Preoperative Assessment of Pancreatic Cancer with [Ga]Ga-DOTA-FAPI-04 PET/MR Versus [F]-FDG PET/CT Plus Contrast-enhanced CT: a Prospective Preliminary Study

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2024 Nov 7

PMID 39508900

Authors

Zeyu Zhang

Shiwei Guo

Weiwei Su

Guixia Pan

Kai Cao

Hui Jiang

Lu Zhang

Chao Cheng

Gang Jin

Changjing Zuo

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the diagnostic performance of [Ga]Ga-DOTA-FAPI-04 PET/MR imaging in the preoperative evaluation of pancreatic cancer and compare it with that of [F]-FDG PET/CT plus contrast-enhanced CT (CECT).

Methods: Thirty-one patients with pancreatic cancer underwent preoperative [Ga]Ga-DOTA-FAPI-04 PET/MR, [F]-FDG PET/CT, and CECT imaging. Two nuclear medicine physicians independently reviewed two sets of images (set 1, [Ga]Ga-DOTA-FAPI-04 PET/MR; set 2, [F]-FDG PET/CT plus CECT) and reached a consensus on tumour resectability, N staging (N0 or N positive) and M staging (M0 or M1). Based on the above indices, the resectability of the tumour was determined according to a five-point scale. Clinical, operative, and pathological findings were used as a reference standard to compare the diagnostic performance of the two imaging sets via the McNemar test.

Results: The diagnostic performance of [Ga]Ga-DOTA-FAPI-04 PET/MR imaging was not significantly different from that of [F]-FDG PET/CT plus CECT imaging in the assessment of tumour resectability (area under the receiver operating characteristic curve: 0.854 vs. 0.775, p = 0.192), N staging [accuracy: 82.4% (14 of 17 patients) vs. 58.8% (10 of 17 patients), p = 0.125] and M staging [accuracy: 100% (31 of 31 patients) vs. 90.3% (28 of 31 patients), p = 0.250]. However, compared with [F]-FDG PET/CT plus CECT imaging, [Ga]Ga-DOTA-FAPI-04 PET/MR imaging changed the M stage in three patients by upstaging from M0 to M1 in 2 patients and downstaging from M1 to M0 in 2 patients. In 13 patients with liver metastases, the number of liver metastases detected via [Ga]Ga-DOTA-FAPI-04 PET/MR imaging was greater than that detected via [F]-FDG PET/CT plus CECT imaging (324 vs. 240). In 3 patients with peritoneal metastases, [Ga]Ga-DOTA-FAPI-04 PET/MR imaging detected more peritoneal metastases than did [F]-FDG PET/CT plus CECT imaging.

Conclusions: [Ga]Ga-DOTA-FAPI-04 PET/MR imaging has diagnostic accuracy comparable to [F]-FDG PET/CT plus CECT in terms of preoperative staging and assessment of resectability in pancreatic cancer; additionally, it exhibits superior capability in detecting liver and peritoneal metastases. Consequently, [Ga]Ga-DOTA-FAPI-04 PET/MR has the potential to become a one-stop imaging tool for the preoperative evaluation of pancreatic cancer.

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