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Comparison of the diagnostic efficacy of 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT in patients with pancreatic cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We sought to assess the performance of 68 Ga-FAPI-04 PET/MR for the diagnosis of primary tumours as well as metastatic lesions in patients with pancreatic cancer and to compare the results with those of 18F-FDG PET/CT.

Methods

Prospectively, we evaluated 33 patients suspected to have pancreatic adenocarcinoma, of whom thirty-two were confirmed by histopathology, and one had autoimmune pancreatitis confirmed by needle biopsy and glucocorticoid treatment. Within 1 week, each patient underwent both 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT. Comparisons of the detection abilities for primary tumours, lymph nodes, and metastases were conducted for the two imaging approaches. The original maximum standard uptake values (SUVmax) and normalised SUVmax (SUVmax/SUVbkgd) of paired lesions on 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT were measured and compared.

Results

Thirty pancreatic cancer patients and three pancreatitis patients were enrolled. 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT exhibited equivalent (100%) detection rates for primary tumours. The original/normalised SUVmax of primary tumours on 68 Ga-FAPI-04 PET was markedly higher than that on 18F-FDG (p < 0.05). Sixteen pancreatic cancer patients had pancreatic parenchymal uptake, whereas 18F-FDG PET images showed parenchymal uptake in only four patients (53.33% vs. 13.33%, p < 0.001). 68 Ga-FAPI-04 PET detected more positive lymph nodes than 18F-FDG PET (42 vs. 30, p < 0.001), while 18F-FDG PET was able to detect more liver metastases than 68 Ga-FAPI-04 (181 vs. 104, p < 0.001). In addition, multisequence MR imaging helped explain ten pancreatic cancers that could not be definitively revealed due to 68 Ga-FAPI-04 inflammatory uptake and identified more liver metastases than 18F-FDG (256 vs. 181, p < 0.001).

Conclusion

68 Ga-FAPI-04 PET might be better than 18F-FDG PET in the detection of suspicious lymph node metastases. MR multiple sequence imaging of 68 Ga-FAPI-04 PET/MR was helpful for explaining pancreatic lesions in patients with obstructive inflammation and detecting tiny liver metastases.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30. https://doi.org/10.3322/caac.21590.

  2. Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, et al. Pancreatic cancer. Nat Rev Dis Primers. 2016;2:16022. https://doi.org/10.1038/nrdp.2016.22.

  3. Kauhanen SP, Komar G, Seppänen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250:957–63. https://doi.org/10.1097/SLA.0b013e3181b2fafa.

    Article  PubMed  Google Scholar 

  4. Lee JW, O JH, Choi M, Choi JY. Impact of F-18 fluorodeoxyglucose PET/CT and PET/MRI on initial staging and changes in management of pancreatic ductal adenocarcinoma: a systemic review and meta-analysis. Diagnostics (Basel). 2020;10:952. https://doi.org/10.3390/diagnostics10110952.

  5. Wang L, Dong P, Shen G, Hou S, Zhang Y, Liu X, et al. 18F-Fluorodeoxyglucose positron emission tomography predicts treatment efficacy and clinical outcome for patients with pancreatic carcinoma: a meta-analysis. Pancreas. 2019;48:996–1002. https://doi.org/10.1097/MPA.0000000000001375.

    Article  CAS  PubMed  Google Scholar 

  6. Rijkers AP, Valkema R, Duivenvoorden HJ, van Eijck CH. Usefulness of F-18-fluorodeoxyglucose positron emission tomography to confirm suspected pancreatic cancer: a meta-analysis. Eur J Surg Oncol. 2014;40:794–804. https://doi.org/10.1016/j.ejso.2014.03.016.

    Article  CAS  PubMed  Google Scholar 

  7. Erkan M, Hausmann S, Michalski CW, Fingerle AA, Dobritz M, Kleeff J, et al. The role of stroma in pancreatic cancer: diagnostic and therapeutic implications. Nat Rev Gastroenterol Hepatol. 2012;9:454–67. https://doi.org/10.1038/nrgastro.2012.115.

