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Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions

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Skeletal Radiology Aims and scope Submit manuscript

Abstract  

Objective

This study investigated the distribution and characteristics of various bone and joint lesions on 18F-FAPI PET/CT in lung cancer patients.

Methods

Seventy-four lung cancer patients who underwent 18F-FAPI PET/CT were reviewed. Bone and joint lesions with elevated 18F-FAPI uptake were recorded and analyzed. The distribution and maximum uptake value (SUVmax) of different benign lesions or bone metastases were presented. In addition, the SUVmax of bone metastases on 18F-FDG and 18F-FAPI-04 PET/CT were also compared.

Results

In 53 patients, a total of 262 lesions presented 18F-FAPI accumulation. Bone metastases were mainly in vertebrae, pelvis, and ribs, while benign lesions were in vertebral margins, alveolar bone, and shoulder joints. The SUVmax of bone metastases was significantly higher than that of benign lesions (\(6.6\pm 2.8\) vs. \(4.3\pm 1.6\), \(P<0.001\)), with NSCLC cases having higher SUVmax values than SCLC cases (\(7.3\pm 2.7\) vs. \(3.7\pm 1.1\), \(P<0.001\)). Among benign lesions, arthritis and periodontitis demonstrated higher SUVmax than degenerative lesions (arthritis: \(5.2\pm 2.3\); periodontitis: \(4.8\pm 1.5\); degenerative diseases: \(3.6\pm 0.9\); \(P<0.01\) and \(P<0.05\), respectively). The SUVmax of bone metastases was comparable between 18F-FDG and 18F-FAPI PET/CT. However, 18F-FAPI PET/CT was found to be superior in identifying cranial metastases compared to 18F-FDG PET/CT (TBRmet/brain: \(54.2\pm 13.5\) vs. \(0.6\pm 0.2\), \(P=0.02\)).

Conclusion

This study demonstrated that 18F-FAPI PET/CT is a valuable imaging modality for detecting bone and joint lesions in lung cancer patients. The SUVmax of malignant lesions was higher than that of benign lesions, but cannot accurately distinguish benign and malignant lesions. The uptake of FAPI differs among lesions with different pathological types.

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Data availability

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

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Funding

The study was supported by funds from the National Natural Science Foundation of China (81872475 and 82073345), Natural Science Innovation and Development Joint Foundation of Shandong (ZR202209010002) and Jinan Clinical Medicine Science and Technology Innovation Plan (202019060), the Natural Science Foundation of Shandong Province (ZR2021QH008), and the Bethune Charitable Foundation (flzh202116).

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Authors and Affiliations

  1. Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China

    Xiaoli Liu, Xueting Qin, Yuchun Wei & Shuanghu Yuan

  2. Department of Radiotherapy, Xuanwu Hospital, Capital Medical University, Beijing, China

    Xiaoli Liu

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

    Shoumei Yan, Kai Cheng, Jinsong Zheng & Hongbo Wu

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  1. Xiaoli Liu
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Correspondence to Yuchun Wei or Shuanghu Yuan.

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This retrospective study was approved by the local ethics committee of Shandong Cancer Hospital and Institute (reference number: SDZLEC2021-112–02).

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Parts of this work have been accepted as oral presentation at the 2022 SNMMI Annual Meeting.

Yuchun Wei and Shuanghu Yuan are co-corresponding authors.

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Liu, X., Yan, S., Qin, X. et al. Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions. Skeletal Radiol 52, 2377–2386 (2023). https://doi.org/10.1007/s00256-023-04335-2

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