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Comparison of 68Ga-FAPI PET/CT and 18FDG PET/CT Modalities in Gastrointestinal System Malignancies with Peritoneal Involvement

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Abstract

Purpose

In this study, we aimed to investigate the utilization of 68Ga-FAPI PET/CT in comparison to 18FDG PET/CT to evaluate the peritoneal involvement of the gastrointestinal malignancies alongside primary lesions and other metastatic foci.

Procedures

A total of 37 patients with various gastrointestinal malignancies with accompanying peritoneal involvement who underwent 68Ga-FAPI PET/CT and 18FDG PET/CT imaging between September 2020 and June 2021 were included in this retrospective study. SUVmax values of 68Ga-FAPI and 18FDG were compared according to lesion locations. Also, the lesion localization ability of both imaging was compared in patient basis.

Results

Of the 37 patients with peritoneal involvement (23 males and 14 females; median age, 62.8 ± 12.7 years), 35.1% (n = 13) had colorectal cancer, 37.8% (n = 14) gastric cancer, and 27.0% (n = 10) pancreaticobiliary cancer. While 45.9% of them were operated, the remaining did not have surgery. The mean time interval between two studies was 3.2 days (range: 2–6 days). The mean SUVmax value of peritoneal metastases (p < 0.001) was significantly higher with 68Ga-FAPI PET/CT compared to that with 18FDG PET/CT, as in primary lesions (p < 0.001), lymph node metastases (p = 0.006), liver metastases (p = 0.002), and bone metastases (p = 0.018). A total of 185 lesions was detected in the initial assessment with 18FDG PET/CT. Of the total lesions detected with 18FDG PET/CT, 5 of them were evaluated as benign lesions with 68Ga-FAPI PET/CT also in accordance with the reference standard. In addition to 180 lesions detected with 18FDG PET/CT, a total of 37 additional malignant lesions, 12 of which were peritoneal metastases, were detected with 68Ga-FAPI PET/CT.

Conclusion

68Ga-FAPI PET/CT was determined to be superior to 18FDG PET/CT in terms of detection of peritoneal involvement with high image quality as well as primary tumor and other metastatic foci. Consequently, 68Ga-FAPI PET/CT can be used as a complementary imaging modality especially for inconclusive 18FDG findings due to the lack of accuracy of 18FDG PET/CT in some of the metastatic regions, especially in the liver.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Gaziantep University, Gaziantep, Turkey

    Umut Elboga, Ertan Sahin, Yusuf Burak Cayirli, Merve Okuyan, Ufuk Cimen, Vuslat Mumcu & Yusuf Zeki Celen

  2. Department of Medical Oncology, Gaziantep University, Gaziantep, Turkey

    Tulay Kus, Havva Yesil Cinkir, Fatih Teker, Ozlem Nuray Sever & Aydın Aytekin

  3. Medical Park Private Hospital, Department of Medical Oncology, Gaziantep, Turkey

    Gokmen Aktas

  4. Department of General Surgery, Gaziantep University, Gaziantep, Turkey

    Alper Aytekin & Latif Yılmaz

  5. Department of R&D, Moltek Health Services Production & Marketing Inc., Kocaeli, Turkey

    Benan Kilbas, Kurtulus Eryilmaz & Davut Cakici

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  1. Umut Elboga
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Contributions

Umut Elboga: conception of the work, revising work critically for important intellectual content, interpretation of data for the work. Ertan Sahin: design of the work, revising work critically for important intellectual content, interpretation of data for the work. Tulay Kus: analysis and interpretation of data for the work, revising work critically for important intellectual content. Yusuf Burak Cayirli: design of the work, interpretation of data for the work, drafting the work. Gokmen Aktas: interpretation of data for the work, revising work critically for important intellectual content. Merve Okuyan: acquisition and interpretation of data for the work, drafting the work. HavvaYesil Cinkir: acquisition of data for the work, revising work critically for important intellectual content. Fatih Teker: acquisition of data for the work, revising work critically for important intellectual content. Ozlem Nuray Sever: acquisition of data for the work, revising work critically for important intellectual content. Alper Aytekin: acquisition of data for the work, revising work critically for important intellectual content. Latif Yılmaz: acquisition of data for the work, revising work critically for important intellectual content. Aydın Aytekin: acquisition of data for the work, revising work critically for important intellectual content. Ufuk Cimen: acquisition of data for the work, drafting the work. Vuslat Mumcu: acquisition of data for the work, drafting the work. Benan Kilbas: interpretation of data for the work, revising work critically for important intellectual content. Kurtulus Eryilmaz: acquisition of data for the work, drafting the work. Davut Cakici: acquisition of data for the work, drafting the work. Yusuf Zeki Celen: interpretation of data for the work, revising work critically for important intellectual content.

All authors approve the final version of the work to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Umut Elboga.

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Elboga, U., Sahin, E., Kus, T. et al. Comparison of 68Ga-FAPI PET/CT and 18FDG PET/CT Modalities in Gastrointestinal System Malignancies with Peritoneal Involvement. Mol Imaging Biol 24, 789–797 (2022). https://doi.org/10.1007/s11307-022-01729-x

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