    Article  CAS  PubMed  Google Scholar 

  8. Nielsen MFB, Mortensen MB, Detlefsen S. Typing of pancreatic cancer-associated fibroblasts identifies different subpopulations. World J Gastroenterol. 2018;24:4663–78. https://doi.org/10.3748/wjg.v24.i41.4663.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Whittle MC, Hingorani SR. Fibroblasts in pancreatic ductal adenocarcinoma: biological mechanisms and therapeutic targets. Gastroenterology. 2019;156:2085–96. https://doi.org/10.1053/j.gastro.2018.12.044.

    Article  CAS  PubMed  Google Scholar 

  10. Piersma B, Hayward MK, Weaver VM. Fibrosis and cancer: a strained relationship. Biochim Biophys Acta Rev Cancer. 2020;1873:188356. https://doi.org/10.1016/j.bbcan.2020.188356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. von Ahrens D, Bhagat TD, Nagrath D, Maitra A, Verma A. The role of stromal cancer-associated fibroblasts in pancreatic cancer. J Hematol Oncol. 2017;10:76. https://doi.org/10.1186/s13045-017-0448-5.

    Article  CAS  Google Scholar 

  12. Mikuła-Pietrasik J, Uruski P, Tykarski A, Książek K. The peritoneal “soil” for a cancerous “seed”: a comprehensive review of the pathogenesis of intraperitoneal cancer metastases. Cell Mol Life Sci. 2018;75:509–25. https://doi.org/10.1007/s00018-017-2663-1.

    Article  CAS  PubMed  Google Scholar 

  13. Yang X, Lin Y, Shi Y, Li B, Liu W, Yin W, et al. FAP Promotes immunosuppression by cancer-associated fibroblasts in the tumor microenvironment via STAT3-CCL2 signaling. Cancer Res. 2016;76:4124–35. https://doi.org/10.1158/0008-5472.CAN-15-2973.

    Article  CAS  PubMed  Google Scholar 

  14. Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. 68Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60:801–5. https://doi.org/10.2967/jnumed.119.227967.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Giesel FL, Kratochwil C, Lindner T, Marschalek MM, Loktev A, Lehnert W, et al. 68Ga-FAPI PET/CT: biodistribution and preliminary dosimetry estimate of 2 DOTA-containing FAP-targeting agents in patients with various cancers. J Nucl Med. 2019;60:386–92. https://doi.org/10.2967/jnumed.118.215913.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Röhrich M, Naumann P, Giesel FL, Choyke PL, Staudinger F, Wefers A, et al. Impact of 68Ga-FAPI PET/CT imaging on the therapeutic management of primary and recurrent pancreatic ductal adenocarcinomas. J Nucl Med. 2021;62:779–86. https://doi.org/10.2967/jnumed.120.253062.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sagiyama K, Watanabe Y, Kamei R, Hong S, Kawanami S, Matsumoto Y, et al. Multiparametric voxel-based analyses of standardized uptake values and apparent diffusion coefficients of soft-tissue tumours with a positron emission tomography/magnetic resonance system: preliminary results. Eur Radiol. 2017;27:5024–33. https://doi.org/10.1007/s00330-017-4912-y.

    Article  PubMed  Google Scholar 

  18. Yeh R, Dercle L, Garg I, Wang ZJ, Hough DM, Goenka AH. The role of 18F-FDG PET/CT and PET/MRI in pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 2018;43:415–34. https://doi.org/10.1007/s00261-017-1374-2.

    Article  Google Scholar 

  19. Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J, et al. Development of quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nucl Med. 2018;59:1415–22. https://doi.org/10.2967/jnumed.118.210443.

