Clinical application of Al18F-NOTA-FAPI PET/CT in diagnosis and TNM staging of pancreatic adenocarcinoma, compared to 18F-FDG

Zhehao Lyu; Wei Han; Qi Zhang; Hongyue Zhao; Shan Liu; Yan Wang; Jin He; Changjiu Zhao; Lin Tian; Peng Fu

doi:10.1186/s40644-023-00596-1

Clinical application of Al¹⁸F-NOTA-FAPI PET/CT in diagnosis and TNM staging of pancreatic adenocarcinoma, compared to ¹⁸F-FDG

Cancer Imaging. 2023 Sep 12;23(1):86. doi: 10.1186/s40644-023-00596-1.

Authors

Zhehao Lyu^#¹, Wei Han^#¹, Qi Zhang², Hongyue Zhao¹, Shan Liu¹, Yan Wang¹, Jin He¹, Changjiu Zhao¹, Lin Tian^#³, Peng Fu^#⁴

Affiliations

¹ The Department of Nuclear Medicine, the First Affiliated Hospital of Harbin Medical University, Postal Street, Harbin, Heilongjiang Province, China.
² The Department of Radiology, the First Affiliated Hospital of Harbin Medical University, Postal Street, Harbin, Heilongjiang Province, China.
³ The Department of Pathology, the First Affiliated Hospital of Harbin Medical University, Postal Street, Harbin, Heilongjiang Province, China. tianlin6225108@163.com.
⁴ The Department of Nuclear Medicine, the First Affiliated Hospital of Harbin Medical University, Postal Street, Harbin, Heilongjiang Province, China. fupeng0451@163.com.

^# Contributed equally.

Abstract

Purpose: This study aimed to investigate the ability of Al¹⁸F-NOTA-FAPI PET/CT to diagnose pancreatic carcinoma and tumor-associated inflammation with the comparison of ¹⁸F-FDG PET/CT.

Methods: Prospective analysis of Al¹⁸F-NOTA-FAPI PET/CT and ¹⁸F-FDG PET/CT scans of 31 patients from 05/2021 to 05/2022 were analyzed. Al¹⁸F-NOTA-FAPI imaging was performed in patients who had Ce-CT and FDG PET/CT and the diagnosis was still unclear. Follow-up histopathology or radiographic examination confirmed the findings. Radiotracer uptake, diagnostic performance, and TNM (tumor-node-metastasis) classifications were compared.

Results: A total of 31 patients with pancreatic carcinoma (all were adenocarcinoma) underwent Al¹⁸F-NOTA-FAPI-04 PET/CT, including 20 male and 11 female patients, with a mean age of 58.2 ± 8.5 years. FAPI-04 PET/CT imaging showed a higher value of SUV_{max-15min/30min/60min}, SUV_{mean-15min/30min/60min}, TBR₁, and TBR₂ in pancreatic carcinoma than FDG (all P < 0.01). The mean level of Al¹⁸F-NOTA FAPI-04 uptake values of the pancreatic ductal adenocarcinoma was higher than that of pancreatitis in both SUV_max-30min (P < 0.01)_, SUV_mean-30min (P < 0.05), SUV_max-60min (P < 0.01)_, and SUV_mean-60min (P < 0.01). The FAPI △SUV_max-1, △SUV_max-2, and △SUV_mean-2 uptake values of pancreatic carcinoma were higher than tumor-associated inflammation (all P < 0.01). TNM staging of 16/31 patients changed after Al¹⁸F-NOTA FAPI-04 PET/CT examination with all upstaging changes.

Conclusion: Al¹⁸F-NOTA-FAPI-04 PET/CT at 15 and 30 min also demonstrated an equivalent detection ability of pancreatic lesion to ¹⁸F-FDG PET/CT. Delayed-phase Al¹⁸F-NOTA-FAPI-04 PET/CT can help differentiate pancreatic carcinoma and tumor-associated inflammation. Al¹⁸F-NOTA FAPI-04 PET/CT also performed better than FDG PET/CT in TNM staging.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2100051406. Registered 23 September 2021, https://www.chictr.org.cn/showproj.html?proj=133033.

Keywords: Al18F-NOTA-FAPI; PET/CT; Pancreatic cancer; Staging; [18F]FDG.

MeSH terms

Adenocarcinoma* / diagnostic imaging
Aged
Female
Fluorodeoxyglucose F18
Humans
Inflammation
Male
Middle Aged
Neoplasm Staging
Pancreatic Neoplasms* / diagnostic imaging
Positron Emission Tomography Computed Tomography

Substances

Fluorodeoxyglucose F18
1,4,7-triazacyclononane-N,N',N''-triacetic acid