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Imaging fibroblast activation protein in liver cancer: a single-center post hoc retrospective analysis to compare [68Ga]Ga-FAPI-04 PET/CT versus MRI and [18F]-FDG PET/CT

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Abstract

Purpose

This study aimed to evaluate the potential utility of [68Ga]Ga-FAPI-04 PET/CT for diagnosing primary and metastatic lesions in patients with liver cancer, as well as to compare it with contrast-enhanced CT (CE-CT), liver MRI, and [18F]-FDG PET/CT.

Methods

We performed a single-center post hoc retrospective analysis of data obtained from a prospective parent study (NCT04416165). This study included 34 patients diagnosed with or suspected hepatic lesions who underwent concomitant [68Ga]Ga-FAPI-04 and [18F]-FDG/CT scans. Moreover, these patients underwent liver MRI (n = 34) and CE-CT (n = 25). Histopathologic (n = 62) or radiographic follow-up (n = 128) served as the reference standard for the final diagnosis.

Results

Among the 34 patients, 20, 12, and 2 patients presented with hepatocellular carcinomas, intrahepatic cholangiocarcinomas, and benign hepatic nodules, respectively. The sensitivities of CE-CT, MRI, [68Ga]Ga-FAPI-04, and [18F]-FDG/CT for detecting primary liver tumors were 96%, 100%, 96%, and 65%, respectively. Regarding the diagnosis of all intrahepatic lesions, the per-lesion detection rate of [68Ga]Ga-FAPI-04 PET/CT was slightly lower than that of MRI (85% vs. 100%, P = 0.34) and significantly higher than that of [18F]-FDG PET/CT (85% vs. 52%, P < 0.001). Regarding the diagnosis of all malignant lesions (including extrahepatic disease), the tumor detection rate of [68Ga]Ga-FAPI-04 PET/CT was 87.4%, which was significantly higher than that of [18F]-FDG PET/CT (65.0%, P < 0.001).

Conclusions

Our findings indicate that the sensitivity of [68Ga]Ga-FAPI-04 PET/CT to correctly identify primary liver tumors and metastatic lesions is equivalent to that of CE-CT and liver MRI. Moreover, [68Ga]Ga-FAPI-04 PET/CT is better at identifying liver lesions than [18F]-FDG PET/CT, and its use may improve tumor staging, recurrence detection, and implementation of necessary treatment modifications.

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Data availability

Not applicable.

Abbreviations

PET/CT:

Positron emission tomography/computed tomography

SUV:

Standard uptake value

BCLC:

Barcelona Clinic Liver Cancer

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

CE-CT:

Contrast-enhanced computed tomography

MRI:

Magnetic resonance imaging

[18F]-FDG:

Fluorine-18 fluoro-2-deoxyglucose

FAP:

Fibroblast activation protein

CAFs:

Cancer-associated fibroblasts

[68Ga]Ga-FAPI-04:

[68Ga]Ga-labeled FAP inhibitor with the DOTA-containing ligand

TBR:

Target-to-background ratio

PPV:

Positive predictive value

NPV:

Negative predictive value

ANOVA:

Analysis of variance

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Funding

This work was supported by the National Natural Science Foundation of China (CN) (Grant No. 81801735 and Grant No. 81701736) and the key medical and health projects in Xiamen (3502Z20191104).

Author information

Author notes

  1. Wei Guo and Yizhen Pang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine & Minnan PET Center, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, China

    Wei Guo, Yizhen Pang, Lanlin Yao, Bing Hao, Hao Fu, Hua Wu, Long Sun & Haojun Chen

  2. Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, China

    Liang Zhao & Qin Lin

  3. Department of Colorectal Tumor Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, China

    Chunlei Fan

  4. Department of Hepatobiliary & Pancreatovascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China

    Jingpeng Ke & Ping Guo

  5. Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, China

    Chengrong Xie

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  1. Wei Guo
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Correspondence to Long Sun or Haojun Chen.

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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any animal experiments.

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Guo, W., Pang, Y., Yao, L. et al. Imaging fibroblast activation protein in liver cancer: a single-center post hoc retrospective analysis to compare [68Ga]Ga-FAPI-04 PET/CT versus MRI and [18F]-FDG PET/CT. Eur J Nucl Med Mol Imaging 48, 1604–1617 (2021). https://doi.org/10.1007/s00259-020-05095-0

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