Ruan Dan, Sun Jianping, Han Chengkun, Cai Jiayu, Yu Lingyu, Zhao Liang, Pang Yizhen, Zuo Changjing, Sun Long, Wang Zhanxiang, Tan Guowei, Qu Xiaobo, Chen Haojun
Department of Nuclear Medicine and Minnan PET Center, Xiamen Key Laboratory of Radiopharmaceuticals, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
National Institute for Data Science in Health and Medicine, Department of Electronic Science, Intelligent Medical Imaging R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, China.
Theranostics. 2024 Oct 21;14(18):6935-6946. doi: 10.7150/thno.103399. eCollection 2024.
This study compared Ga-FAPI-46 PET/CT, F-fluorodeoxyglucose (FDG) PET/CT, and contrast-enhanced MRI (CE-MRI) for glioma imaging, classification, and recurrence detection and explored PET parameters and molecular pathological profiles. Between June 2020 and June 2024, we prospectively enrolled patients with space-occupying lesions in the brain or previously treated gliomas. All patients underwent sequential CE-MRI, Ga-FAPI-46, and F-FDG PET/CT. Diagnostic accuracy was assessed based on a reference standard, and PET parameters were analysed for correlations with WHO grading and molecular characteristics. Forty-eight patients (median age, 51 years; 32 men) with 40 confirmed gliomas were enrolled. For primary tumour diagnosis, the sensitivity of Ga-FAPI-46 PET/CT was equivalent to CE-MRI (95% vs. 100%, = 0.99) and F-FDG PET/CT (95% vs. 77%, = 0.13). Ga-FAPI-46 uptake was higher in grade IV than in grade I-II gliomas (5.03 vs. 1.14, = 0.02). Ga-FAPI-46 PET/CT showed significantly higher maximum standardized uptake value and tumour-to-background ratio (TBR) in recurrent tumours than in treatment-related changes and demonstrated favourable sensitivity and specificity for detecting recurrent gliomas, though not significantly superior to F-FDG PET/CT (sensitivity: 100% vs. 85%, = 0.48; specificity: 100% vs. 80%, = 0.99) and CE-MRI (sensitivity: 100% vs. 100%, = NA; specificity: 100% vs. 40%, = 0.25). Glial fibrillary acidic protein-mutant gliomas exhibited higher Ga-FAPI-46 uptake than wild-type gliomas. Ga-FAPI-46 PET/CT outperformed F-FDG and CE-MRI in diagnosing glioma recurrence, although the results were not statistically significant. For primary glioma diagnosis, Ga-FAPI-46 PET/CT, despite having a better TBR, did not surpass F-FDG PET/CT and CE-MRI in terms of sensitivity and specificity. However, Ga-FAPI-46 PET/CT is superior to F-FDG for visualizing and classifying gliomas.
本研究比较了镓标记的FAPI-46正电子发射断层显像/计算机断层扫描（Ga-FAPI-46 PET/CT）、氟脱氧葡萄糖（F-FDG）PET/CT和对比增强磁共振成像（CE-MRI）在胶质瘤成像、分类及复发检测中的应用，并探讨了PET参数和分子病理特征。在2020年6月至2024年6月期间，我们前瞻性纳入了有脑内占位性病变或既往接受过治疗的胶质瘤患者。所有患者均依次接受CE-MRI、Ga-FAPI-46和F-FDG PET/CT检查。基于参考标准评估诊断准确性，并分析PET参数与世界卫生组织（WHO）分级及分子特征的相关性。共纳入48例患者（中位年龄51岁；男性32例），其中40例确诊为胶质瘤。对于原发性肿瘤诊断，Ga-FAPI-46 PET/CT的敏感性与CE-MRI相当（95%对100%，P = 0.99），与F-FDG PET/CT相比（95%对77%，P = 0.13）。IV级胶质瘤的Ga-FAPI-46摄取高于I-II级胶质瘤（5.03对1.14，P = 0.02）。Ga-FAPI-46 PET/CT显示复发性肿瘤的最大标准化摄取值和肿瘤与本底比值（TBR）显著高于治疗相关改变，对检测复发性胶质瘤具有良好的敏感性和特异性，尽管并不显著优于F-FDG PET/CT（敏感性：100%对8
