Msherghi Ahmed, Abuajamieh Maram, Ekreer Moad, Alzlitni Muhab, Hajalamin Mohamed, Aldieb Ebtesam, Khalleefah Dua Rajab, Alzein Abdussalam I A, Chenfouh Imane, Mohammed Hudi, Elkhadar Abdulmhoimen, Benghatnsh Ahmed, Salim Hamza Adel, Alsharedi Mohamed, Elhadi Muhammed, Wintermark Max, Alavi Abass
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cairo University School of Medicine, Cairo, Egypt.
Eur J Nucl Med Mol Imaging. 2025 Apr 11. doi: 10.1007/s00259-025-07264-5.
Biliary tract cancers (BTCs) are aggressive malignancies with poor prognosis due to late-stage diagnosis. While [18 F]-FDG PET/CT is widely used for detection and staging, its sensitivity for certain BTC subtypes is limited, prompting the evaluation of 68 Ga-FAPI PET/CT as a promising alternative.
To compare the diagnostic performance of [68 Ga]Ga-FAPI PET/CT and [18 F]FDG PET/CT in detecting BTCs, including primary tumors, lymph node involvement, and distant metastases.
We searched PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Library until March 2024 to identify studies that directly compared [68 Ga]Ga-FAPI and [18 F]FDG PET/CT in detecting BTCs. Sensitivity, specificity, pooled mean differences of tumor SUVmax and TBRmax, and odds ratios for detecting primary tumors, lymph nodes, and distant metastases using a random-effects model with the corresponding 95% confidence intervals were evaluated. Subgroup analyses were performed for intrahepatic cholangiocarcinoma (IHCC).
The pooled OR for [68 Ga]Ga-FAPI PET/CT versus [18 F]FDG PET/CT was 4.87 (95% CI: 1.75-13.56, I2 = 0.0%, p = 0.60), indicating a statistically significant preference for [68 Ga]Ga-FAPI. In the IHCC subgroup, the pooled OR was 2.98 (95% CI: 0.86-10.38, I2 = 0.0%, p = 0.63) favors [68 Ga]Ga-FAPI. Furthermore, [68 Ga]Ga-FAPI demonstrated significantly higher tumor uptake compared to [18 F]FDG PET/CT, with pooled mean differences in SUVmax of 6.47 (95% CI: 1.81-11.13) and TBRmax of 9.45 (95% CI: 3.88-15.03) across BTCs. Subgroup analysis for IHCC showed a trend favoring [68 Ga]Ga-FAPI, though the TBRmax difference did not reach statistical significance (mean difference: 7.71, 95% CI: - 0.58-16.01). For lymph node metastasis detection, [68 Ga]Ga-FAPI outperformed [18 F]FDG with an odds ratio of 2.81 (95% CI: 1.07-7.35), and for distant metastases, the odds ratio was 3.45 (95% CI: 1.12-10.63). However, moderate variability was observed across the studies for lymph nodes and organ metastases (I2 = 46.9 and 52.4%, respectively).
[68 Ga]Ga-FAPI PET/CT offers superior diagnostic performance and tumor uptake compared to [18 F]FDG PET/CT in BTCs, particularly for lymph nodes and distant metastasis detection. These findings support the potential clinical utility of [68 Ga]Ga-FAPI PET/CT as a preferred imaging modality in BTCs, though further research is needed to standardize protocols and confirm these results in larger cohorts.
胆道癌（BTCs）是侵袭性恶性肿瘤，由于诊断较晚，预后较差。虽然[18F]-FDG PET/CT广泛用于检测和分期，但其对某些BTC亚型的敏感性有限，促使人们评估68Ga-FAPI PET/CT作为一种有前景的替代方法。
比较[68Ga]Ga-FAPI PET/CT和[18F]FDG PET/CT在检测BTCs（包括原发性肿瘤、淋巴结受累和远处转移）方面的诊断性能。
我们检索了PubMed、EMBASE、Web of Science、Scopus和Cochrane图书馆，直至2024年3月，以确定直接比较[68Ga]Ga-FAPI和[18F]FDG PET/CT检测BTCs的研究。使用随机效应模型及相应的95%置信区间评估敏感性、特异性、肿瘤SUVmax和TBRmax的合并平均差异，以及检测原发性肿瘤、淋巴结和远处转移的比值比。对肝内胆管癌（IHCC）进行亚组分析。
[68Ga]Ga-FAPI PET/CT与[18F]FDG PET/CT的合并OR为4.87（95%CI：1.75-13.56，I2 = 0.0%，p = 0.60），表明对[68Ga]Ga-FAPI有统计学上的显著偏好。在IHCC亚组中，合并OR为2.98（95%CI：0.86-10.38，I2 = 0.0%，p = 0.63），支持[68Ga]Ga-FAPI。此外，与[18F]FDG PET/CT相比，[68Ga]Ga-FAPI显示出显著更高的肿瘤摄取，BTCs的SUVmax合并平均差异为6.47（95%CI：1.81-11.13），TBRmax合并平均差异为9.4（95%CI：3.88-15.03）。IHCC的亚组分析显示出支持[68Ga]Ga-FAPI的趋势，尽管TBRmax差异未达到统计学显著性（平均差异：7.71，95%CI：-0.58-16.01）。对于淋巴结转移检测，[68Ga]Ga-FAPI优于[18F]FDG，比值比为2.81（95%CI：1.07-7.35），对于远处转移，比值比为3.45（95%CI：1.12-10.63）。然而，各研究在淋巴结和器官转移方面观察到中等程度的异质性（I2分别为46.9%和52.4%）。
与[18F]FDG PET/CT相比，[68Ga]Ga-FAPI PET/CT在BTCs中具有更好的诊断性能和肿瘤摄取，特别是在淋巴结和远处转移检测方面。这些发现支持[68Ga]Ga-FAPI PET/CT作为BTCs首选成像方式的潜在临床应用价值，不过需要进一步研究来规范方案并在更大队列中证实这些结果。
