[F]FAPI-42与[F]FDG PET/CT在系统性血管炎评估中的比较
Comparison of [F]FAPI-42 and [F]FDG PET/CT in the evaluation of systemic vasculitis.
作者信息
Zhong Kaixiang, Chen Haiming, Hou Peng, Cheng Linling, Guo Wenliang, Li Youcai, Lv Jie, Ke Miao, Wu Xiaofeng, Lei Yongxia, Liu Chunli, Hong Cheng, Wang Xinlu
机构信息
Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510010, China.
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510010, China.
出版信息
Eur J Nucl Med Mol Imaging. 2025 Feb;52(3):1083-1094. doi: 10.1007/s00259-024-06986-2. Epub 2024 Nov 27.
PURPOSE
The role of fibroblast activation protein (FAP)-targeted imaging in systemic vasculitis is currently unclear. We aimed to evaluate the clinical value of fluorine-18-labeled FAP inhibitor 42 ([F]FAPI-42) in patients with systemic vasculitis and to compare with [F]fluorodeoxyglucose (FDG) imaging.
METHODS
Patients with systemic vasculitis who underwent dual-tracer PET/CT([F]FDG and [F]FAPI) imaging from September 2020 to March 2022 were retrospectively analyzed. Positive lesions are defined as vascular/extravascular lesions with increased tracer uptake above surrounding background, which cannot be attributed to the physiologic biodistribution of the radiotracer. The vascular/extravascular lesion detection rate and semiquantitative values (SUVmax, TBR and TBR) of [F]FAPI and [F]FDG were compared, and the correlation between the extent and range of tracer uptake and levels of inflammatory markers was investigated.
RESULTS
Thirty patients (13 males and 17 females; mean age, 52.5 ± 17.2 years) with systemic vasculitis were included (17 large vessel vasculitis, 10 anti-neutrophil cytoplasmic antibody-associated vasculitis, 2 Behcet's disease and 1 polyarteritis nodosa). [F]FDG PET/CT had positive findings in 93.3% (28/30) of patients, while [F]FAPI PET/CT had positive findings in all patients (100%, P = 0.500). Compared with [F]FDG PET/CT, [F]FAPI PET/CT detected more lesions (161/168 vs. 145/168, P = 0.005), and more extensive vascular involvement in 60% (18/30) of patients. Although SUVmax did not differ significantly between [F]FAPI and [F]FDG (median, 5.94 vs. 5.46, P = 0.517), [F]FAPI had higher TBR (median, 9.59 vs. 3.15, P < 0.001) and TBR (median, 5.45 vs. 4.20, P = 0.006). The total number of positive lesions in FAPI PET/CT show a moderate correlation with erythrocyte sedimentation rate (r =0.478, P = 0.008) and C-reactive protein (r =0.486, P = 0.006). After treatment, follow-up FAPI PET/CT of 6 patients showed decreased SUVmax, TBR and number of detected lesions, paralleling the clinical remission.
CONCLUSION
[F]FAPI PET/CT imaging is a promising imaging modality for the diagnosis and therapeutic monitoring of systemic vasculitis.
目的
目前，成纤维细胞活化蛋白（FAP）靶向成像在系统性血管炎中的作用尚不清楚。我们旨在评估氟-18标记的FAP抑制剂42（[F]FAPI-42）在系统性血管炎患者中的临床价值，并与[F]氟脱氧葡萄糖（FDG）成像进行比较。
方法
回顾性分析2020年9月至2022年3月期间接受双示踪剂PET/CT（[F]FDG和[F]FAPI）成像的系统性血管炎患者。阳性病变定义为示踪剂摄取高于周围背景的血管/血管外病变，且不能归因于放射性示踪剂的生理性生物分布。比较[F]FAPI和[F]FDG的血管/血管外病变检出率和半定量值（SUVmax、TBR和TBR），并研究示踪剂摄取程度和范围与炎症标志物水平之间的相关性。
结果
纳入30例系统性血管炎患者（13例男性，17例女性；平均年龄52.5±17.2岁）（17例大血管血管炎，10例抗中性粒细胞胞浆抗体相关性血管炎，2例白塞病，1例结节性多动脉炎）。[F]FDG PET/CT在93.3%（28/30）的患者中有阳性发现，而[F]FAPI PET/CT在所有患者中均有阳性发现（100%，P = 0.500）。与[F]FDG PET/CT相比，[F]FAPI PET/CT检测到更多病变（161/168 vs. 145/168，P = 0.005），60%（18/30）的患者血管受累范围更广。虽然[F]FAPI和[F]FDG之间的SUVmax无显著差异（中位数，5.94 vs. 5.46，P = 0.517），但[F]FAPI的TBR更高（中位数，9.59 vs. 3.15，P < 0.001）和TBR更高（中位数，5.45 vs. 4.20，P = 0.006）。FAPI PET/CT阳性病变总数与红细胞沉降率（r = 0.478，P = 0.008）和C反应蛋白（r = 0.486，P = 0.006）呈中度相关。治疗后，6例患者的随访FAPI PET/CT显示SUVmax、TBR和检测到的病变数量减少，与临床缓解情况平行。
结论
[F]FAPI PET/CT成像对于系统性血管炎的诊断和治疗监测是一种有前景的成像方式。
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