A Retrospective Study of Ga-FAPI PET/CT in Differentiating the Nature of Pulmonary Lesions

Overview

Journal Front Oncol

Specialty Oncology

Date 2024 May 23

PMID 38779097

Authors

Yang Xie

Wenxin Tang

Jiao Ma

Yue Chen

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to investigate the characteristics of various pulmonary lesions as revealed by Ga-FAPI PET/CT and to determine the utility of Ga-FAPI PET/CT in distinguishing the nature of these pulmonary lesions.

Methods: A retrospective analysis was conducted on 99 patients with pulmonary lesions, who were categorized into three distinct groups: primary lung tumors (G1), metastatic lung tumors (G2), and benign lesions (G3). Each participant underwent a Ga-FAPI PET/CT scan. Among these groups, variables such as the Tumor/Background Ratio (TBR), Maximum Standardized Uptake Value (SUVmax), and the true positive rate of the lesions were compared. Furthermore, the FAPI uptake in nodular-like pulmonary lesions (d<3cm) and those with irregular borders was evaluated across the groups. A correlation analysis sought to understand the relationship between FAPI uptake in primary and pulmonary metastatic lesions.

Results: The study's participants were composed of 52 males and 47 females, with an average age of 56.8 ± 13.2 years. A higher uptake and detection rate for pulmonary lesions were exhibited by Group G1 compared to the other groups (SUVmax [G1 vs. G2 vs. G3: 9.1 ± 4.1 vs. 6.1 ± 4.1 vs. 5.3 ± 5.8], <0.05; TBR [G1 vs. G2 vs. G3: 6.2 ± 2.4 vs. 4.1 ± 2.2 vs. 3.2 ± 2.7], <0.01; true positive rate 95.1% vs. 88% vs. 75.6%]. In nodular-like lung lesions smaller than 3 cm, G1 showed a significantly higher FAPI uptake compared to G2 and G3 (SUVmax [G1 vs. G2 vs. G3: 8.8 ± 4.3 vs. 5.2 ± 3.2 vs. 4.9 ± 6.1], <0.01; TBR [G1 vs. G2 vs. G3: 5.7 ± 2.7 vs. 3.7 ± 2.1 vs. 3.3 ± 4.4], <0.05). Both G1 and G2 demonstrated significantly elevated FAPI agent activity in irregular-bordered pulmonary lesions when compared to G3 (SUVmax [G1 vs. G2 vs. G3: 10.9 ± 3.3 vs. 8.5 ± 2.7 vs. 4.6 ± 2.7], <0.01; TBR [G1 vs. G2 vs. G3: 7.2 ± 2.1 vs. 6.4 ± 1.3 vs. 3.2 ± 2.4], <0.01). A positive correlation was identified between the level of Ga-FAPI uptake in primary lesions and the uptake in pulmonary metastatic lesions within G2 (r=0.856, <0.05).

Conclusion: Ga-FAPI PET/CT imaging proves to be of significant value in the evaluation of pulmonary lesions, offering distinctive insights into their nature.

Citing Articles

Evaluating the diagnostic value of F-FAPI-04 PET/CT in various malignant tumors: a head-to-head comparison with F-FDG PET/CT.

Tian X, Wang Y, Zhang Y, Teng Y, Cui Z, Liu J Jpn J Radiol. 2024; .

PMID: 39630333 DOI: 10.1007/s11604-024-01714-0.

References

Yang A, Kim Y, Yan X, Abe H, Aslam M, Park K . Fibroblast Activation Protein Activates Macrophages and Promotes Parenchymal Liver Inflammation and Fibrosis. Cell Mol Gastroenterol Hepatol. 2022; 15(4):841-867. PMC: 9972574. DOI: 10.1016/j.jcmgh.2022.12.005. View

Mori Y, Dendl K, Cardinale J, Kratochwil C, Giesel F, Haberkorn U . FAPI PET: Fibroblast Activation Protein Inhibitor Use in Oncologic and Nononcologic Disease. Radiology. 2023; 306(2):e220749. DOI: 10.1148/radiol.220749. View

Caruso D, Polici M, Zerunian M, Pucciarelli F, Polidori T, Guido G . Quantitative Chest CT analysis in discriminating COVID-19 from non-COVID-19 patients. Radiol Med. 2020; 126(2):243-249. PMC: 7548413. DOI: 10.1007/s11547-020-01291-y. View

Li Y, Deng L, Feng Y, Liu L, Lv F, Qiu L . Potential utility of [Ga]DOTA-FAPI-04 as a broad-spectrum benign disease imaging agent-comparison with [F]FDG and [Tc]MDP. Eur Radiol. 2023; 33(12):9378-9389. DOI: 10.1007/s00330-023-09952-y. View

