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Usefulness of [68Ga]FAPI-04 and [18F]FDG PET/CT for the detection of primary tumour and metastatic lesions in gastrointestinal carcinoma: a comparative study

  • Gastrointestinal
  • Published:
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Abstract

Objective

To assess and compare the diagnostic performance of gallium-68-labelled fibroblast activation protein inhibitor ([68Ga]FAPI-04) and fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in gastrointestinal cancer.

Methods

Fifty-one patients who underwent both [18F]FDG and [68Ga]FAPI-04 PET/CT for initial staging or restaging were enrolled. Histopathological findings, typical radiological appearances, and clinical imaging follow-up were used as the reference standard. The diagnostic performance of the two tracers was calculated and compared. The maximum standardised uptake value (SUVmax), mean SUV (SUVmean), tumour-to-mediastinal blood pool ratio (TBR), and tumour-to-liver ratio (TLR) of primary and metastatic lesions were measured and compared between two imaging modalities.

Results

In patient-based analysis, [68Ga]FAPI-04 showed much better diagnostic sensitivity than [18F]FDG in detecting primary tumour (94.44% [17/18] vs. 61.11% [11/18]), postoperative recurrence and metastases (95.65% [22/23] vs. 69.57% [16/23]), and peritoneal carcinomatosis (100% [28/28] vs. 60.71% [17/28]) (all p < 0.05). In lesion-based analysis, [68Ga]FAPI-04 showed higher sensitivity than [18F]FDG for detecting lymph node metastases. In peritoneal carcinomatosis, the median SUVmax (12.12 vs. 7.18) and SUVmean (6.84 vs. 4.11) with [68Ga]FAPI-04 were significantly higher than those with [18F]FDG (all p < 0.005). The TBR and TLR of [68Ga]FAPI-04 were significantly higher than those of [18F]FDG for detecting primary tumour, lymph node, liver, and peritoneal metastases (all p < 0.005). Therapeutic management changed in 13 patients according to [68Ga]FAPI-04 PET/CT compared with conventional imaging.

Conclusions

[68Ga]FAPI-04 is superior to [18F]FDG PET/CT for detecting primary tumour, postoperative recurrence and metastasis, and peritoneal carcinomatosis in gastrointestinal cancer.

Key Points

• [68Ga]FAPI-04 PET/CT showed significantly higher sensitivity than [18F]FDG PET/CT in the detection of primary tumour and postoperative recurrence and metastasis in patients with gastrointestinal carcinoma.

• [68Ga]FAPI-04 PET/CT had obvious advantages over [18F]FDG PET/CT in the detection of peritoneal carcinomatosis from gastrointestinal carcinoma with a much higher FAPI uptake value, TBR, and TLR.

• Although the median SUVmax and SUVmean of [68Ga]FAPI-04 were similar to those of [18F]FDG for the primary tumour, lymph node metastases, and liver metastases in gastrointestinal carcinoma, the TBR and TLR of the SUVmax and SUVmean were significantly higher on [68Ga]FAPI-04 PET/CT, causing the lesions to be displayed more clearly.

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Abbreviations

CAF:

Cancer-associated fibroblast

CT:

Computed tomography

FAP:

Fibroblast activation protein

FAPI:

Fibroblast activation protein inhibitor

FDG:

Fluorodeoxyglucose

IQR:

Interquartile range

MAC:

Mucinous adenocarcinoma

MRI:

Magnetic resonance imaging

PET/CT:

Positron emission tomography/computed tomography

SRCC:

Signet ring cell carcinoma

SUV:

Standardised uptake value

TBR:

Tumour-to-mediastinal blood pool ratio

TLR:

Tumour-to-normal liver parenchyma ratio

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Funding

This study has received funding by the Improvement Project for Theranostic Ability on Difficulty Miscellaneous Disease (tumour) (No. ZLYNXM202007), the National Natural Science Foundation of China (No. 82171986), the Medical Sci-Tech Innovation Platform of Zhongnan Hospital of Wuhan University (PTXM2022013), and Science, Technology and Innovation Seed Fund of Zhongnan Hospital of Wuhan University (CXPY2020045).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, No. 169 East Lake Road, Wuchang District, Wuhan, 430071, Hubei Province, China

    Chongjiao Li, Yueli Tian, Jie Chen, Yaqun Jiang, Zejian Xue, Diankui Xing, Bing Wen & Yong He

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  1. Chongjiao Li
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  8. Yong He
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Correspondence to Yong He.

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The scientific guarantor of this publication is prof. Yong He, MD, PhD.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Li, C., Tian, Y., Chen, J. et al. Usefulness of [68Ga]FAPI-04 and [18F]FDG PET/CT for the detection of primary tumour and metastatic lesions in gastrointestinal carcinoma: a comparative study. Eur Radiol 33, 2779–2791 (2023). https://doi.org/10.1007/s00330-022-09251-y

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