[Ga]Ga-FAPI-04 PET/MR Imaging Strategy in Management of Krukenberg Tumors (KTs) from Gastric Signet-ring-cell Carcinoma: to Overcome Limitation of [Ga]Ga-FAPI-04 PET Imaging in KTs

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2024 May 20

PMID 38767660

Authors

Tingting Wang

Gan Huang

Haitao Zhao

Lianghua Li

Yanying Shen

Weihua Lou

Jianjun Liu

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare performance of whole-body [Ga]Ga-FAPI-04 and [F]FDG PET imaging in the detection of Krukenberg tumors (KTs), primary site and extra-ovarian metastases of gastric signet-ring-cell carcinoma (GSRCC), and evaluate the value of [Ga]Ga-FAPI-04 PET/MR imaging strategy and its potential impact on the management of KTs from GSRCC.

Methods: Twelve patients with twenty-three KTs from GSRCC, who underwent both [Ga]Ga-FAPI-04 pelvic PET/MR and whole-body [Ga]Ga-FAPI-04 and [F]FDG PET imaging were retrospectively analyzed. [Ga]Ga-FAPI-04 and [F]FDG uptakes were compared by using Wilcoxon signed-rank test or paired t test. McNemar's test was used to compare lesion detectability between two modalities. Two-tailed P<0.05 was considered statistically significant. Immunohistochemistry staining was utilized to analyze the fibroblast activation protein (FAP) expression in KTs.

Results: A total of 12 patients with 23 KTs from GSRCC (8 synchronous and 4 metachronous) were evaluated. [Ga]Ga-FAPI-04 was superior to [F]FDG PET in detecting primary sites of GSRCC (100% [11/11] vs. 18.2% [2/11], p = 0.002), involved lymph nodes (90.9% [10/11] vs. 54.5% [6/11], p = 0.046) and peritoneal metastases (100% [12/12] vs. 41.7% [5/12], p = 0.008), with higher SUVmax and TBR (all p < 0.005). Both tracers had limited value in identifying KTs, with 100% false negative rate on [Ga]Ga-FAPI-04 PET and a low detection rate of 8.7% on [F]FDG PET. Fap immunohistochemistry showed negative or slight FAP expression in neoplastic signet ring cells and ovarian stroma. [Ga]Ga-FAPI-04 PET/MR imaging strategy greatly improved the detection rate of Krukenberg tumors (87%, 20/23). After adding diffusion-weighted imaging (DWI), the detection rate was further improved (87.5% vs. 100%, p = 0.083). [Ga]Ga-FAPI-04 PET/MR imaging strategy either upgraded TNM staging or changed treatment management in twelve patients.

Conclusions: [Ga]Ga-FAPI-04 PET outperformed [F]FDG PET in detecting primary site and most extra-ovarian metastases of GSRCC, but both tracers had limited value in identifying Krukenberg tumors. Pelvis MRI should be applied to compensate the limitation of [Ga]Ga-FAPI-04 PET imaging to identify Krukenberg tumours. The [Ga]Ga-FAPI-04 PET/MR imaging strategy has the potential to impact treatment decisions for GSRCC patients with KTs.

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