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Purpose <p>To evaluate the diagnostic performance of [<sup>18</sup>F]FAPI-04 PET/CT in differentiating hepatocellular carcinoma (HCC) recurrence from treatment-induced lesions (TILs) after therapy and compare it with contrast-enhanced CT/MRI (Ce-CT/MRI).</p> Methods <p>Patients with suspected HCC recurrence after resection or local–regional therapy, who underwent Ce-CT/MRI and [<sup>18</sup>F]FAPI-04 PET/CT, were prospectively enrolled. For each patient or lesion, a three-point-scale (positive, negative, or equivocal) was assigned to Ce-CT/MRI and [<sup>18</sup>F]FAPI-04 PET/CT. The diagnostic performances of Ce-CT/MRI, [<sup>18</sup>F]FAPI-04 PET/CT, and their combination were compared by McNemar’s test, with histopathology or radiographic follow-up as a reference standard. The maximum standardized uptake value (SUV<sub>max</sub>) and lesion-to-background ratio (LBR) of lesions derived from [<sup>18</sup>F]FAPI-04 PET/CT were analyzed, and the cut-off points for distinguishing between HCC recurrence and TILs were calculated.</p> Results <p>A total of 44 patients with 129 lesions were analyzed, of which 31 patients (91 lesions) were proved to be recurrent HCC and 38 lesions were TILs. On lesion-based analysis, the combination of [<sup>18</sup>F]FAPI-04 PET/CT with Ce-CT/MRI demonstrated superior sensitivity (86.8% vs. 70.3% vs. 72.5%), specificity (89.5% vs. 42.1% vs. 52.6%), and accuracy (87.6% vs. 62.0% vs. 66.7%) compared to Ce-CT/MRI and [<sup>18</sup>F]FAPI-04 PET/CT alone (all <i>P</i> &lt; 0.001). The combination altered therapy management in 22.7% of patients. On semiquantitative analysis, the SUV<sub>max</sub> and LBR of [<sup>18</sup>F]FAPI-04 PET in HCC recurrence (<i>n = </i>91) were significantly higher than those in TILs (<i>n = </i>38) (SUV<sub>max</sub>: 8.1 vs. 3.65, <i>P</i> &lt; 0.001; LBR: 5.4 vs. 1.9, <i>P</i> &lt; 0.001). Using cutoff points of 5.1 for SUV<sub>max</sub> and 2.3 for LBR, [<sup>18</sup>F]FAPI-04 PET/CT exhibited high sensitivity and specificity in differentiating recurrent HCC from TILs, with 83.5%, 78.9% and 96.2%, 63.2%, respectively.</p> Conclusions <p>The combination of [<sup>18</sup>F]FAPI-04 PET/CT with Ce-CT/MRI significantly improved diagnostic sensitivity, specificity, and accuracy in differentiating recurrent HCC from TILs. [<sup>18</sup>F]FAPI-04 PET may be a promising imaging modality in detecting recurrent HCC.</p> Trial registration <p>clinicaltrials.gov: NCT 05485792.</p>

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Diagnostic performance of [18F]FAPI-04 PET/CT in suspected recurrent hepatocellular carcinoma: prospective comparison with contrast-enhanced CT/MRI

  • 期刊论文

  • 发表日期：

    2025年4月15日

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  • Jiucen Liang,
  • Shaojuan Weng,
  • Jing Zhang,
  • Shuqin Jiang,
  • Wen Li,
  • Shuyi Li,
  • Jian Rong,
  • Hao Liu,
  • Haipeng Chen,
  • Zhidong Liu,
  • Hao Peng,
  • Sha Yan,
  • Rusen Zhang,
  • Steven H. Liang,
  • Linqi Zhang

摘要

Purpose

To evaluate the diagnostic performance of [18F]FAPI-04 PET/CT in differentiating hepatocellular carcinoma (HCC) recurrence from treatment-induced lesions (TILs) after therapy and compare it with contrast-enhanced CT/MRI (Ce-CT/MRI).

Methods

Patients with suspected HCC recurrence after resection or local–regional therapy, who underwent Ce-CT/MRI and [18F]FAPI-04 PET/CT, were prospectively enrolled. For each patient or lesion, a three-point-scale (positive, negative, or equivocal) was assigned to Ce-CT/MRI and [18F]FAPI-04 PET/CT. The diagnostic performances of Ce-CT/MRI, [18F]FAPI-04 PET/CT, and their combination were compared by McNemar’s test, with histopathology or radiographic follow-up as a reference standard. The maximum standardized uptake value (SUVmax) and lesion-to-background ratio (LBR) of lesions derived from [18F]FAPI-04 PET/CT were analyzed, and the cut-off points for distinguishing between HCC recurrence and TILs were calculated.

Results

A total of 44 patients with 129 lesions were analyzed, of which 31 patients (91 lesions) were proved to be recurrent HCC and 38 lesions were TILs. On lesion-based analysis, the combination of [18F]FAPI-04 PET/CT with Ce-CT/MRI demonstrated superior sensitivity (86.8% vs. 70.3% vs. 72.5%), specificity (89.5% vs. 42.1% vs. 52.6%), and accuracy (87.6% vs. 62.0% vs. 66.7%) compared to Ce-CT/MRI and [18F]FAPI-04 PET/CT alone (all P < 0.001). The combination altered therapy management in 22.7% of patients. On semiquantitative analysis, the SUVmax and LBR of [18F]FAPI-04 PET in HCC recurrence (n = 91) were significantly higher than those in TILs (n = 38) (SUVmax: 8.1 vs. 3.65, P < 0.001; LBR: 5.4 vs. 1.9, P < 0.001). Using cutoff points of 5.1 for SUVmax and 2.3 for LBR, [18F]FAPI-04 PET/CT exhibited high sensitivity and specificity in differentiating recurrent HCC from TILs, with 83.5%, 78.9% and 96.2%, 63.2%, respectively.

Conclusions

The combination of [18F]FAPI-04 PET/CT with Ce-CT/MRI significantly improved diagnostic sensitivity, specificity, and accuracy in differentiating recurrent HCC from TILs. [18F]FAPI-04 PET may be a promising imaging modality in detecting recurrent HCC.

Trial registration

clinicaltrials.gov: NCT 05485792.