镓[^68^Ga]镓[^18^F]双半胱氨酸二肽[FAPI]-04 正电子发射断层扫描/计算机断层扫描（PET/CT）在胃癌评估中的应用：与[^18^F]氟脱氧葡萄糖（FDG）PET/CT 的比较。
[Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [F]FDG PET/CT.
机构信息
Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China.
Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
出版信息
Eur J Nucl Med Mol Imaging. 2022 Jul;49(8):2960-2971. doi: 10.1007/s00259-022-05799-5. Epub 2022 Apr 25.
PURPOSE
This study aimed to compare the performance of [Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT in the evaluation of primary and metastatic lesions of gastric cancer.
METHODS
Fifty-six patients with histologically proven gastric carcinomas were enrolled in this study, including 45 patients for staging and 11 patients for restaging after surgery. Each patient underwent both [F]FDG and [Ga]Ga-DOTA-FAPI-04 PET/CT within 1 week. The activity of tracer accumulation in lesions was assessed by maximum standardized uptake value (SUV) and TBR (lesions SUV/ascending aorta SUV). Histological workup served as a standard of reference. If tissue diagnosis was not applicable, the follow-up data including the results of laboratory tests and medical imaging could also serve as a reference.
RESULTS
[Ga]Ga-DOTA-FAPI-04 PET/CT was comparable to [F]FDG on detecting primary tumors and lymph node (LN) metastases, whereas [Ga]Ga-DOTA-FAPI-04 outperformed [F]FDG in detecting peritoneal (159 vs. 47, P < 0.001) and bone metastases (64 vs. 55, P = 0.003) by the lesion-based analysis. [Ga]Ga-DOTA-FAPI-04 showed higher SUV (10.3 vs. 8.1, P = 0.004) and TBR (11.6 vs. 5.8, P < 0.001) in primary tumor, and higher TBR in LN involvement (8.0 vs. 3.7, P < 0.001) and peritoneal metastases (8.1 vs. 3.2, P < 0.001), compared with [F]FDG PET/CT. The specificity and positive predictive value of [ Ga]Ga-DOTA-FAPI-04 were significantly higher than that of [F]FDG (100.0% vs. 97.7%, P < 0.001; 100.0% vs. 57.1%, P = 0.001) in determining the LN status. [Ga]Ga-DOTA-FAPI-04 was comparable to [F]FDG in evaluating N-staging (47.1% vs. 23.5%, P = 0.282). [Ga]Ga-DOTA-FAPI-04 PET/CT detected more positive recurrent lesions in all restaging patients and showed clearer tumor delineation. Two patients underwent follow-up [Ga]Ga-DOTA-FAPI-04 PET/CT scans after chemotherapy, which both showed remission.
CONCLUSIONS
[Ga]Ga-DOTA-FAPI-04 PET/CT can better evaluate primary gastric cancer and metastatic lesions in the peritoneum, abdominal LNs, and bone. Furthermore, [Ga]Ga-DOTA-FAPI-04 PET/CT provided more information for patients with recurrent disease and had the potential in monitoring response to treatment.
目的
本研究旨在比较 [Ga]Ga-DOTA-FAPI-04 和 [F]FDG PET/CT 在评估胃癌原发和转移病灶中的性能。
方法
本研究纳入了 56 例经组织学证实的胃癌患者，其中 45 例用于分期，11 例用于手术后的再分期。每位患者在 1 周内同时接受 [F]FDG 和 [Ga]Ga-DOTA-FAPI-04 PET/CT 检查。通过最大标准化摄取值（SUV）和 TBR（病灶 SUV/升主动脉 SUV）评估示踪剂在病灶中的活性。组织学检查作为标准参考。如果无法进行组织诊断，则可以根据随访数据（包括实验室检查和医学影像学结果）作为参考。
结果
[Ga]Ga-DOTA-FAPI-04 PET/CT 在检测原发肿瘤和淋巴结（LN）转移方面与 [F]FDG 相当，而在检测腹膜（159 比 47，P<0.001）和骨转移（64 比 55，P=0.003）方面，[Ga]Ga-DOTA-FAPI-04 优于 [F]FDG。与 [F]FDG PET/CT 相比，[Ga]Ga-DOTA-FAPI-04 在原发肿瘤中具有更高的 SUV（10.3 比 8.1，P=0.004）和 TBR（11.6 比 5.8，P<0.001），在 LN 受累（8.0 比 3.7，P<0.001）和腹膜转移（8.1 比 3.2，P<0.001）中具有更高的 TBR。与 [F]FDG 相比，[Ga]Ga-DOTA-FAPI-04 在确定 LN 状态时的特异性和阳性预测值显著更高（100.0%比 97.7%，P<0.001；100.0%比 57.1%，P=0.001）。[Ga]Ga-DOTA-FAPI-04 在评估 N 分期方面与 [F]FDG 相当（47.1%比 23.5%，P=0.282）。[Ga]Ga-DOTA-FAPI-04 PET/CT 在所有再分期患者中检测到更多阳性复发性病灶，并显示出更清晰的肿瘤边界。两名患者在化疗后接受了后续的 [Ga]Ga-DOTA-FAPI-04 PET/CT 检查，均显示缓解。
结论
[Ga]Ga-DOTA-FAPI-04 PET/CT 可更好地评估胃癌原发灶和腹膜、腹部 LN 和骨骼中的转移病灶。此外，[Ga]Ga-DOTA-FAPI-04 PET/CT 可为复发性疾病患者提供更多信息，并具有监测治疗反应的潜力。
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