18F-FAPI-04 Outperforms 18F-FDG PET/CT in Clinical Assessments of Patients with Pancreatic Adenocarcinoma.

Abstract

Accurate diagnosis and staging are crucial for selecting treatment for patients with pancreatic ductal adenocarcinoma (PDAC). The desmoplastic responses associated with PDAC are often characterized by hypometabolism. Here, we investigated 18F-fibroblast activation protein inhibitor (FAPI)-04 PET/CT in evaluation of PDAC and compared the findings with those obtained using 18F-FDG. Methods: Sixty-two PDAC patients underwent 18F-FAPI-04 PET/CT and 18F-FDG PET/CT. Identification of primary lesions, lymph node (LN) metastasis, and distant metastasis (DM) by these methods was evaluated, and TNM staging was performed. Correlation between SUVmax of the primary lesion and treatment response was explored in patients who received systemic therapy. Results: 18F-FAPI-04 PET/CT identified all patients with PDAC; 18F-FDG PET/CT missed 1 patient. Tracer uptake was higher in 18F-FAPI-04 PET/CT than in 18F-FDG PET/CT in primary tumors (10.63 vs. 2.87, P < 0.0001), LN metastasis (2.90 vs. 1.43, P < 0.0001), and DM (liver, 6.11 vs. 3.10, P = 0.002; peritoneal, 4.70 vs. 2.08, P = 0.015). The methods showed no significant difference in the T staging category, but the N and M values were significantly higher for 18F-FAPI-04 PET/CT than for 18F-FDG PET/CT (P = 0.002 and 0.008, respectively). Thus, 14 patients were upgraded, and only 1 patient was downgraded, by 18F-FAPI-04 PET/CT compared with 18F-FDG PET/CT. A high SUVmax of the primary tumor did not correlate with treatment response for either 18F-FAPI-04 or 18F-FDG. Conclusion: 18F-FAPI-04 PET/CT performed better than 18F-FDG PET/CT in identification of primary tumors, LN metastasis, and DM and in TNM staging of PDAC.

• Authors: Xiang Li, Na Lu, Lili Lin, Yiwen Chen, Shuye Yang, Huatao Wang, Xinyuan Liu, Chengyi Wu, Xing Xue, Xinhui Su, Xueli Bai, Tingbo Liang
• Journal: Journal of nuclear medicine : official publication, Society of Nuclear Medicine (J Nucl Med) Vol. 65 Issue 2 Pg. 206-212 (Feb 01 2024) ISSN: 1535-5667 [Electronic] United States
• PMID: 38176719 (Publication Type: Journal Article)
• Copyright: © 2024 by the Society of Nuclear Medicine and Molecular Imaging.

Chemical References

• Fluorodeoxyglucose F18
• 68Ga-FAPI
• Gallium Radioisotopes
• Quinolines

Topics

• Humans
• Positron Emission Tomography Computed Tomography
• Pancreatic Neoplasms (diagnostic imaging)
• Fluorodeoxyglucose F18
• Adenocarcinoma (diagnostic imaging)
• Carcinoma, Pancreatic Ductal
• Lymphatic Metastasis (diagnostic imaging)
• Gallium Radioisotopes
• Quinolines