Comparison of PET imaging of activated fibroblasts and 18 F-FDG for diagnosis of primary hepatic tumours: a prospective
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ORIGINAL ARTICLE
Comparison of PET imaging of activated fibroblasts and 18F-FDG for diagnosis of primary hepatic tumours: a prospective pilot study Ximin Shi 1 & Haiqun Xing 1 & Xiaobo Yang 2 & Fang Li 1 & Shaobo Yao 3 & Jia Congwei 4 & Haitao Zhao 2 & Marcus Hacker 5 & Li Huo 1 & Xiang Li 5 Received: 10 August 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed to compare the performance of 68Ga-labelled fibroblast activating protein inhibitor (FAPI) PET and 18 F-FDG PET for imaging of hepatic tumours. Methods We prospectively assessed 20 patients with suspected intrahepatic lesions. Tumour radiological features, pathology, or follow-up examinations were assessed as ground truth in correlation with PET scans. Semiquantitative analysis was additionally performed by measuring the standardised uptake value (SUV). Tumour-to-liver background ratios (TBR) were calculated and compared between 68Ga-FAPI PET and 18F-FDG PET. FAPI expression was assessed by immunochemistry in samples obtained from 7 patients with hepatocellular carcinomas (HCC)/intrahepatic cholangiocarcinoma (ICC) or granulomas. Results Primary intrahepatic tumours, including 16 HCC in 14 patients and 4 ICC in 3 patients with extrahepatic metastases, were determined by histology (n = 14) and clinical examinations (n = 3). Based on visual analysis, 17 patients presented elevated 68 Ga-FAPI uptake (sensitivity: 100%, specificity: 100%), while 7 patients presented 18F-FDG avid tumours (sensitivity: 58.8%, specificity: 100%). 68Ga-FAPI PET/CT identified 17 extrahepatic metastases vs. 13 in 18F-FDG PET/CT in 2 ICC patients. Three benign liver nodules in three patients showed negligible uptake in dual-PET scans. The SUVmax_HCC = 8.47 ± 4.06 and TBRmax_HCC = 7.13 ± 5.52, and SUVmax_ICC = 14.14 ± 2.20 TBRmax_ICC = 26.46 ± 4.94 in 68Ga-FAPI-04 PET/CT were significantly higher than the 18 F-FDG uptake presenting SUV max_HCC = 4.86 ± 3.58 and TBR max_HCC = 2.39 ± 2.21, and SUVmax_ICC = 9.19 ± 3.60 and TBRmax_ICC = 2.39 ± 2.21 (all p values < 0.05). ICC patients showed higher levels of FAPI uptake in the primary hepatic lesions compared to extrahepatic metastases, TBRmax_ICC = 15.18 ± 5.80 (p = 0.04). Conclusions 68Ga-FAPI PET-CT has superior potential in the detection of primary hepatic malignancy compared to 18F-FDG. Keywords 68Ga-FAPI-04 . 18F-FDG . Fibroblast activating protein . Hepatic nodule . Hepatocellular carcinoma . Intrahepatic cholangiocarcinoma
This article is part of the Topical Collection on Oncology - General Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00259-020-05070-9) contains supplementary material, which is available to authorized users. * Li Huo [email protected] 1
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Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Chinese Academy of Medical Science and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng Di
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