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The potential utility of [68 Ga]Ga-DOTA-FAPI-04 as a novel broad-spectrum oncological and non-oncological imaging agent—comparison with [18F]FDG

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Abstract

Purpose

This study aimed to compare the detection performance of [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the patients with various oncological and non-oncological lesions.

Methods

A total of 123 patients underwent contemporaneous [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT were included in this prospective study. The maximum standard uptake value (SUVmax) was measured to compare oncological and non-oncological lesion uptake. The sensitivity, specificity, predictive values, and accuracy of [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT for detecting primary, metastatic, and non-oncological lesions were calculated and compared to evaluate the detection efficacy.

Results

The study subjects consisted of 123 patients (69 men and 54 women; mean age 56.11 ± 11.94 years). Among the 102 patients with either newly diagnosed (82 patients) or previously treated solid tumor (20 patients), a total of 88 solid primary malignant tumors in 84/102 patients were detected. Two patients had two primary tumors each and 1 patient had three primary tumors. Among them, 58/102 and 43/102 patients had nodal (376 lesions) and distant metastases (406 lesions), respectively. Eight patients had hematological neoplasm. No malignant oncological diseases were detected in the remaining 13 patients. A total of 145 non-oncological lesions and benign tumors in 52/123 patients were detected incidentally. [68 Ga]Ga-DOTA-FAPI-04 PET/CT demonstrated a significantly higher uptake and detection rate for the primary (SUVmax 10.98 ± 5.83 vs. 8.36 ± 6.43, p < 0.001; sensitivity 97.67 vs. 84.89%; and accuracy 96.59 vs. 82.95%, X2 = 0.538, p = 0.021), nodal (SUVmax 10.50 ± 5.98 vs. 8.20 ± 6.29, p = 0.011; sensitivity 97.59 vs. 84.72%; and accuracy 97.34 vs. 84.31%, X2 = 2.067, p < 0.001), and distant metastatic lesions (SUVmax 9.64 ± 6.45 vs. 6.74 ± 4.83; p < 0.001; sensitivity 98.01 vs. 65.59%; and accuracy 97.04 vs. 65.51%, X2 = 4.897, p < 0.001) of solid tumor than did [18F]FDG PET/CT. [68 Ga]Ga-DOTA-FAPI-04 PET/CT demonstrated a lower activity (SUVmax: 6.84 ± 4.67 vs. 13.09 ± 7.29, p < 0.001) and detection rate (sensitivity 50.65 vs. 96.75%, and accuracy 51.28 vs. 95.51%, X2 = 5.166, p < 0.001) for multiple myeloma and lymphoma compared to [18F]FDG PET/CT. [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT PET/CT demonstrated a comparative activity (SUVmax 6.40 ± 3.95 vs. 5.74 ± 15.78, p = 0.729) and detection efficacy (sensitivity 86.52 vs. 72.34%, and accuracy 84.83 vs. 72.41%, X2 = 9.460, p = 0.007) for non-oncological lesion and benign tumor detection.

Conclusions

Except for myeloma and lymphoma, [68 Ga]Ga-DOTA-FAPI-04 PET/CT showed a superior detection efficacy for detecting various primary and metastatic lesions than [18F]FDG PET/CT. A comparative detection utility for non-oncological lesion was obtained with both tracers. [68 Ga]Ga-DOTA-FAPI-04 could be used as a broad-spectrum tumor and inflammatory imaging agent in the clinical especially for various solid tumors and non-oncological lesions.

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Funding

This study was supported in part by research foundation projects from Luzhou Science & Technology Department (20107) and The Affiliated Hospital of Southwest Medical University (20087).

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Authors and Affiliations

  1. Department of Radiology, The Affiliated Hospital of Southwest Medical University, No 25. Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People’s Republic of China

    Lianjun Lan

  2. Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People’s Republic of China

    Hanxiang Liu, Yingwei Wang, Jia Deng, Dengsai Peng, Yue Feng, Li Wang, Yue Chen & Lin Qiu

  3. Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People’s Republic of China

    Hanxiang Liu, Yingwei Wang, Jia Deng, Dengsai Peng, Yue Feng, Li Wang, Yue Chen & Lin Qiu

  4. Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People’s Republic of China

    Hanxiang Liu, Yingwei Wang, Jia Deng, Dengsai Peng, Yue Feng, Li Wang, Yue Chen & Lin Qiu

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  1. Lianjun Lan
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Correspondence to Yue Chen or Lin Qiu.

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The Affiliated Hospital of Southwest Medical University Review Board approved this study and all patients received oral and written information on the routine tests performed in this study.

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First author: Lianjun Lan and Lin Qiu

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

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Lan, L., Liu, H., Wang, Y. et al. The potential utility of [68 Ga]Ga-DOTA-FAPI-04 as a novel broad-spectrum oncological and non-oncological imaging agent—comparison with [18F]FDG. Eur J Nucl Med Mol Imaging 49, 963–979 (2022). https://doi.org/10.1007/s00259-021-05522-w

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