Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions

Xiaoli Liu; Shoumei Yan; Xueting Qin; Kai Cheng; Jinsong Zheng; Hongbo Wu; Yuchun Wei; Shuanghu Yuan

doi:10.1007/s00256-023-04335-2

Increased ¹⁸F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions

Skeletal Radiol. 2023 Dec;52(12):2377-2386. doi: 10.1007/s00256-023-04335-2. Epub 2023 May 2.

Authors

Xiaoli Liu^{1

2}, Shoumei Yan³, Xueting Qin¹, Kai Cheng³, Jinsong Zheng³, Hongbo Wu³, Yuchun Wei⁴, Shuanghu Yuan⁵

Affiliations

¹ Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
² Department of Radiotherapy, Xuanwu Hospital, Capital Medical University, Beijing, China.
³ Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
⁴ Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China. yuchunwei0000@foxmail.com.
⁵ Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China. yuanshuanghu@sina.com.

PMID: 37129613
DOI: 10.1007/s00256-023-04335-2

Abstract

Objective: This study investigated the distribution and characteristics of various bone and joint lesions on ¹⁸F-FAPI PET/CT in lung cancer patients.

Methods: Seventy-four lung cancer patients who underwent ¹⁸F-FAPI PET/CT were reviewed. Bone and joint lesions with elevated ¹⁸F-FAPI uptake were recorded and analyzed. The distribution and maximum uptake value (SUV_max) of different benign lesions or bone metastases were presented. In addition, the SUV_max of bone metastases on ¹⁸F-FDG and ¹⁸F-FAPI-04 PET/CT were also compared.

Results: In 53 patients, a total of 262 lesions presented ¹⁸F-FAPI accumulation. Bone metastases were mainly in vertebrae, pelvis, and ribs, while benign lesions were in vertebral margins, alveolar bone, and shoulder joints. The SUV_max of bone metastases was significantly higher than that of benign lesions ([Formula: see text] vs. [Formula: see text], [Formula: see text]), with NSCLC cases having higher SUV_max values than SCLC cases ([Formula: see text] vs. [Formula: see text], [Formula: see text]). Among benign lesions, arthritis and periodontitis demonstrated higher SUV_max than degenerative lesions (arthritis: [Formula: see text]; periodontitis: [Formula: see text]; degenerative diseases: [Formula: see text]; [Formula: see text] and [Formula: see text], respectively). The SUV_max of bone metastases was comparable between ¹⁸F-FDG and ¹⁸F-FAPI PET/CT. However, ¹⁸F-FAPI PET/CT was found to be superior in identifying cranial metastases compared to ¹⁸F-FDG PET/CT (TBR_met/brain: [Formula: see text] vs. [Formula: see text], [Formula: see text]).

Conclusion: This study demonstrated that ¹⁸F-FAPI PET/CT is a valuable imaging modality for detecting bone and joint lesions in lung cancer patients. The SUV_max of malignant lesions was higher than that of benign lesions, but cannot accurately distinguish benign and malignant lesions. The uptake of FAPI differs among lesions with different pathological types.

Keywords: Bone metastases; Differential diagnosis; Fibroblast activation protein inhibitor; Lung cancer; PET/CT.

MeSH terms

Arthritis*
Fluorodeoxyglucose F18
Humans
Lung Neoplasms* / diagnostic imaging
Periodontitis*
Positron Emission Tomography Computed Tomography

Substances

Fluorodeoxyglucose F18

Abstract

MeSH terms

Substances

Grants and funding