Comparison of the diagnostic efficacy of 68 Ga-FAPI-04 PET/MR and 18F-FDG PET/CT in patients with pancreatic cancer

Zeyu Zhang; Guorong Jia; Guixia Pan; Kai Cao; Qinqin Yang; Hongyu Meng; Jian Yang; Lu Zhang; Tao Wang; Chao Cheng; Changjing Zuo

doi:10.1007/s00259-022-05729-5

Comparison of the diagnostic efficacy of ⁶⁸ Ga-FAPI-04 PET/MR and ¹⁸F-FDG PET/CT in patients with pancreatic cancer

Eur J Nucl Med Mol Imaging. 2022 Jul;49(8):2877-2888. doi: 10.1007/s00259-022-05729-5. Epub 2022 Mar 4.

Authors

Zeyu Zhang^#¹, Guorong Jia^#¹, Guixia Pan¹, Kai Cao², Qinqin Yang¹, Hongyu Meng³, Jian Yang¹, Lu Zhang¹, Tao Wang¹, Chao Cheng⁴, Changjing Zuo⁵

Affiliations

¹ Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
² Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
³ Department of Radiology, Shanghai Fourth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai, 200434, China.
⁴ Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. 13501925757@163.com.
⁵ Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. changjing.zuo@qq.com.

^# Contributed equally.

PMID: 35243518
DOI: 10.1007/s00259-022-05729-5

Abstract

Purpose: We sought to assess the performance of ⁶⁸ Ga-FAPI-04 PET/MR for the diagnosis of primary tumours as well as metastatic lesions in patients with pancreatic cancer and to compare the results with those of ¹⁸F-FDG PET/CT.

Methods: Prospectively, we evaluated 33 patients suspected to have pancreatic adenocarcinoma, of whom thirty-two were confirmed by histopathology, and one had autoimmune pancreatitis confirmed by needle biopsy and glucocorticoid treatment. Within 1 week, each patient underwent both ⁶⁸ Ga-FAPI-04 PET/MR and ¹⁸F-FDG PET/CT. Comparisons of the detection abilities for primary tumours, lymph nodes, and metastases were conducted for the two imaging approaches. The original maximum standard uptake values (SUV_max) and normalised SUV_max (SUV_max/SUV_bkgd) of paired lesions on ⁶⁸ Ga-FAPI-04 PET/MR and ¹⁸F-FDG PET/CT were measured and compared.

Results: Thirty pancreatic cancer patients and three pancreatitis patients were enrolled. ⁶⁸ Ga-FAPI-04 PET/MR and ¹⁸F-FDG PET/CT exhibited equivalent (100%) detection rates for primary tumours. The original/normalised SUV_max of primary tumours on ⁶⁸ Ga-FAPI-04 PET was markedly higher than that on ¹⁸F-FDG (p < 0.05). Sixteen pancreatic cancer patients had pancreatic parenchymal uptake, whereas ¹⁸F-FDG PET images showed parenchymal uptake in only four patients (53.33% vs. 13.33%, p < 0.001). ⁶⁸ Ga-FAPI-04 PET detected more positive lymph nodes than ¹⁸F-FDG PET (42 vs. 30, p < 0.001), while ¹⁸F-FDG PET was able to detect more liver metastases than ⁶⁸ Ga-FAPI-04 (181 vs. 104, p < 0.001). In addition, multisequence MR imaging helped explain ten pancreatic cancers that could not be definitively revealed due to ⁶⁸ Ga-FAPI-04 inflammatory uptake and identified more liver metastases than ¹⁸F-FDG (256 vs. 181, p < 0.001).

Conclusion: ⁶⁸ Ga-FAPI-04 PET might be better than ¹⁸F-FDG PET in the detection of suspicious lymph node metastases. MR multiple sequence imaging of ⁶⁸ Ga-FAPI-04 PET/MR was helpful for explaining pancreatic lesions in patients with obstructive inflammation and detecting tiny liver metastases.

Keywords: 18F-FDG; 68 Ga-FAPI-04; PET/CT; PET/MR; Pancreatic cancer.

MeSH terms

Adenocarcinoma*
Fluorodeoxyglucose F18
Humans
Liver Neoplasms*
Magnetic Resonance Imaging
Pancreatic Neoplasms* / diagnostic imaging
Positron Emission Tomography Computed Tomography / methods
Quinolines

Substances

68Ga-FAPI
Quinolines
Fluorodeoxyglucose F18