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Purpose <p>Fibroblast activation protein (FAP)-targeted PET/CT has emerged as a promising tool for visualizing tumor stroma. This study aimed to validate the diagnostic efficacy of [<sup>18</sup>F]AlF-NOTA-FAPI-04 PET/CT in detecting subclinical metastases in recurrent differentiated thyroid cancer (DTC), with direct comparison to [<sup>18</sup>F]FDG PET/CT.</p> Methods <p>Twenty-three DTC participants with biochemical recurrence (suppressed thyroglobulin [Tg] ≥ 1 ng/mL or Tg antibodies [Tg-Ab] &gt; 115 IU/mL) underwent [<sup>18</sup>F]AlF-NOTA-FAPI-04 PET/CT, including 16 who underwent paired [<sup>18</sup>F]FDG scans. Lesion classification followed histopathology or 15.5-month clinical follow-up (median, 8–32 months).</p> Results <p>[<sup>18</sup>F]AlF-NOTA-FAPI-04 PET/CT demonstrated significantly higher lesion-level sensitivity (75% vs. 13%, <i>P</i> = 0.002) and accuracy (80% vs. 27%, <i>P</i> &lt; 0.001) than [<sup>18</sup>F]FDG. Participant-level sensitivity reached 100% (7/7 vs. 14% [1/7], <i>P</i> = 0.003). Notably, 7 cervical lymph node metastases (mean diameter 5.9 ± 1.4&#xa0;mm) were detected exclusively by FAPI imaging.</p> Conclusion <p>[<sup>18</sup>F]AlF-NOTA-FAPI-04 PET/CT exhibits superior diagnostic performance over [<sup>18</sup>F]FDG PET/CT in detecting small metastatic lesions in recurrent DTC, potentially enabling earlier intervention and improved patient management.</p>

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[18F]AlF-NOTA-FAPI-04 PET/CT improves detection of subcentimeter recurrent lesions in differentiated thyroid cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月15日

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  • Kai Zheng,
  • Wanjing Zhou,
  • Jian Yang,
  • Yanyin Zhang,
  • Chengzhi Jiang,
  • Aimin Xie,
  • Xiang Peng,
  • Jiashun Dai,
  • Haifeng He,
  • Xiaowei Peng,
  • Hui Ye

摘要

Purpose

Fibroblast activation protein (FAP)-targeted PET/CT has emerged as a promising tool for visualizing tumor stroma. This study aimed to validate the diagnostic efficacy of [18F]AlF-NOTA-FAPI-04 PET/CT in detecting subclinical metastases in recurrent differentiated thyroid cancer (DTC), with direct comparison to [18F]FDG PET/CT.

Methods

Twenty-three DTC participants with biochemical recurrence (suppressed thyroglobulin [Tg] ≥ 1 ng/mL or Tg antibodies [Tg-Ab] > 115 IU/mL) underwent [18F]AlF-NOTA-FAPI-04 PET/CT, including 16 who underwent paired [18F]FDG scans. Lesion classification followed histopathology or 15.5-month clinical follow-up (median, 8–32 months).

Results

[18F]AlF-NOTA-FAPI-04 PET/CT demonstrated significantly higher lesion-level sensitivity (75% vs. 13%, P = 0.002) and accuracy (80% vs. 27%, P < 0.001) than [18F]FDG. Participant-level sensitivity reached 100% (7/7 vs. 14% [1/7], P = 0.003). Notably, 7 cervical lymph node metastases (mean diameter 5.9 ± 1.4 mm) were detected exclusively by FAPI imaging.

Conclusion

[18F]AlF-NOTA-FAPI-04 PET/CT exhibits superior diagnostic performance over [18F]FDG PET/CT in detecting small metastatic lesions in recurrent DTC, potentially enabling earlier intervention and improved patient management.