镓[^68Ga]DOTA-乏血供型氟代苯丙氨酸正电子发射断层扫描（FAPI）对比氟[^18F]脱氧葡萄糖正电子发射断层扫描（FDG PET/CT）在胸腺瘤评估中的优势。
Superiority of [Ga]Ga-DOTA-FAPI-04 PET/CT to [F]FDG PET/CT in the evaluation of thymic epithelial tumours.
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, No. 52 Fucheng Rd, Beijing, 100142, China.
出版信息
Eur J Nucl Med Mol Imaging. 2023 Sep;50(11):3414-3424. doi: 10.1007/s00259-023-06294-1. Epub 2023 Jun 15.
PURPOSE
The purpose of this study is to compare the ability of [Ga]Ga-DOTA-FAPI-04 PET/CT and [F]FDG PET/CT to stratify the malignancy and invasiveness of thymic epithelial tumours (TETs).
METHODS
From April 2021 to November 2022, participants with suspected TETs confirmed by histopathology or follow-up imaging were prospectively analysed. All participants underwent [F]FDG and [Ga]Ga-DOTA-FAPI-04 PET/CT within 1 week. Clinical characteristics, CT features, and metabolic parameters (maximum standardized uptake value [SUV] and tumour-to-mediastinum ratio [TMR]) of subjects with different pathological types and stages were compared. The diagnostic capacities of [F]FDG and [Ga]Ga-DOTA-FAPI-04 PET/CT were compared using receiver operating characteristic (ROC) curves and McNemar's test.
RESULTS
Fifty-seven participants were included. [Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [F]FDG PET/CT in differentiating thymomas from thymic carcinomas (TCs) (AUC: 0.99 vs. 0.90, P = 0.02). Logistic regression revealed that SUV (P = 0.04) was a significant predictive factor for TCs. SUV and TMR showed an excellent ability to differentiate low-risk thymomas (types A, AB, and B1), high-risk thymomas (types B2 and B3), and TCs (both P < 0.001). In thymomas, only SUV (P < 0.001), TMR (P < 0.001), and nonsmooth edges (P = 0.02) were significantly higher in the advanced-stage (Masaoka-Koga [MK] stage III/IV) group than in the early-stage group (MK stage I/II). Compared with [F]FDG PET/CT, [Ga]Ga-DOTA-FAPI-04 PET/CT showed significantly higher specificity (67% [46 of 69] vs. 93% [64 of 69], P < 0.001) in the detection of lymph node metastases and higher sensitivity (49% [19 of 39] vs. 97% [38 of 39], P < 0.001) in evaluating distant metastases. Both SUV and TMR were correlated with FAP expression (both r = 0.843, P < 0.001).
CONCLUSION
[Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [F]FDG PET/CT in evaluating the World Health Organization (WHO) classification, MK staging, and metastatic status of TETs.
TRIAL REGISTRATION
ChiCTR2000038080, registration date 2020-09-09, https://www.chictr.org.cn/com/25/showproj.aspx?proj=61192.
目的
本研究旨在比较 [Ga]Ga-DOTA-FAPI-04 PET/CT 和 [F]FDG PET/CT 在分层胸腺上皮肿瘤（TET）恶性程度和侵袭性方面的能力。
方法
2021 年 4 月至 2022 年 11 月，前瞻性分析经组织病理学或随访影像学证实为疑似 TET 的患者。所有患者均在 1 周内接受 [F]FDG 和 [Ga]Ga-DOTA-FAPI-04 PET/CT 检查。比较不同病理类型和分期患者的临床特征、CT 特征和代谢参数（最大标准化摄取值 [SUV]和肿瘤-纵隔比 [TMR]）。使用受试者工作特征（ROC）曲线和 McNemar 检验比较 [F]FDG 和 [Ga]Ga-DOTA-FAPI-04 PET/CT 的诊断能力。
结果
共纳入 57 例患者。[Ga]Ga-DOTA-FAPI-04 PET/CT 在鉴别胸腺瘤和胸腺癌（TC）方面优于 [F]FDG PET/CT（AUC：0.99 比 0.90，P=0.02）。Logistic 回归显示 SUV（P=0.04）是 TC 的显著预测因素。SUV 和 TMR 显示出极好的区分低危胸腺瘤（A、AB 和 B1 型）、高危胸腺瘤（B2 和 B3 型）和 TC 的能力（均 P<0.001）。在胸腺瘤中，仅 SUV（P<0.001）、TMR（P<0.001）和非光滑边缘（P=0.02）在晚期（Masaoka-Koga [MK] 分期 III/IV）组中显著高于早期组（MK 分期 I/II）。与 [F]FDG PET/CT 相比，[Ga]Ga-DOTA-FAPI-04 PET/CT 在检测淋巴结转移方面具有显著更高的特异性（67%[69 例中的 46 例]比 93%[69 例中的 64 例]，P<0.001），在评估远处转移方面具有更高的敏感性（49%[39 例中的 19 例]比 97%[39 例中的 38 例]，P<0.001）。SUV 和 TMR 均与 FAP 表达相关（均 r=0.843，P<0.001）。
结论
[Ga]Ga-DOTA-FAPI-04 PET/CT 在评估 TET 的世界卫生组织（WHO）分类、MK 分期和转移状态方面优于 [F]FDG PET/CT。
临床试验注册
ChiCTR2000038080，注册日期 2020-09-09，https://www.chictr.org.cn/com/25/showproj.aspx?proj=61192。
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