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One-stop [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 total-body PET/CT examination with dual-low activity: a feasibility study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

A Correction to this article was published on 01 July 2023

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Abstract

Purpose

Positron emission tomography/computed tomography (PET/CT) based on fibroblast activation protein inhibitors (FAPI) has shown complementary values to 2-[18F]-fluoro-2-deoxy-D-glucose ([18F]FDG) in cancer imaging. This study aimed to investigate the feasibility of a one-stop FDG-FAPI dual-tracer imaging protocol with dual-low activity for oncological imaging.

Methods

Nineteen patients with malignancies underwent one-stop [18F]FDG (0.37 MBq/kg) PET (PETFDG) and dual-tracer PET 30–40 and 50–60 min (hereafter, PETD30–40 and PETD50–60, respectively) after additional injection of [68Ga]Ga-DOTA-FAPI-04 (0.925 MBq/kg), with a single diagnostic CT to generate the PET/CT. The lesion detection rate and tumor-to-normal ratios (TNRs) of tracer uptake were compared between PETFDG/CT and PETD50–60/CT and between PETD50–60/CT and PETD30–40/CT. In addition, a visual scoring system was established to compare the lesion detectability.

Results

The dual-tracer PETD50–60 and PETD30–40/CT showed similar performance in detecting primary tumors but presented significantly higher lesion TNRs than PETFDG. Significantly, more metastases with higher TNRs were identified on PETD50–60 than PETFDG (491 vs. 261, P < 0.001). The dual-tracer PETD50–60 received significantly higher visual scores than single PETFDG (111 vs. 10) in demonstrating both primary tumors (12 vs. 2) and metastases (99 vs. 8). However, these differences were not significant between PETD50–60 and PETD30–40. These resulted in tumor upstaging in 44.4% patients taking PET/CT for initial assessment, and more recurrences (68 vs. 7) were identified in patients taking PET/CT for restaging, both on PETD50–60 and PETD30–40, compared to PETFDG. The reduced effective dosimetry per patient (26.2 ± 2.57 mSv) was equal to that of a single standard whole-body PET/CT.

Conclusion

The one-stop dual-tracer dual-low-activity PET imaging protocol combines the strengths of [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 with shorter duration and lesser radiation and is thus clinically applicable.

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Data availability

The dataset used and/or analyzed in the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

This study was funded by the Shanghai Municipal Key Clinical Specialty Project (grant number: SHSLCZDZK03401 to H.S.), the Major Science and Technology Projects for Major New Drug Creation (grant number: 2019ZX09302001 to H.S.), the Shanghai Science and Technology Committee Program (grant number: 20DZ2201800 to H.S.), the Three-year Action Plan of Clinical Skills and Innovation of Shanghai Hospital Development Center (grant number: SHDC2020CR3079B to H.S.), and the Next Generation Information Infrastructure Construction Project founded by Shanghai Municipal Commission of Economy and Informatization (grant number: 201901014 to H.S.).

Author information

Author notes

  1. Guobing Liu and Wujian Mao contributed equally to this study.

Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

    Guobing Liu, Wujian Mao, Haojun Yu, Yan Hu & Hongcheng Shi

  2. Institute of Nuclear Medicine, Fudan University, Shanghai, China

    Guobing Liu, Wujian Mao, Haojun Yu, Yan Hu & Hongcheng Shi

  3. Shanghai Institute of Medical Imaging, Shanghai, China

    Guobing Liu, Wujian Mao, Haojun Yu, Yan Hu & Hongcheng Shi

  4. Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Guobing Liu, Wujian Mao, Haojun Yu, Yan Hu & Hongcheng Shi

  5. Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    Jianying Gu

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  1. Guobing Liu
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Contributions

G. Liu and W. Mao had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. G. Liu, W. Mao, J. Gu, and H. Shi were responsible for the concept and design of the study. G. Liu, W. Mao, and H. Yu were involved in data acquisition. G. Liu and Y. Hu were involved in image review, data analysis, and interpretation. G. Liu and W. Mao drafted the manuscript, and all authors revised it critically. G. Liu and Y. Hu did the statistical analysis. J. Gu and H. Shi supervised the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. J. Gu and H. Shi are the guarantors.

Corresponding authors

Correspondence to Jianying Gu or Hongcheng Shi.

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Ethics approval

This study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (approval number: B2022-098R2).

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Written informed consents were obtained from included subjects for participation of this study.

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The authors affirm that human research participants provided informed consent for publication of the studied data and the images in Figs. 3, 4, and 5.

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The authors declare no competing interests.

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The original online version of this article was revised: The authors regret to inform that the following statement was not included in the legend of Figure 1: “This figure was adapted with permission from a JNM article—Roth KS, Voltin CA, van Heek L, etal. J Nucl Med 2022; 63(11):1683-1686. © SNMMI (ref. 9).” The original article has been corrected.

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Liu, G., Mao, W., Yu, H. et al. One-stop [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 total-body PET/CT examination with dual-low activity: a feasibility study. Eur J Nucl Med Mol Imaging 50, 2271–2281 (2023). https://doi.org/10.1007/s00259-023-06207-2

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