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A comparative study of [68Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in the diagnostic accuracy and resectability prediction of ovarian cancer

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

Abstract

Purpose

To provide a theory for guiding clinical treatment by comparing the clinical application value of [18F]fluorodeoxyglucose ([18F]FDG) PET/CT and [68Ga]Ga-FAPI (fibroblast activating protein inhibitor) PET/MR in the diagnosis and evaluation of resectability of ovarian cancer.

Methods

Thirty patients with high clinical suspicion of ovarian malignancies were enrolled from July 2021 to October 2022 and underwent [18F]FDG PET/CT and [68Ga]Ga-FAPI-04 PET/MR within 5 days. Twenty patients underwent [18F]FDG PET/MR at once completing [18F]FDG PET/CT for consistency checking. Images were analysed for comparing SUVs and for judging incomplete resectability according to the peritoneal cancer index (PCI) and SUIDAN scoring system. The expression of FAP, HK2 and Ki67 was analysed by immunohistochemistry staining.

Results

There was no significant difference between PET/MR and PET/CT in SUVs-FDG at different locations (p > 0.05), and their diagnostic accuracies were similar. The diagnostic accuracy of [68Ga]Ga-FAPI-04 PET/MR had advantages for peritoneal metastasis since SUVsFAPI were higher (p < 0.01). The sensitivity of [68Ga]Ga-FAPI-04 PET/MR in the diagnosis of peridiaghragmatic metastases was higher because SUVmax in the liver was decreased (p < 0.001). [68Ga]Ga-FAPI-04 PET/MR might have advantages in diagnosing gastrointestinal invasion. In PCI score analysis, [68Ga]Ga-FAPI-04 PET/MR could partially correct missing or underestimated scores by [18F]FDG PET/CT, but the matching probability between left peri-intestinal metastasis scores was low and easy to overestimate. Interestingly, diaphragmatic metastasis detected by [68Ga]Ga-FAPI-04 PET/MR had the greatest correlation with the prediction of incomplete resectability (logistic regression p = 0.02). Through immunohistochemistry, the expression of FAP had a strong correlation with SUVmax-FAPI (p < 0.001), while the expression of HK2 was correlated with SUVmax-FDG (p < 0.01). In addition, SUVmax-FDG with Ki67 ≥ 20% was significantly higher than that with Ki67 < 20% (p < 0.05).

Conclusions

[68Ga]Ga-FAPI-04 PET/MR had obvious advantages for metastases diagnosis and could more accurately assess tumour load and predict incomplete resectability. SUVmax-FDG was conducive to evaluating the degree of tumour malignancy.

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Data Availability

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

PCI:

Peritoneal cancer index

EOC:

Epithelial ovarian cancer

PDS:

Primary debulking surgery

IDS:

Interval debulking surgery

NACT:

Chemotherapy and neoadjuvant chemotherapy

NCCN:

National Comprehensive Cancer Network

US:

Ultrasonography

PET:

Positron emission computed tomography

[18F]FDG:

[18F]fluorodeoxyglucose

[18F]FDG-6-PO4 :

[18F]fluorodeoxyglucose-6-phosphate

HK:

Hexokinase

FAP:

Fibroblast activating protein

FAPI:

68Ga-Fibroblast activating protein inhibitor

CAFs:

Cancer-related fibroblasts

NAFs:

Normal activated fibroblasts

ROI:

Region of interest

TBR:

Tumour background ratio

AUC:

Area under the curve

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Funding

This study was supported by the National Natural Science Foundation of China (grant number 81801728 from Author Yun Xi; grant number 82172601 from author Weiwei Feng), the Natural Science Foundation of Shanghai Science and Technology Commission (grant number 20ZR1433700 from author Weiwei Feng), and the Shanghai Municipal Key Clinical Specialty (grant number shslczdzk03403 from author Biao Li).

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Author notes

  1. Yun Xi and Lili Sun contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China

    Yun Xi, Xinyun Huang, Hongping Meng, Yuxin Miao, Qian Qu, Wangxi Hai & Biao Li

  2. Department of Obstetrics and Gynecology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197, Ruijin Er Road, Shanghai, 200025, China

    Lili Sun, Xiaoxia Che, Hua Liu, Qun Wang & Weiwei Feng

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  1. Yun Xi
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Contributions

Weiwei Feng and Biao Li designed the study. Yun Xi and Lili Sun performed the experiments and wrote the manuscript. Xiaoxia Che, Hua Liu, and Qun Wang selected cases and performed the clinical evaluation. Qian Qu and Wangxi Hai prepared radionuclides. Hongping Meng and Yuxin Miao operated PET/MR and PET/CT. All authors discussed the results and commented on the manuscript.

Corresponding authors

Correspondence to Biao Li or Weiwei Feng.

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This clinical investigation was approved by the Medical Ethical Committee of Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital (N2021-284).

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

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The authors declare no competing interests.

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Xi, Y., Sun, L., Che, X. et al. A comparative study of [68Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in the diagnostic accuracy and resectability prediction of ovarian cancer. Eur J Nucl Med Mol Imaging 50, 2885–2898 (2023). https://doi.org/10.1007/s00259-023-06235-y

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