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Value of [18F]AlF-NOTA-FAPI-04 PET/CT for differential diagnosis of malignant and various inflammatory lung lesions: comparison with [18F]FDG PET/CT

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A Commentary to this article was published on 09 November 2023

Abstract

Objective

Uptake of the imaging tracers [18F]AlF-NOTA-FAPI-04 and [18F]FDG varies in some inflammatory lesions, which may result in false-positive findings for malignancy on PET/CT. Our aim was to compare the [18F]AlF-NOTA-FAPI-04 and [18F]FDG PET/CT imaging features of malignant and various inflammatory lung lesions and to analyze their value for differential diagnosis.

Methods

We retrospectively analyzed [18F]AlF-NOTA-FAPI-04 PET/CT scans from 67 cancer patients taken between December 2020 and January 2022, as well as the scans of 32 patients who also underwent [18F]FDG PET/CT imaging. The maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) and lesion-to-background ratio (LBR) were calculated. The predictive capabilities of semiquantitative PET/CT parameters were analyzed by receiver operating characteristic curve analysis.

Results

A total of 70 inflammatory and 37 malignant lung lesions were evaluated by [18F]AlF‑NOTA‑FAPI‑04 PET/CT, and 33 inflammatory and 26 malignant lung lesions also were evaluated by [18F]FDG PET/CT. Inflammatory lesions exhibited lower [18F]AlF-NOTA-FAPI-04 and [18F]FDG uptake compared to malignant lesions, with statistically significant differences in SUVmax, SUVmean, and LBR (all p < 0.001). [18F]AlF-NOTA-FAPI-04 uptake also varied among different types of inflammatory lesions (SUVmax, p = 0.005; SUVmean, p = 0.008; LBR, p < 0.001), with the highest uptake observed in bronchiectasis with infection, followed by postobstructive pneumonia, and the lowest in pneumonia. [18F]FDG uptake was higher in postobstructive pneumonia than in pneumonia (SUVmax, p = 0.009; SUVmean, p = 0.016; LBR, p = 0.004).

Conclusion

[18F]AlF-NOTA-FAPI-04/[18F]FDG PET/CT showed significantly lower uptake in inflammatory lesions than malignancies as well as variation in different types of inflammatory lesions, and thus, may be valuable for distinguishing malignant and various inflammatory findings.

Clinical relevance statement

Our study confirmed that the uptake of [18F]AlF-NOTA-FAPI-04/[18F]FDG PET/CT in inflammatory and malignant lung lesions is different, which is beneficial to distinguish inflammatory and malignant lung lesions in clinic.

Key Points

• Malignant and different inflammatory lung lesions showed varying degrees of uptake of [18F]AlF-NOTA-FAPI-04 and [18F]FDG.

• Inflammatory lung lesions showed significantly less uptake than malignancies, and uptake varied among different types of inflammatory lesions.

• Both types of PET/CT could differentiate malignant and various inflammatory lung findings.

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Abbreviations

AUC:

Area under the ROC curve

CAF:

Cancer-associated fibroblast

CT:

Computed tomography

FAP:

Fibroblast activation protein

FAPI:

Fibroblast activation protein-specific inhibitor

FDG:

Fluorodeoxyglucose

fILD:

Fibrotic interstitial lung disease

IQR:

Interquartile range

LBR:

Lesion-to-background ratio

PET:

Positron emission tomography

PMF:

Progressive massive fibrosis

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

SUVmax:

Maximum standardized uptake value

SUVmean:

Mean standardized uptake value

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Funding

This work was funded by the Natural Science Foundation of China (NSFC82203218), the Natural Science Foundation of Shandong Province (ZR2021QH008), and Bethune Charitable Foundation (flzh202116).

Author information

Author notes

  1. Kailin Qiao and Xueting Qin contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Shandong University Cancer Center, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

    Kailin Qiao, Jing Jia, Shuanghu Yuan & Yuchun Wei

  2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China

    Kailin Qiao, Xueting Qin, Jing Jia, Xinying Hu, Yuanyuan Tao, Shuanghu Yuan & Yuchun Wei

  3. Department of Respiratory Medicine II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China

    Shuai Fu

  4. Department of PET/CT Center, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China

    Jiazhong Ren

Authors
  1. Kailin Qiao
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Correspondence to Shuanghu Yuan or Yuchun Wei.

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Qiao, K., Qin, X., Fu, S. et al. Value of [18F]AlF-NOTA-FAPI-04 PET/CT for differential diagnosis of malignant and various inflammatory lung lesions: comparison with [18F]FDG PET/CT. Eur Radiol 34, 1948–1959 (2024). https://doi.org/10.1007/s00330-023-10208-y

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