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Background <p>Sarcoidosis is a multisystem granulomatous disease that most commonly affects the lungs. <sup>18</sup>F-2-fluoro-2-deoxyglucose (<sup>18</sup>F-FDG) PET/CT is a sensitive imaging modality for assessing of sarcoidosis. However, fasting before <sup>18</sup>F-FDG PET/CT is generally required to improve image quality and diagnostic accuracy. In this context, our study aims to explore the utility of <sup>68</sup>Ga-fibroblast activation protein inhibitors (<sup>68</sup>Ga-FAPI) PET/CT in sarcoidosis, with particular emphasis on lesion uptake patterns and intensity, as well as the correlation with disease activity.</p> Methods <p>This is a prospective, single-center, observational study conducted at the Peking Union Medical College Hospital. Eight patients with newly diagnosed thoracic sarcoidosis were consecutively recruited for <sup>68</sup>Ga-FAPI PET/CT between January 2024 and December 2024. The follow-up <sup>68</sup>Ga-FAPI PET/CT imaging was scheduled 6–12 months after standard treatment. In addition, we retrospectively analyzed <sup>18</sup>F-FDG PET/CT scans from 16 sarcoidosis patients. For both imaging groups, the maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) and corrected lesion-to-background ratio (LBR) were calculated.</p> Results <p><sup>68</sup>Ga-FAPI PET/CT imaging detected FAPI-avid lesions in all 8 patients, including enlarged lymph nodes (8 patients, SUVmax = 7.78 ± 3.98, LBR = 7.4 ± 5.9), pulmonary infiltrates (6 patients, SUVmax = 5.35 ± 1.15, LBR = 10.4 ± 3.8), spleen nodules (2 patients) and hepatic nodules (1 patient). Following treatment, the follow-up <sup>68</sup>Ga-FAPI PET/CT scans showed lesion shrinkage and decreased uptake parameters. However, some pulmonary lesions showed non-significant changes of SUV or LBR. Addtionally, the average SUVmax, SUVmean, and LBR for <sup>68</sup>Ga-FAPI of lymph nodes tended to be lower than <sup>18</sup>F-FDG uptake parameters in the retrospective cohort.</p> Conclusions <p><sup>68</sup>Ga-FAPI PET/CT can be useful for evaluating both active and chronic granulomatous inflammation. It is also potentially valuable for determining disease extent, detecting occult disease, and monitoring treatment response in sarcoidosis.</p>

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68Ga-FAPI PET/CT features of thoracic sarcoidosis: a prospective observational study

  • 期刊论文

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  • 发表日期：

    2026年5月29日

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  • Ruxuan Chen,
  • Silu Liu,
  • Zhiyi Li,
  • Yujie Shi,
  • Chi Shao,
  • Xinyu Song,
  • Yaping Luo,
  • Zuojun Xu,
  • Hui Huang

摘要

Background

Sarcoidosis is a multisystem granulomatous disease that most commonly affects the lungs. 18F-2-fluoro-2-deoxyglucose (18F-FDG) PET/CT is a sensitive imaging modality for assessing of sarcoidosis. However, fasting before 18F-FDG PET/CT is generally required to improve image quality and diagnostic accuracy. In this context, our study aims to explore the utility of 68Ga-fibroblast activation protein inhibitors (68Ga-FAPI) PET/CT in sarcoidosis, with particular emphasis on lesion uptake patterns and intensity, as well as the correlation with disease activity.

Methods

This is a prospective, single-center, observational study conducted at the Peking Union Medical College Hospital. Eight patients with newly diagnosed thoracic sarcoidosis were consecutively recruited for 68Ga-FAPI PET/CT between January 2024 and December 2024. The follow-up 68Ga-FAPI PET/CT imaging was scheduled 6–12 months after standard treatment. In addition, we retrospectively analyzed 18F-FDG PET/CT scans from 16 sarcoidosis patients. For both imaging groups, the maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) and corrected lesion-to-background ratio (LBR) were calculated.

Results

68Ga-FAPI PET/CT imaging detected FAPI-avid lesions in all 8 patients, including enlarged lymph nodes (8 patients, SUVmax = 7.78 ± 3.98, LBR = 7.4 ± 5.9), pulmonary infiltrates (6 patients, SUVmax = 5.35 ± 1.15, LBR = 10.4 ± 3.8), spleen nodules (2 patients) and hepatic nodules (1 patient). Following treatment, the follow-up 68Ga-FAPI PET/CT scans showed lesion shrinkage and decreased uptake parameters. However, some pulmonary lesions showed non-significant changes of SUV or LBR. Addtionally, the average SUVmax, SUVmean, and LBR for 68Ga-FAPI of lymph nodes tended to be lower than 18F-FDG uptake parameters in the retrospective cohort.

Conclusions

68Ga-FAPI PET/CT can be useful for evaluating both active and chronic granulomatous inflammation. It is also potentially valuable for determining disease extent, detecting occult disease, and monitoring treatment response in sarcoidosis.