68Ga-FAPI-04 PET/CT 用于胆管癌评估：与 18F-FDG PET/CT 和腹部 68Ga-FAPI-04 PET/MR 的比较
68 Ga-FAPI-04 PET/CT for the Evaluation of Cholangiocarcinoma : Comparison With 18 F-FDG PET/CT and Abdominal 68 Ga-FAPI-04 PET/MR.
机构信息
From the Departments of Nuclear Medicine.
Pathology, Changhai Hospital.
出版信息
Clin Nucl Med. 2024 May 1;49(5):409-418. doi: 10.1097/RLU.0000000000005112. Epub 2024 Mar 6.
PURPOSE
In this study, we evaluated and compared the diagnostic performances of 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT for primary and metastatic cholangiocarcinoma (CCA) lesions. We also investigated the performance of PET/MR for visualizing and characterizing CCA and liver metastasis lesions.
PATIENTS AND METHODS
Forty-four patients with suspected CCA were recruited and underwent 68 Ga-FAPI-04 and 18 F-FDG PET/CT within 1 week, including 30 patients who underwent simultaneous abdominal 68 Ga-FAPI-04 PET/MR scanning. The findings were confirmed by histopathology or radiographic follow-up.
RESULTS
Compared with 18 F-FDG PET/CT, 68 Ga-FAPI-04 PET/CT showed higher sensitivity (94.3% vs 88.6%) and the same accuracy (86.4% vs 86.4%) in evaluating primary tumors. However, its specificity was lower (55.6% vs 77.8%). 68 Ga-FAPI-04 PET was superior to 18 F-FDG PET in both patient-based and lesion-based evaluations except for metastatic lesions in the liver and bone. For intrahepatic CCA, 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT (100% vs 100%) had similar detection rates, with similar uptake levels between tracers ( P > 0.05). However, for extrahepatic CCA, 68 Ga-FAPI-04 PET/CT had a higher detection rate (89.5% vs 78.9%), and 68 Ga-FAPI-04 had a higher uptake ( P < 0.05). PET/MR was more effective than PET/CT in terms of lesion conspicuity and diagnostic confidence for primary tumors and liver metastases. In addition, multisequence MRI identified more liver metastases than 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT.
CONCLUSIONS
Compared with 18 F-FDG PET/CT, 68 Ga-FAPI-04 PET/CT showed a higher sensitivity in detecting primary CCA tumors, involved lymph nodes, and peritoneal metastases. Compared with 68 Ga-FAPI-04 PET/CT, PET/MR detected primary and liver metastatic lesions more accurately. For extrahepatic CCA, the combination of 68 Ga-FAPI-04 PET/CT and abdominal PET/MRI may replace 18 F-FDG PET/CT.
目的
本研究旨在评估和比较 68Ga-FAPI-04 PET/CT 和 18F-FDG PET/CT 对原发性和转移性胆管癌（CCA）病变的诊断性能。我们还研究了 PET/MR 对 CCA 和肝转移病变的可视化和特征描述的性能。
方法
招募了 44 例疑似 CCA 的患者，并在 1 周内进行了 68Ga-FAPI-04 和 18F-FDG PET/CT 检查，其中 30 例患者同时进行了腹部 68Ga-FAPI-04 PET/MR 扫描。通过组织病理学或影像学随访确认结果。
结果
与 18F-FDG PET/CT 相比，68Ga-FAPI-04 PET/CT 在评估原发性肿瘤时具有更高的灵敏度（94.3% vs 88.6%）和相同的准确性（86.4% vs 86.4%）。然而，其特异性较低（55.6% vs 77.8%）。68Ga-FAPI-04 PET 在患者和病变基础评估中均优于 18F-FDG PET，除了肝和骨的转移性病变。对于肝内 CCA，68Ga-FAPI-04 PET/CT 和 18F-FDG PET/CT（100% vs 100%）具有相似的检测率，示踪剂之间的摄取水平相似（P>0.05）。然而，对于肝外 CCA，68Ga-FAPI-04 PET/CT 的检测率更高（89.5% vs 78.9%），68Ga-FAPI-04 的摄取更高（P<0.05）。与 PET/CT 相比，PET/MR 在原发性肿瘤和肝转移瘤的病变显影和诊断信心方面更有效。此外，多序列 MRI 比 68Ga-FAPI-04 PET/CT 和 18F-FDG PET/CT 更准确地识别肝转移瘤。
结论
与 18F-FDG PET/CT 相比，68Ga-FAPI-04 PET/CT 在检测原发性 CCA 肿瘤、累及淋巴结和腹膜转移方面具有更高的灵敏度。与 68Ga-FAPI-04 PET/CT 相比，PET/MR 更准确地检测到原发性和肝转移性病变。对于肝外 CCA，68Ga-FAPI-04 PET/CT 联合腹部 PET/MRI 可能取代 18F-FDG PET/CT。
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