通过F-FAPI-04 PET/CT对肾移植排斥反应进行无创诊断和分类
Noninvasive diagnosis and classification of kidney transplantation rejection by F-FAPI-04 PET/CT.
作者信息
Luo Sulin, Xu Mimi, Shen Rongfang, Wang Meifang, Wu Qinyun, Zhang Tianlu, Jin Zhenpeng, Yan Pengpeng, Guo Luying, Zhou Jingyi, Zhou Qin, Wang Huiping, Zhao Kui, Su Xinhui, Wang Rending
机构信息
Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Institute of Nephrology, Zhejiang University, Hangzhou, China.
出版信息
Eur J Nucl Med Mol Imaging. 2025 May 8. doi: 10.1007/s00259-025-07307-x.
PURPOSE
Rejection, especially chronic rejection is a key factor influencing the prognosis of kidney transplantation patients. While F-fibroblast activation protein inhibitor (FAPI)-04 PET/CT has been widely utilized for diagnosing various diseases, its diagnostic efficacy in kidney transplant rejection remains unexplored.
METHODS
In this study, 24 kidney transplant recipients were prospectively enrolled and divided into a control cohort and a rejection cohort (KTR), which were further classified into acute rejection (AR), mixed rejection (MR), and chronic rejection (CR) subgroups. All patients underwent F-FAPI-04 PET/CT and F-FDG PET/CT scans, along with immunohistochemical FAP staining and Banff pathological scoring. The maximum and average standardized uptake values (SUVs) of the two imaging methods were calculated.
RESULTS
Compared with the control cohort, the KTR cohort showed significantly higher serum creatinine levels, lower estimated glomerular filtration rates, and lower hemoglobin levels. The SUVmax of F-FAPI-04 PET/CT in the allograft kidney cortex (AKC) and allograft kidney biopsy site (AKB) in the KTR cohort was significantly greater than that in the control cohort. The SUVmax of F-FDG PET/CT between the two cohorts was significantly different only in the AKC. For the KTR cohort, the SUVmax of F-FAPI-04 PET/CT in AKC and AKB was considerably greater than that of F-FDG PET/CT (5.5 vs. 2.8 and 3.6 vs. 2.5, respectively; both p < 0.01). In the CR cohort, the SUVmax of F-FAPI-04 PET/CT in the AKC, AKB, and allograft kidney medulla (AKM) was significantly greater (7.1, 5.3, and 3.2) than that of F-FDG PET/CT (2.5, 2.1 and 1.8) (p = 0.009, 0.009 and 0.016, respectively). The SUVmax of F-FAPI-04 PET/CT in AKB increased gradually in the AR, MR, and CR cohorts (2.8 vs. 3.6 vs. 5.3, p = 0.02). The above results were consistent with the SUVavg statistics. The number of FAP-positive stromal cells was different between the control and KTR groups and among the AR, MR, and CR subgroups.
CONCLUSION
F-FAPI-04 PET/CT outperforms F-FDG PET/CT in distinguishing kidney transplant rejection, especially chronic rejection.
目的
排斥反应，尤其是慢性排斥反应是影响肾移植患者预后的关键因素。虽然F-成纤维细胞活化蛋白抑制剂（FAPI）-04 PET/CT已被广泛用于诊断各种疾病，但其在肾移植排斥反应中的诊断效能仍未得到探索。
方法
在本研究中，前瞻性纳入了24名肾移植受者，并将其分为对照组和排斥反应组（KTR），后者又进一步分为急性排斥反应（AR）、混合排斥反应（MR）和慢性排斥反应（CR）亚组。所有患者均接受了F-FAPI-04 PET/CT和F-FDG PET/CT扫描，以及免疫组化FAP染色和Banff病理评分。计算了两种成像方法的最大和平均标准化摄取值（SUVs）。
结果
与对照组相比，KTR组的血清肌酐水平显著更高，估计肾小球滤过率更低，血红蛋白水平更低。KTR组中移植肾皮质（AKC）和移植肾活检部位（AKB）的F-FAPI-04 PET/CT的SUVmax显著高于对照组。两组之间F-FDG PET/CT的SUVmax仅在AKC中有显著差异。对于KTR组，AKC和AKB中F-FAPI-04 PET/CT的SUVmax明显大于F-FDG PET/CT的SUVmax（分别为5.5对2.8和3.6对2.5；均p < 0.01）。在CR亚组中，AKC、AKB和移植肾髓质（AKM）中F-FAPI-04 PET/CT 的SUVmax显著大于F-FDG PET/CT的SUVmax（分别为7.1、5.3和3.2）（分别为2.5、2.1和1.8）（p分别为0.009、0.009和0.016）。AKB中F-FAPI-04 PET/CT的SUVmax在AR、MR和CR亚组中逐渐升高（2.8对3.6对5.3，p = 0.02）。上述结果与SUVavg统计结果一致。对照组与KTR组之间以及AR、MR和CR亚组之间FAP阳性基质细胞的数量不同。
结论
在区分肾移植排斥反应，尤其是慢性排斥反应方面，F-FAPI-04 PET/CT优于F-FDG PET/CT。
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