Zhu Dongling, Song Shuang, Zou Sijuan, Kuang Dong, Wang Dongdong, Min Xiangde, Feng Zhaoyan, Zhu Yuankai, Cheng Zhaoting, Cheng Siyuan, Zhou Jianyuan, Pan Ruping, Chen Haojun, Zhu Xiaohua
Department of Nuclear Medicine and PET, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eur J Nucl Med Mol Imaging. 2025 May;52(6):2132-2144. doi: 10.1007/s00259-024-07062-5. Epub 2025 Jan 20.
To investigate the efficacy of [Ga]Ga-FAPI-04 PET/CT for assessing viable tumours (VTs) after local regional treatment (LRT) in hepatocellular carcinoma (HCC) patients. The related imaging features of HCC after LRT are preliminarily discussed.
A cohort of 37 LRT patients with HCC (encompassing 51 lesions) was retrospectively included from a prospective parent study (ChiCTR2000039099), and sequential PET/CT using [F]FDG and [Ga]Ga-FAPI-04 was performed. The diagnostic accuracies of [Ga]Ga-FAPI-04 and [F]FDG PET/CT and multiphasic CT/MRI for detecting VTs after LRT were calculated and analysed. Pathological examination was considered the gold standard for VT diagnosis, and clinical follow-up was used as the reference standard. The SUVmax and tumour-to-background ratio (TBR) derived from [F]FDG and [Ga]Ga-FAPI-04 PET/CT were calculated and compared. Moreover, the SUVmax, target-to-normal liver ratio (TNR) of VT, tumour necrosis (TN), benign rim (BR), and normal liver (NL) from different imaging modalities after LRT for HCC were compared.
Both the sensitivity (96.0% [24/25] vs. 36.0% [9/25], p < 0.001) and accuracy (94.1%, [48/51] vs. 68.6% [35/51], p = 0.004) of [Ga]Ga-FAPI-04 PET/CT for detecting VTs after LRT were greater than those of [F]FDG PET/CT, whereas their specificities were comparable (92.3% [24/26] vs. 100% [26/26]). Notably, [Ga]Ga-FAPI-04 PET/CT had a greater SUVmax (9.80 vs. 3.60) and TBR (9.93 vs. 1.57) than [F]FDG PET/CT in VT patients (all p < 0.001). Furthermore, VT had a greater SUVmax and TNR than did TN, BR, and NL on [Ga]Ga-FAPI-04 PET/CT (all p < 0.001) and exhibited morphologic nodular, mass-like, or irregular tracer uptake. Although no significant differences were observed for VT detection (all p > 0.05), [Ga]Ga-FAPI-04 PET/CT and multiphasic CT/MRI complemented each other in some cases.
[Ga]Ga-FAPI-04 PET/CT not only presented higher sensitivity and accuracy than [F]FDG PET/CT for diagnosing VTs after LRT for HCC but also showed comparable diagnostic accuracy and complementary roles with multiphasic CT/MRI. Overall, [Ga]Ga-FAPI-04 PET/CT may play an essential role in surveillance after LRT for HCC.
Chinese Clinical Trial Registry ChiCTR2000039099. Registered 17 October 2020.
探讨[镓]Ga-FAPI-04 PET/CT评估肝细胞癌（HCC）患者局部区域治疗（LRT）后存活肿瘤（VT）的疗效。初步讨论LRT后HCC的相关影像学特征。
回顾性纳入一项前瞻性母研究（ChiCTR2000039099）中的37例接受LRT的HCC患者（共51个病灶），并进行[氟]FDG和[镓]Ga-FAPI-04序贯PET/CT检查。计算并分析[镓]Ga-FAPI-04和[氟]FDG PET/CT以及多期CT/MRI检测LRT后VT的诊断准确性。病理检查被视为VT诊断的金标准，临床随访用作参考标准。计算并比较[氟]FDG和[镓]Ga-FAPI-04 PET/CT得出的SUVmax和肿瘤与本底比值（TBR）。此外，比较HCC患者LRT后不同成像方式下VT的SUVmax、肿瘤与正常肝比值（TNR）、肿瘤坏死（TN）、良性边缘（BR）和正常肝（NL）。
[镓]Ga-FAPI-04 PET/CT检测LRT后VTs的敏感性（96.0%[24/25]对36.0%[9/25]，p<0.001）和准确性（94.1%，[48/51]对68.6%[35/51]，p = 0.004）均高于[氟]FDG PET/CT，而它们的特异性相当（92.3%[24/26]对100%[26/26]）。值得注意的是，VT患者中，[镓]Ga-FAPI-04 PET/CT的SUVmax（9.80对3.60）和TBR（9.93对1.57）高于[氟]FDG PET/CT（均p<0.001）。此外，在[镓]Ga-FAPI-04 PET/CT上，VT的SUVmax和TNR高于TN、BR和NL（均p<0.001），并表现出形态学上的结节状、肿块样或不规则放射性摄取。虽然在VT检测方面未观察到显著差异（均p>0.05），但在某些情况下，[镓]Ga-FAPI-04 PET/CT和多期CT/MRI相互补充。
[镓]Ga-FAPI-04 PET/CT不仅在诊断HCC患者LRT后VT方面比[氟]FDG PET/CT具有更高的敏感性和准确性，而且与多期CT/MRI具有相当的诊断准确性和互补作用。总体而言，[镓]Ga-FAPI-04 PET/CT可能在HCC患者LRT后的监测中发挥重要作用。
中国临床试验注册中心ChiCTR2000039099。2020年10月17日注册。
