Wei Jinhui, Zou Kun, Sun Fangfang, Feng Qiaochu, Liu Haodong, Zheng Hongna, Guo Yanjie, Li Longjie
Departments of Radiation Oncology.
Departments of Nuclear Medicine, The First Hospital of Dalian Medical University, Dalian.
Clin Nucl Med. 2025 Aug 21. doi: 10.1097/RLU.0000000000006103.
To explore the potential utility of 18 F-AlF-NOTA-fibroblast activation protein inhibitor (FAPI)-04 PET/CT (denoted as 18 F-FAPI-04 PET/CT) in the evaluation of cervical cancer through a head-to-head comparison with 18 F-FDG PET/CT for detecting primary tumors and metastatic lymph nodes.
A total of 22 patients with a pathologic diagnosis of cervical cancer underwent 18 F-FDG PET/CT and 18 F-FAPI-04 PET/CT within a 7-day period. Out of the 22 patients, 19 (median age, 62.3 y) were included in the final analysis. Comparisons were made between the ability of 18 F-FDG PET/CT and 18 F-FAPI-04 PET/CT to detect primary lesions and metastatic lymph nodes; semiquantitative PET/CT parameters were also analyzed, including SUV max , SUV mean , metabolic tumor volume (MTV for 18 F-FDG) and fibroblast tumor volume (FTV for 18 F-FAPI-04), tumor lesion glycolysis (TLG for 18 F-FDG) and tumor lesion FAPI (TLF for 18 F-FAPI-04), and tumor-to-background ratios (TBR liver and TBR blood ), calculated by dividing the SUV max of the lesion by the SUV mean of normal liver or blood pool.
18 F-FAPI-04 PET/CT identified a greater number of primary lesions and metastatic lymph nodes compared with 18 F-FDG PET/CT. 18 F-FAPI-04 PET/CT detected 19/19 primary tumors, achieving a detection rate of 100%, while 18 F-FDG PET/CT identified 18/19 primary tumors, with a detection rate of 95%. The PPV for both tracers was 100%, the NPV for 18 F-FDG PET/CT was 0%. For metastatic lymph nodes, 18 F-FAPI-04 PET/CT detected 82 nodes in 7 patients, while 18 F-FDG PET/CT detected 44 nodes in the same 7 patients. TBR was significantly higher for 18 F-FAPI-04 PET/CT compared with 18 F-FDGPET/CT for primary lesions (TBR blood : 16.33 vs 9.83, P = 0.005; TBR liver : 21.59 vs 7.04, P < 0.0001) and metastatic lymph nodes (TBR blood : 9.16 vs 7.64, P = 0.033; TBR liver : 10.38 vs 5.29, P < 0.0001). No significant differences were observed in other semiquantitative parameters.
18 F-FAPI-04 PET/CT had superior performance in detecting primary lesions and metastatic lymph nodes in cervical cancer compared with 18 F-FDG PET/CT. 18 F-FAPI-04 exhibited lower uptake in normal tissues, leading to a higher TBR. These findings imply that 18 F-FAPI-04 PET/CT has potential for clinical application in cervical cancer.
通过与18F-FDG PET/CT进行头对头比较，以检测原发性肿瘤和转移性淋巴结，探讨18F-AlF-NOTA-成纤维细胞活化蛋白抑制剂（FAPI）-04 PET/CT（称为18F-FAPI-04 PET/CT）在宫颈癌评估中的潜在效用。
共有22例经病理诊断为宫颈癌的患者在7天内接受了18F-FDG PET/CT和18F-FAPI-04 PET/CT检查。22例患者中，19例（中位年龄62.3岁）纳入最终分析。比较了18F-FDG PET/CT和18F-FAPI-04 PET/CT检测原发性病变和转移性淋巴结的能力；还分析了半定量PET/CT参数，包括SUV最大值、SUV平均值、代谢肿瘤体积（18F-FDG的MTV）和成纤维细胞瘤体积（18F-FAPI-04的FTV）、肿瘤病变糖酵解（18F-FDG的TLG）和肿瘤病变FAPI（18F-FAPI-04的TLF），以及通过将病变的SUV最大值除以正常肝脏或血池的SUV平均值计算得出的肿瘤与背景比值（TBR肝脏和TBR血液）。
与18F-FDG PET/CT相比，18F-FAPI-04 PET/CT发现的原发性病变和转移性淋巴结数量更多。18F-FAPI-04 PET/CT检测到19/19例原发性肿瘤，检出率为100%，而18F-FDG PET/CT识别出18/19例原发性肿瘤，检出率为95%。两种示踪剂的PPV均为100%，18F-FDG PET/CT的NPV为0%。对于转移性淋巴结，18F-FAPI-04 PET/CT在7例患者中检测到82个淋巴结，而18F-FDG PET/CT在同一7例患者中检测到44个淋巴结。与18F-FDG PET/CT相比，18F-FAPI-04 PET/CT在原发性病变（TBR血液：16.33对9.83，P = 0.005；TBR肝脏：21.59对7.04，P < 0.0001）和转移性淋巴结（TBR血液：9.16对7.64，P = 0.033；TBR肝脏：10.38对5.29，P < 0.0001）方面的TBR显著更高。在其他半定量参数方面未观察到显著差异。
与18F-FDG PET/CT相比，18F-FAPI-04 PET/CT在检测宫颈癌原发性病变和转移性淋巴结方面具有更优的性能。18F-FAPI-04在正常组织中的摄取较低，导致TBR更高。这些发现表明18F-FAPI-04 PET/CT在宫颈癌临床应用中具有潜力。
