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Comparison of PET imaging of activated fibroblasts and 18F-FDG for diagnosis of primary hepatic tumours: a prospective pilot study

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Abstract

Purpose

This study aimed to compare the performance of 68Ga-labelled fibroblast activating protein inhibitor (FAPI) PET and 18F-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 68Ga-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 18F-FDG uptake presenting SUVmax_HCC = 4.86 ± 3.58 and TBRmax_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.

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Funding

This work was sponsored in part by the National Natural Science Foundation of China (Grant No. 81571713), Fundamental Research Funds for the Central Universities (No. 3332020011), and the CAMS Innovation Fund for Medical Sciences (Grant No. 2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001).

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Authors and Affiliations

  1. 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 District, Beijing, 100730, China

    Ximin Shi, Haiqun Xing, Fang Li & Li Huo

  2. Department of Hepatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiaobo Yang & Haitao Zhao

  3. Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Shaobo Yao

  4. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Jia Congwei

  5. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Marcus Hacker & Xiang Li

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  1. Ximin Shi
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Contributions

Ximin Shi, Li Huo, and Xiang Li designed the study, interpreted the data, and led the writing and review of the manuscript. Ximin Shi, Haiqun Xing, and Shaobo Yao synthesised the 68Ga-FAPI-4 and performed the examination. Xiaobo Yang and Haitao Zhao collected clinical data. Congwei Jia evaluated the FAP IHC images. Fang Li and Marcus Harcker participated in the review of the manuscript.

Corresponding author

Correspondence to Li Huo.

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The authors declare that they have no conflict of interest.

Ethics approval

This prospective study was approved by the Peking Union Medical College Hospital ethics committee (IRB protocol #ZS1810).

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All subjects provided written informed consent.

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Shi, X., Xing, H., Yang, X. et al. Comparison of PET imaging of activated fibroblasts and 18F-FDG for diagnosis of primary hepatic tumours: a prospective pilot study. Eur J Nucl Med Mol Imaging 48, 1593–1603 (2021). https://doi.org/10.1007/s00259-020-05070-9

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