Zhou Y, Zhou X, Ma J, Zhang W, Yan Z, Luo J . Nomogram for Predicting the Prognosis of Patients with Hepatocellular Carcinoma Presenting with Pulmonary Metastasis. Cancer Manag Res. 2021; 13:2083-2094. PMC: 7935331. DOI: 10.2147/CMAR.S296020. View

Groheux D, Quere G, Blanc E, Lemarignier C, Vercellino L, de Margerie-Mellon C . FDG PET-CT for solitary pulmonary nodule and lung cancer: Literature review. Diagn Interv Imaging. 2016; 97(10):1003-1017. DOI: 10.1016/j.diii.2016.06.020. View

Torrealba J, Fisher S, Kanne J, Butt Y, Glazer C, Kershaw C . Pathology-radiology correlation of common and uncommon computed tomographic patterns of organizing pneumonia. Hum Pathol. 2017; 71:30-40. DOI: 10.1016/j.humpath.2017.10.028. View

Deppen S, Blume J, Kensinger C, Morgan A, Aldrich M, Massion P . Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis. JAMA. 2014; 312(12):1227-36. PMC: 4315183. DOI: 10.1001/jama.2014.11488. View

Telo S, Calderoni L, Vichi S, Zagni F, Castellucci P, Fanti S . Alternative and New Radiopharmaceutical Agents for Lung Cancer. Curr Radiopharm. 2019; 13(3):185-194. PMC: 8206190. DOI: 10.2174/1874471013666191223151402. View

10.

Shu Q, Wang Y, Deng M, Chen X, Liu M, Cai L . Benign lesions with Ga-FAPI uptake: a retrospective study. Br J Radiol. 2023; 96(1144):20220994. PMC: 10078866. DOI: 10.1259/bjr.20220994. View

11.

Erdogan Y, Akinci Ozyurek B, Ozmen O, Demirci N, Sahin Duyar S, Dadali Y . The Evaluation of FDG PET/CT Scan Findings in Patients with Organizing Pneumonia Mimicking Lung Cancer. Mol Imaging Radionucl Ther. 2015; 24(2):60-5. PMC: 4563171. DOI: 10.4274/mirt.03016. View

12.

Can C, Kepenek F, Komek H, Gundogan C, Kaplan I, Tasdemir B . Comparison of 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT in patients with non-small cell lung cancer. Nucl Med Commun. 2022; 43(10):1084-1091. DOI: 10.1097/MNM.0000000000001607. View

13.

Hoy H, Lynch T, Beck M . Surgical Treatment of Lung Cancer. Crit Care Nurs Clin North Am. 2019; 31(3):303-313. DOI: 10.1016/j.cnc.2019.05.002. View

14.

Flechsig P, Mehndiratta A, Haberkorn U, Kratochwil C, Giesel F . PET/MRI and PET/CT in Lung Lesions and Thoracic Malignancies. Semin Nucl Med. 2015; 45(4):268-81. DOI: 10.1053/j.semnuclmed.2015.03.004. View

15.

Cheung S, Chen S, Wong Y, Wu K, Ho C . Diagnosis of Seronegative Rheumatoid Arthritis by Ga-FAPI PET/CT. Nucl Med Mol Imaging. 2023; 57(1):44-45. PMC: 9832189. DOI: 10.1007/s13139-022-00779-x. View

16.

Bankier A, MacMahon H, Goo J, Rubin G, Schaefer-Prokop C, Naidich D . Recommendations for Measuring Pulmonary Nodules at CT: A Statement from the Fleischner Society. Radiology. 2017; 285(2):584-600. DOI: 10.1148/radiol.2017162894. View

17.

Hotta M, Rieger A, Jafarvand M, Menon N, Farolfi A, Benz M . Non-oncologic incidental uptake on FAPI PET/CT imaging. Br J Radiol. 2022; 96(1142):20220463. PMC: 9975522. DOI: 10.1259/bjr.20220463. View

18.

Wang L, Tang G, Hu K, Liu X, Zhou W, Li H . Comparison of Ga-FAPI and F-FDG PET/CT in the Evaluation of Advanced Lung Cancer. Radiology. 2022; 303(1):191-199. DOI: 10.1148/radiol.211424. View

19.

Rohrich M, Leitz D, Glatting F, Wefers A, Weinheimer O, Flechsig P . Fibroblast Activation Protein-Specific PET/CT Imaging in Fibrotic Interstitial Lung Diseases and Lung Cancer: A Translational Exploratory Study. J Nucl Med. 2021; 63(1):127-133. PMC: 8717194. DOI: 10.2967/jnumed.121.261925. View

20.

Chandekar K, Prashanth A, Vinjamuri S, Kumar R . FAPI PET/CT Imaging-An Updated Review. Diagnostics (Basel). 2023; 13(12). PMC: 10297281. DOI: 10.3390/diagnostics13122018. View