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[18F]FAPI-42 PET/CT versus [18F]FDG PET/CT for imaging of recurrent or metastatic gastrointestinal stromal tumors

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A Correction to this article was published on 16 September 2022

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Abstract

Purpose

PET has been important for monitoring recurrence and metastasis of Gastrointestinal Stromal Tumors (GISTs) and the selection of therapeutic strategies. A significant portion of GISTs lesions show negative FDG uptake and therefore calls for more tumor-specific imaging biomarkers. This study compared the imaging performance of [18F]FAPI-42 PET/CT and [18F]FDG PET/CT in recurrent or metastatic gastrointestinal stromal tumors (R/M GISTs).

Methods

This study retrospectively included 35 patients with R/M GISTs who underwent both FAPI PET/CT and FDG PET/CT. The definite diagnosis was confirmed by pathology or follow-up drug treatment effects. The differences in detection rates and tumor-to-background SUVmax ratio (SUVTBR) of different locations between dual-tracer PET/CT were compared. Factors including tumor size, degree of enhancement, type of gene mutation, and targeted treatment potentially influencing the uptake of both tracers were assessed. The excised lesions (n = 3) underwent immunohistochemical staining to verify FAP expression in the tissue.

Results

A total of 106 lesions in 35 patients were identified, out of which 38/106 (35.8%) lesions (FAPI + /FDG −) were additionally detected by FAPI PET/CT as compared to that by FDG, including 26 liver metastases, ten peritoneal metastases, one gastrointestinal recurrence, and one bone metastasis. The positive detection rate of FAPI PET/CT for recurrent or metastatic GISTs was higher than that of FDG (80.2% vs. 53.8%,  P< 0.001), especially in liver metastases (87.5% vs. 33.3%, P< 0.001). Moreover, the SUVTBR of liver metastases of GISTs in FAPI PET/CT was higher than that in FDG [2.4 (0.3 to 11.2) vs. 0.9 (0.3 to 6.5), P< 0.001]. The longest diameter of tumors in the FDG-positive group was higher than that of the FDG-negative group (P= 0.005); still, it did not differ between the FAPI-positive group and the FAPI-negative group. No difference in the degree of enhancement was observed between both tracers’ positive and negative groups. Besides, the SUVTBR of FDG but not FAPI differed significantly among various gene mutations (P< 0.001) as well as the targeted therapy and no targeted therapy groups (P= 0.001). FAP was expressed in R/M GISTs, and the uptake of FAPI corresponded to the level of FAP expression.

Conclusion

In conclusion, FAPI for imaging of R/M GISTs could be superior to FDG, specifically for liver metastases. The uptake of FAPI could reflect the level of FAP expression, and it was independent of tumor size, degree of enhancement, type of gene mutation, and targeted therapy as compared to FDG.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58 2nd Zhongshan Road, Guangzhou, 510080, Guangdong Province, China

    Chunhui Wu, Yu Zeng, Renbo Wu, Zhifeng Chen, Xiangsong Zhang & Xiaoyan Wang

  2. Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou , Guangdong Province, China

    Xinhua Zhang

  3. Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou , Guangdong Province, China

    Li Ding

  4. Department of Pharmacy, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou , Guangdong Province, China

    Yanzhe Xia

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  1. Chunhui Wu
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Correspondence to Xiangsong Zhang or Xiaoyan Wang.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University. Informed consent was obtained from all individual participants included in the study.

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The authors Chunhui Wu, Xinhua Zhang, and Yu Zeng contributed equally as first authors.

This article is part of the Topical Collection on Oncology - Digestive tract

The original online version of this article was revised: The authors regret that some of the reference citations in the original article are incorrect. The sequence number incorrectly presented are as follows: [1, 2, 3] as [1], [3, 4, 5] as [3], [1, 5] as [1]; [9, 10, 11] as [9], [12, 13, 14] as [12]，[16, 17] as [16], [18, 19] as [18], [20, 21] as [20], [27, 28, 29] as [27], [9, 30, 31] as [31], [36, 37] as [36], [20, 25] as [20].

The original article has been corrected.

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Wu, C., Zhang, X., Zeng, Y. et al. [18F]FAPI-42 PET/CT versus [18F]FDG PET/CT for imaging of recurrent or metastatic gastrointestinal stromal tumors. Eur J Nucl Med Mol Imaging 50, 194–204 (2022). https://doi.org/10.1007/s00259-022-05955-x

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