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Fibroblast imaging of hepatic carcinoma with 68Ga-FAPI-04 PET/CT: a pilot study in patients with suspected hepatic nodules

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Abstract

Purpose

68Ga-FAPI-04 is a rapidly evolving PET tracer for whole-body imaging in a variety of cancers. We aimed to evaluate the diagnostic performance of 68Ga-FAPI-04 for detecting and characterizing hepatic nodules in patients with suspected carcinoma.

Methods

Twenty-five patients showing suspicious hepatic lesions for malignancy underwent 68Ga-FAPI-04 PET. The maximum and mean standardised uptake values (SUVmax, SUVmean) were measured for all detected lesions and normal hepatic tissues, respectively. The target-to-background ratio (TBR) was calculated by dividing the lesion SUVmax with the SUVmean of non-tumour liver tissue. Lesion uptake value was correlated with the in vitro hepatic FAP expression determined by immunohistochemistry (IHC).

Results

In total, 17 patients who underwent surgery or biopsy were recruited for the final analysis. A total of 28 intrahepatic malignant lesions were detected in 16 patients; the mean SUVmax was 8.36 ± 4.21 (range 2.21 to 15.86), and mean TBR was 13.15 ± 9.48 (range 2.79 to 38.12) in all detected lesions (n = 28). One benign patient showed negligible hepatic uptake (SUVmax = 0.47), whereas 75% of the primary intrahepatic hepatocellular carcinoma (HCC) lesions (n = 6) showed prominent FAP expression, 12.5% of the lesions (n = 1) showed moderate expression in stromal cells, and one showed negligible expression.

Conclusions

68Ga-FAPI-04 showed high sensitivity in detecting hepatic malignancies, particularly in poorly differentiated forms with concordantly elevated FAP expression.

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Funding

This work was sponsored in part by the National Natural Science Foundation of China (Grant Nos. 81571713, No. 81671722, No. 81801741), Fundamental Research Funds for the Central Universities (3332020011) and the CAMS Innovation Fund for Medical Sciences (Grant Nos. 2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Ximin Shi, Haiqun Xing, Fang Li & Li Huo

  2. Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China

    Ximin Shi, Haiqun Xing, Fang Li & Li Huo

  3. Department of Hepatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiaobo Yang & Haitao Zhao

  4. Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

    Shaobo Yao

  5. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Hui Zhang

  6. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Marcus Hacker & Xiang Li

Authors
  1. Ximin Shi
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  2. Haiqun Xing
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  3. Xiaobo Yang
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  4. Fang Li
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  5. Shaobo Yao
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  6. Hui Zhang
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  7. Haitao Zhao
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  8. Marcus Hacker
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  9. Li Huo
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  10. Xiang Li
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Contributions

Ximin Shi, Li Huo and Xiang Li designed the study, interpreted the data and led the writing and review of the manuscript. Ximin Shi, Haiqun Xing and Shaobo Yao synthesised the 68Ga-FAPI-4 and performed the examination. Xiaobo Yang and Haitao Zhao collected clinical data. Hui Zhang evaluated the FAP IHC images. Fang Li and Marcus Hacker participated in the review of the manuscript.

Corresponding author

Correspondence to Li Huo.

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The authors declare that they have no conflicts of interest.

Ethics approval

This prospective study was approved by the Peking Union Medical College Hospital ethics committee (IRB protocol #ZS1810).

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All subjects provided written informed consent.

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This article is part of the Topical Collection on Oncology - General

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Shi, X., Xing, H., Yang, X. et al. Fibroblast imaging of hepatic carcinoma with 68Ga-FAPI-04 PET/CT: a pilot study in patients with suspected hepatic nodules. Eur J Nucl Med Mol Imaging 48, 196–203 (2021). https://doi.org/10.1007/s00259-020-04882-z

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