    Article  CAS  PubMed  Google Scholar 

  20. Qin C, Shao F, Gai Y, Liu Q, Ruan W, Liu F, et al. 68Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with 18F-FDG PET/CT. J Nucl Med. 2022;63(1):81–8. https://doi.org/10.2967/jnumed.120.258467.

  21. González-Borja I, Viúdez A, Goñi S, Santamaria E, Carrasco-García E, Pérez-Sanz J, et al. Omics approaches in pancreatic adenocarcinoma. Cancers (Basel). 2019;11:1052. https://doi.org/10.3390/cancers11081052.

    Article  CAS  Google Scholar 

  22. Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060. https://doi.org/10.1038/nrdp.2017.60

  23. Luo Y, Pan Q, Yang H, Peng L, Zhang W, Li F. Fibroblast activation protein-targeted PET/CT with 68Ga-FAPI for imaging IgG4-related disease: comparison to 18F-FDG PET/CT. J Nucl Med. 2021;62:266–71. https://doi.org/10.2967/jnumed.120.244723.

    Article  CAS  PubMed  Google Scholar 

  24. Chen H, Pang Y, Wu J, Zhao L, Hao B, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging. 2020;47:1820–32. https://doi.org/10.1007/s00259-020-04769-z.

    Article  PubMed  Google Scholar 

  25. Qin C, Liu F, Huang J, Ruan W, Liu Q, Gai Y, et al. A head-to-head comparison of 68Ga-DOTA-FAPI-04 and 18F-FDG PET/MR in patients with nasopharyngeal carcinoma: a prospective study. Eur J Nucl Med Mol Imaging. 2021;48:3228–37. https://doi.org/10.1007/s00259-021-05255-w.

    Article  CAS  PubMed  Google Scholar 

  26. Loktev A, Lindner T, Burger EM, Altmann A, Giesel F, Kratochwil C, et al. Development of fibroblast activation protein-targeted radiotracers with improved tumor retention. J Nucl Med. 2019;60:1421–9. https://doi.org/10.2967/jnumed.118.224469.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kanematsu M, Hoshi H, Yamada T, Nandate Y, Kato M, Yokoyama R, et al. Overestimating the size of hepatic malignancy on helical CT during arterial portography: equilibrium phase CT and pathology. J Comput Assist Tomogr. 1997;21:713–9. https://doi.org/10.1097/00004728-199709000-00006.

    Article  CAS  PubMed  Google Scholar 

  28. Peng J, Wang Y, Zhang R, Deng Y, Xiao B, Ou Q, et al. Immune cell infiltration in the microenvironment of liver oligometastasis from colorectal cancer: intratumoural CD8/CD3 ratio is a valuable prognostic index for patients undergoing liver metastasectomy. Cancers (Basel). 2019;11:1922. https://doi.org/10.3390/cancers11121922.

    Article  CAS  Google Scholar 

  29. Wang XY, Yang F, Jin C, Fu DL. Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 2014;20:15580–9. https://doi.org/10.3748/wjg.v20.i42.15580.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sharon Y, Raz Y, Cohen N, Ben-Shmuel A, Schwartz H, Geiger T, et al. Tumor-derived osteopontin reprograms normal mammary fibroblasts to promote inflammation and tumor growth in breast cancer. Cancer Res. 2015;75:963–73. https://doi.org/10.1158/0008-5472.CAN-14-1990.

    Article  CAS  PubMed  Google Scholar 

  31. Neesse A, Bauer CA, Öhlund D, Lauth M, Buchholz M, Michl P, et al. Stromal biology and therapy in pancreatic cancer: ready for clinical translation? Gut. 2019;68:159–71. https://doi.org/10.1136/gutjnl-2018-316451.

    Article  CAS  PubMed  Google Scholar 

  32. Chen WS, Li JJ, Hong L, Xing ZB, Wang F, Li CQ. Comparison of MRI, CT and 18F-FDG PET/CT in the diagnosis of local and metastatic of nasopharyngeal carcinomas: an updated meta analysis of clinical studies. Am J Transl Res. 2016;8:4532–47.

