Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Chemistry, Johannes Gutenberg University, Mainz, Germany.
Eur J Nucl Med Mol Imaging. 2023 Dec;51(1):233-244. doi: 10.1007/s00259-023-06404-z. Epub 2023 Aug 29.
In the context of radioiodine-resistant follicular-cell derived thyroid cancers (RAI-R-FCTC), [F]F-FDG PET/CT serves as a widely used and valuable diagnostic imaging method. However, there is growing interest in utilizing molecular imaging probes that target cancer-associated fibroblasts (CAFs) as an alternative approach. This study sought to compare the diagnostic capabilities of [Ga]Ga-DOTA.SA.FAPi and [F]F-FDG PET/CT in patients with RAI-R-FCTC.
In this retrospective study, a total of 117 patients with RAI-R-FCTC were included. The study population consisted of 68 females and 49 males, with a mean age of 53.2 ± 11.7 years. The aim of the study was to perform a comprehensive qualitative and quantitative assessment of [Ga]Ga-DOTA.SA.FAPi and [F]F-FDG PET/CT scans in RAI-R-FCTC patients. The qualitative assessment involved comparing patient-based and lesion-based visual interpretations of both scans, while the quantitative assessment included analyzing standardized uptake values corrected for lean body mass (SULpeak and SULavg). The findings obtained from the scans were validated by correlating them with morphological findings from diagnostic computed tomography and/or histopathological examination.
Among the 117 RAI-R-FCTC patients, 60 had unilateral local disease, and 9 had bilateral lesions with complete concordance in the detection rate on both PET scans. [Ga]Ga-DOTA.SA.FAPi had a higher detection rate for lymph nodes (95.4% vs 86.6%, p<0.0001), liver metastases (100% vs. 81.3%, p<0.0001), and brain metastases (100% vs. 39%, p<0.0001) compared to [F]F-FDG. The detection rates for pleural and bone metastases were similar between the two radiotracers. For lung metastases, [Ga]Ga-DOTA.SA.FAPi showed a detection rate of 81.7%, whereas [F]F-FDG had a detection rate of 64.6%. Remarkably, [Ga]Ga-DOTA.SA.FAPi was able to detect a bowel metastasis that was missed on [F]F-FDG scan. The median standardized uptake values (SUL) were generally comparable between the two radiotracers, except for brain metastases (SULpeak [Ga]Ga-DOTA.SA.FAPi vs. [F]F-FDG: 13.9 vs. 6.7, p-0.0001) and muscle metastases (SULpeak [Ga]Ga-DOTA.SA.FAPi vs. [F]F-FDG: 9.56 vs. 5.62, p-0.0085), where [Ga]Ga-DOTA.SA.FAPi exhibited higher uptake.
The study results demonstrate the superior performance of [Ga]Ga-DOTA.SA.FAPi compared to [F]F-FDG PET/CT in detecting lymph nodal, liver, bowel, and brain metastases in patients with RAI-R-FCTC. These findings highlight the potential of [Ga]Ga-DOTA.SA.FAPi as a theranostic tool that can complement the benefits of [F]F-FDG PET/CT in the imaging of RAI-R-FCTC.
在放射性碘难治性滤泡细胞衍生甲状腺癌（RAI-R-FCTC）的背景下，[F]F-FDG PET/CT 作为一种广泛使用且有价值的诊断成像方法。然而，人们越来越感兴趣的是利用靶向癌症相关成纤维细胞（CAFs）的分子成像探针作为替代方法。本研究旨在比较[Ga]Ga-DOTA.SA.FAPi 和 [F]F-FDG PET/CT 在 RAI-R-FCTC 患者中的诊断能力。
在这项回顾性研究中，共纳入 117 例 RAI-R-FCTC 患者。研究人群包括 68 名女性和 49 名男性，平均年龄为 53.2±11.7 岁。本研究的目的是对 [Ga]Ga-DOTA.SA.FAPi 和 [F]F-FDG PET/CT 扫描在 RAI-R-FCTC 患者中的进行全面的定性和定量评估。定性评估包括比较两种扫描的基于患者和基于病变的视觉解释，而定量评估包括分析标准化摄取值校正瘦体重（SULpeak 和 SULavg）。通过将扫描结果与诊断性计算机断层扫描和/或组织病理学检查的形态学结果相关联来验证扫描结果。
在 117 例 RAI-R-FCTC 患者中，60 例为单侧局部疾病，9 例为双侧病变，两种 PET 扫描的检测率完全一致。[Ga]Ga-DOTA.SA.FAPi 对淋巴结（95.4%比 86.6%，p<0.0001）、肝转移（100%比 81.3%，p<0.0001）和脑转移（100%比 39%，p<0.0001）的检测率高于 [F]F-FDG。两种示踪剂对胸膜和骨转移的检测率相似。对于肺转移，[Ga]Ga-DOTA.SA.FAPi 的检测率为 81.7%，而 [F]F-FDG 的检测率为 64.6%。值得注意的是，[Ga]Ga-DOTA.SA.FAPi 能够检测到 [F]F-FDG 扫描遗漏的肠道转移。两种示踪剂的中位标准化摄取值（SUL）通常相当，除了脑转移（SULpeak [Ga]Ga-DOTA.SA.FAPi 比 [F]F-FDG：13.9 比 6.7，p-0.0001）和肌肉转移（SULpeak [Ga]Ga-DOTA.SA.FAPi 比 [F]F-FDG：9.56 比 5.62，p-0.0085）外，[Ga]Ga-DOTA.SA.FAPi 的摄取量更高。
研究结果表明，[Ga]Ga-DOTA.SA.FAPi 与 [F]F-FDG PET/CT 相比，在检测 RAI-R-FCTC 患者的淋巴结、肝、肠和脑转移方面表现出更好的性能。这些发现强调了 [Ga]Ga-DOTA.SA.FAPi 作为一种治疗性工具的潜力，它可以补充 [F]F-FDG PET/CT 在 RAI-R-FCTC 成像中的益处。
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