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[68Ga]Ga-FAPI-04 PET/CT on assessing Crohn’s disease intestinal lesions

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An Editorial to this article was published on 11 February 2023

Abstract

Background

Fibrosis and inflammation are major pathological changes of Crohn’s disease (CD). Early detection and accurate severity evaluation of CD are critical for patient’s prognosis. Endoscopy is widely used to evaluate CD progression. Herein, we evaluated the efficacy of [68Ga]Ga-FAPI-04 PET/CT to identify lesions and assess the progression of CD.

Methods

All CD patients received computed tomography enterography (CTE), [68Ga]Ga-FAPI-04 PET/CT examination, and ileocolonoscopy within 1 week. Two independent gastroenterologists computed the Crohn’s disease activity index (CDAI) of all patients. Two radiology physicians assessed the CTE images separately, and the CTE scores were calculated. Lastly, two nuclear medicine physicians independently examined the [68Ga]Ga-FAPI-04 PET/CT images. Once the FAPI uptake of the intestinal segment was equal or higher relative to the liver (considered FAPI-positive), the target-to-background ratio (TBR) and global FAPI PET/CT score were computed, representing the independent intestinal activity and activity of all intestinal segments, respectively. Levels of fecal calprotectin (FCP) and C-reactive protein (CRP) were determined before the endoscopy. The Crohn’s disease endoscopy index of severity (CDEIS) and the simple endoscopic score for Crohn’s disease (SES-CD) were calculated during the endoscopy. Finally, all data were obtained and analyzed.

Results

There were 74 intestinal segments in 16 patients were assessed. [68Ga]Ga-FAPI-04 PET/CT identified 42 of 45 endoscopically lesioned segments (endoscopic lesions detection sensitivity: 93.3%), while CTE identified 39 of them (endoscopic lesions detection sensitivity: 86.7%). According to the receiver operating characteristic (ROC) analysis, [68Ga]Ga-FAPI-04 PET/CT showed better performance in the detection of endoscopic lesions compared with CTE (P < 0.05). The TBR was significantly associated with the CTE score (r = 0.81; (95% CI): 0.736–0.869; P < 0.0001) and SES-CD values (r = 0.86; (95% CI): 0.776–0.908; P < 0.0001). In addition, the global FAPI PET/CT score was significantly correlated with FCP (r = 0.52; 95% CI, 0.02–0.81; P = 0.039), CRP (r = 0.60; 95% CI, 0.13–0.85; P = 0.014), CDEIS (r = 0.55; 95% CI, 0.06–0.83; P = 0.028), and CDAI (r = 0.81; 95% CI, 0.50–0.93; P < 0.0001).

Conclusion

In summary, [68Ga]Ga-FAPI-04 PET/CT correlated well with endoscopic, CTE, clinical, and biomarkers of CD. It was also highly sensitive in the detection of different classes of lesions in all intestinal segments, and unlike other examinations, this technique required no patient fasting or bowel preparation. Therefore, [68Ga]Ga-FAPI-04 PET/CT may be a promising method for assessing the activity of CD.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The Luzhou Science and Technology Bureau (Grant No. 2021LZXNYD-J09) and the National Outstanding Youth Science Fund Project of the National Natural Science Foundation of China (Grant No. 82100632) provided financial support for this study.

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Author notes

  1. Liming Chen, Xiaolin Zhong, and Limin Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China

    Liming Chen, Xue Li, Ya Liu, Chunmei Guo, Yue Chen & Zhanwen Huang

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

    Liming Chen, Xue Li, Ya Liu, Chunmei Guo, Yue Chen & Zhanwen Huang

  3. Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China

    Liming Chen, Xue Li, Ya Liu, Chunmei Guo, Yue Chen & Zhanwen Huang

  4. Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China

    Xiaolin Zhong & Limin Li

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  1. Liming Chen
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Correspondence to Zhanwen Huang.

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Chen, L., Zhong, X., Li, L. et al. [68Ga]Ga-FAPI-04 PET/CT on assessing Crohn’s disease intestinal lesions. Eur J Nucl Med Mol Imaging 50, 1360–1370 (2023). https://doi.org/10.1007/s00259-023-06107-5

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