Fibroblast Activating Protein Targeted Imaging
Comparison of clinical utility of 18F-FAPI-42 and 18F-FDG PET/CT imaging in the diagnosis of newly diagnosed lung cancer
Li Youcai, Zhang Xiaoyao, Zhang Yan, Liu Shaoyu, Chen Penghao, Wu Fang, Zhou Yanxiang, Hou Peng, Liang Wenhua, Wang Xinlu
Published 2021-12-25
Cite as Chin J Nucl Med Mol Imaging, 2021, 41(12): 709-716. DOI: 10.3760/cma.j.cn321828-20210831-00300
Abstract
ObjectiveTo compare the clinical utility of 18F-fibroblast activating protein inhibitor (FAPI)-42 and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in newly diagnosed lung cancer patients.
MethodsFrom May 2020 to September 2021, the images of 43 lung cancer patients (32 males, 11 females, age: 37-80 years) who pathologically confirmed and received 18F-FDG and 18F-FAPI-42 PET/CT within 2 weeks in the First Affiliated Hospital of Guangzhou Medical University were prospectively analyzed. The maximum standardized uptake value (SUVmax) of 18F-FDG and 18F-FAPI-42 and the number of lesions detected by 2 imaging methods were compared by using paired t test and Wilcoxon rank sum test.
ResultsThe 43 newly diagnosed lung cancer patients included 35 adenocarcinoma, 2 squamous cell carcinoma, 4 small cell lung cancer, and 2 high-grade neuroendocrine tumors. 18F-FAPI-42 had a very high tumor uptake (SUVmax: 12.24±3.97) and lesion detection rate (positive rate: 100%(37/37)) in primary lung adenocarcinoma and squamous cell carcinoma. The uptake of 18F-FAPI-42 in lymph node (10.13±5.43), pleura (6.75(4.96, 8.58)) and bone lesion (7.18(4.33, 9.66)) were significantly higher than those of 18F-FDG (6.35±3.30, 2.69(1.81, 5.00), 4.38(2.96, 6.36); t=12.19, z values: 5.47, 5.79, all P<0.001). In lung adenocarcinoma and squamous cell carcinoma, although the uptake of18F-FAPI-42 in brain metastases was significantly lower than that of 18F-FDG (0.72(0.15, 1.82) vs 6.53(4.65, 9.34); z=6.42, P<0.001), the tumor/background (T/B) ratio was significantly higher than that of18F-FDG (3.54(1.15, 14.88) vs 0.96(0.77, 1.04); z=6.05, P<0.001). In lung adenocarcinoma and squamous cell carcinoma, the number of lesions detected by18F-FAPI-42 PET/CT was significantly more than that of 18F-FDG (lymph node: 6.0(2.3, 11.5) vs 4.5(2.0, 10.8); brain: 2.0(1.0, 3.0) vs 0.0(0.0, 0.0); pleura: 6.0(2.8, 10.0) vs 4.0(0.8, 5.5); z values: 2.16, 3.10, 2.04, all P<0.05). However, in high-grade neuroendocrine tumors and small cell lung cancer, the SUVmax of 18F-FAPI-42 in primary lesions (8.05±2.60), lymph node lesions (5.98±2.21) and brain lesions (0.44(0.13, 0.82)) were lower than those of 18F-FDG (16.28±5.17, 12.30±5.47, 4.94(4.84, 6.25); t values: 3.58, 7.52, z=3.06, all P<0.05).
ConclusionsIn lung adenocarcinoma and squamous cell carcinoma, 18F-FAPI-42 has a very high tumor uptake and lesion detection rate in primary tumor. In addition, compared with 18F-FDG PET/CT, 18F-FAPI-42 PET/CT shows clearer tumor contours and more lesions. Therefore, 18F-FAPI-42 is more suitable for preliminary staging of lung adenocarcinoma and squamous cell carcinoma than 18F-FDG, while the opposite is true in small cell lung cancer and high-grade neuroendocrine tumors.
Key words:
Lung neoplasms; Antagonists and inhibitors; Membrane proteins; Fibroblasts; Fluorine radioisotopes; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose
Contributor Information
Li Youcai
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Zhang Xiaoyao
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Zhang Yan
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Liu Shaoyu
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Chen Penghao
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Wu Fang
Guangzhou Medical University, Guangzhou 510120, China
Zhou Yanxiang
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Hou Peng
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Liang Wenhua
Department of Thoracic Oncology and Surgery, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Wang Xinlu
Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
