal system cancers, compared with F-FDG PET/CT.
Patients diagnosed with gastrointestinal system malignancies were prospectively enrolled. All patients underwent both F-FDG and F-FAPI-04 PET/CT scans within one week, with 44 (73.3%) for cancer staging and 16 (26.7%) for tumor restaging. Diagnostic efficacy of the primary tumor, as well as the presence and number of lymph nodes and distant metastases, were assessed. Tumor uptake was quantified by the maximum standard uptake value (SUVmax).
For detection of primary tumor, the diagnostic sensitivity of F-FDG PET/CT was 72.7%, while it was 97.7% for F-FAPI-04 PET/CT. Based on per-lymph node analysis, the sensitivity, specificity, and accuracy of F-FAPI-04 PET/CT in diagnosing metastatic lymph nodes were 91.89%, 92.00%, and 91.96%, respectively. These values were notably higher than those F-FDG PET/CT (79.72%, 81.33% and 80.80%, respectively). The F-FAPI-04 PET/CT surpassed F-FDG PET/CT in detecting suspected metastases in the brain (7 vs. 3), liver (39 vs. 20), bone (79 vs. 51), lung (11 vs. 4), and peritoneal carcinoma (48 vs. 22). Based on per-patient analysis, differential diagnostic accuracies (F-FAPI-04 vs. F-FDG PET/CT) were observed in all patients (91.7% vs. 76.7%), the initial staging group (90.9% vs. 79.5%), and the re-staging group (93.8% vs. 68.7%). Additionally, F-FAPI-04 PET/CT revised final diagnosis in 31.7% of patients, contrasting with F-FDG PET/CT, and prompted changes in clinical management for 21.7% of the patients.
F-FAPI-04 PET/CT outperforms F-FDG PET/CT in delineating the primary gastrointestinal tumors and detecting suspected metastatic lesions due to a higher target-to-background ratio (TBR). Moreover, F-FAPI-04 PET/CT could provide valuable guidance for tumor staging, thereby having a potential impact on patient management.
放射性药物 [F]AlF-NOTA-FAPI-04 由于其相对较长的半衰期，成为 Ga-FAPI 的有前途的替代品。本研究旨在评估 [F]AlF-NOTA-FAPI-04 PET/CT 与 F-FDG PET/CT 相比，用于诊断各种类型胃肠道癌的原发和转移性病变的临床实用性。
前瞻性纳入诊断为胃肠道恶性肿瘤的患者。所有患者均在一周内接受 F-FDG 和 F-FAPI-04 PET/CT 扫描，其中 44 例（73.3%）用于癌症分期，16 例（26.7%）用于肿瘤再分期。评估了原发肿瘤的诊断效能，以及淋巴结和远处转移的存在和数量。通过最大标准摄取值（SUVmax）定量肿瘤摄取。
对于检测原发肿瘤，F-FDG PET/CT 的诊断灵敏度为 72.7%，而 F-FAPI-04 PET/CT 为 97.7%。基于每淋巴结分析，F-FAPI-04 PET/CT 诊断转移性淋巴结的灵敏度、特异性和准确性分别为 91.89%、92.00%和 91.96%，明显高于 F-FDG PET/CT（分别为 79.72%、81.33%和 80.80%）。F-FAPI-04 PET/CT 在检测脑（7 对 3）、肝（39 对 20）、骨（79 对 51）、肺（11 对 4）和腹膜癌（48 对 22）中的可疑转移方面优于 F-FDG PET/CT。基于每位患者的分析，在所有患者（91.7%对 76.7%）、初始分期组（90.9%对 79.5%）和再分期组（93.8%对 68.7%）中观察到 F-FAPI-04 与 F-FDG PET/CT 的鉴别诊断准确性差异。此外，F-FAPI-04 PET/CT 在 31.7%的患者中修正了最终诊断，与 F-FDG PET/CT 相比，促使 21.7%的患者改变了临床管理。
由于靶与背景比（TBR）较高，F-FAPI-04 PET/CT 在描绘胃肠道原发肿瘤和检测可疑转移病灶方面优于 F-FDG PET/CT。此外，F-FAPI-04 PET/CT 可为肿瘤分期提供有价值的指导，从而对患者管理产生潜在影响。