    PubMed  PubMed Central  Google Scholar 

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Funding

We gratefully acknowledge the financial support of the National Natural Science Foundation of China (Grant Nos. 82001867 and 81871390) and the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (Grant Nos. 2019YPT002 and 2020YPT002).

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Author notes

  1. Zeyu Zhang and Guorong Jia contributed equally.

Authors and Affiliations

  1. Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China

    Zeyu Zhang, Guorong Jia, Guixia Pan, Qinqin Yang, Jian Yang, Lu Zhang, Tao Wang, Chao Cheng & Changjing Zuo

  2. Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China

    Kai Cao

  3. Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University, School of Medicine, Shanghai, 200434, China

    Hongyu Meng

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  1. Zeyu Zhang
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Contributions

Zeyu Zhang, Guorong Jia, Chao Cheng, and Changjing Zuo designed the study, interpreted the data, and led the writing and review of the manuscript. Kai Cao, Guixia Pan, Lu Zhang, and Tao Wang synthesised 68 Ga-FAPI-04 and performed the examination. Chao Cheng, Changjing Zuo, Zeyu Zhang, Guorong Jia, Qinqin Yang, Hongyu Meng, and Jian Yang collected clinical and imaging data. Chao Cheng and Changjing Zuo participated in the review of the manuscript.

Corresponding authors

Correspondence to Chao Cheng or Changjing Zuo.

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Ethics approval

This article does not contain any studies with animals. All procedures of this study followed the principles of the Declaration of Helsinki. This prospective study was approved by the Ethics Committee of the First Affiliated Hospital of Naval Medical University (Changhai Hospital, CHEC2020-071).

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All subjects provided written informed consent.

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Informed consent was obtained from all individual participants included in this study.

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This article is part of the Topical Collection on Oncology - Digestive tract

Supplementary Information

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259_2022_5729_MOESM1_ESM.tif

Supplementary Fig. 1 Radiographic follow-up date of 4 patients with abnormal 18F-FDG uptake in pancreas parenchyma.(a)A 61-year-old man (Patient 6) with pancreatic head cancer. 18F-FDG PET/CT showed diffuse increased 18F-FDG uptake in the pancreatic parenchyma of the body and tail. Radiographic follow-up 5 months later showed the peripancreatic inflammation and inflammatory exudation, and no abnormal lesions were found in pancreatic parenchyma. (b) A 65-year-old woman (Patient 10) with pancreatic body cancer. 18F-FDG PET/CT showed focal increased uptake of 18F-FDG in the pancreatic tail parenchyma. Radiographic follow-up 8 months later showed no significant lesions in the tail of the pancreas. (c) A 66-year-old man (Patient 28) with pancreatic head cancer. 18F-FDG PET/CT showed diffuse increased 18F-FDG uptake in the pancreatic parenchyma of the body and tail. Radiographic follow-up 4 months later showed dilation of the pancreatic duct in the body andtail, and no obvious lesions in the pancreatic parenchyma. (d) A 72-year-old man (Patient 30) with pancreatic body cancer.18F-FDG PET/CT showed atrophied pancreatic parenchymal in the body and tail with diffuse increased 18F-FDG uptake. Radiographic follow-up 3 months later showed no significant lesions inthe body and tail of the pancreas. (TIF 52555 KB)

259_2022_5729_MOESM2_ESM.tif

Supplementary Fig. 2 MIP images of 68Ga-FAPI-04 PET and 18F-FDG PET in patients with multiple hepatic metastases (patients 8, 9, 29 and 30) (TIF 41013 KB)

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Zhang, Z., Jia, G., Pan, G. et al. Comparison of the diagnostic efficacy of 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging 49, 2877–2888 (2022). https://doi.org/10.1007/s00259-022-05729-5

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