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Background <p>Pneumoconiosis, characterized by dust-induced pulmonary fibrosis, lacks reliable methods to assess fibrotic activity. This study aimed to monitor fibroblast activation and identify activated pulmonary fibrosis for early diagnosis and anti-fibrotic therapy response by <sup>18</sup>F-fibroblast activation protein inhibitors (FAPI) positron emission tomography/computed tomography (PET/CT) in pneumoconiosis.</p> Methods <p>A single-center prospective clinical study was conducted on 6 pneumoconiosis patients and 4 healthy control individuals. The uptake of <sup>18</sup>F-FAPI in the pulmonary fibrosis areas of participants and its correlation with pulmonary diffusion function were analyzed. Sprague-Dawley rat experiments were performed on three groups including pneumoconiosis model, pirfenidone-treated, and normal control groups. <sup>18</sup>F-FAPI and <sup>18</sup>F-fluoro-D-glucose (FDG) PET/CT, histopathologic, and hematological analysis were assessed monthly from modeling until 6 months.</p> Results <p>In our preliminary cohort, compared to the controls, the <sup>18</sup>F-FAPI uptake in fibrotic areas of pneumoconiosis patients was higher, and a strong negative correlation with the diffusing function was observed (<i>r</i> = -0.929, <i>P</i> = 0.022). In the pneumoconiosis model, <sup>18</sup>F-FAPI activity peaked one month earlier than relative collagen content (%) in Masson trichrome staining and the level of connective tissue growth factor in plasma, an indicator reflecting the fibroblast activation. The uptake of <sup>18</sup>F-FAPI in the pirfenidone-treated group significantly decreased compared to the pneumoconiosis group. Additionally, in pneumoconiosis rats, <sup>18</sup>F-FDG uptake peaked at Month 3, correlating with progressive inflammation (granuloma formation, elevated interleukin-6 [IL-6]/tumor necrosis factor-α [TNF-α]), while pirfenidone showed timepoint-specific metabolic reduction, no significant difference in the overall mean standardized uptake value (SUVmean) was observed.</p> Conclusions <p><sup>18</sup>F-FAPI PET/CT imaging may hold promise for identifying active pulmonary fibrosis and monitoring its progression in pneumoconiosis, suggesting a potential clinical opportunity for targeted anti-fibrotic treatment. These preliminary findings warrant further investigation in larger studies.</p>

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18F-FAPI PET/CT imaging in pneumoconiosis: a pilot study on a novel tool for early diagnosis and guiding the treatment of pulmonary fibrosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Chaofeng Liu,
  • Zhongyuan Guo,
  • Yiwei Shi,
  • Zhifang Wu,
  • Zhenyu Xiang,
  • Tian Yao,
  • Gang Liang,
  • Zhixing Qin,
  • Ruonan Wang,
  • Li Li,
  • Min Guo,
  • Hailong Wang,
  • Min Pang,
  • Sijin Li

摘要

Background

Pneumoconiosis, characterized by dust-induced pulmonary fibrosis, lacks reliable methods to assess fibrotic activity. This study aimed to monitor fibroblast activation and identify activated pulmonary fibrosis for early diagnosis and anti-fibrotic therapy response by 18F-fibroblast activation protein inhibitors (FAPI) positron emission tomography/computed tomography (PET/CT) in pneumoconiosis.

Methods

A single-center prospective clinical study was conducted on 6 pneumoconiosis patients and 4 healthy control individuals. The uptake of 18F-FAPI in the pulmonary fibrosis areas of participants and its correlation with pulmonary diffusion function were analyzed. Sprague-Dawley rat experiments were performed on three groups including pneumoconiosis model, pirfenidone-treated, and normal control groups. 18F-FAPI and 18F-fluoro-D-glucose (FDG) PET/CT, histopathologic, and hematological analysis were assessed monthly from modeling until 6 months.

Results

In our preliminary cohort, compared to the controls, the 18F-FAPI uptake in fibrotic areas of pneumoconiosis patients was higher, and a strong negative correlation with the diffusing function was observed (r = -0.929, P = 0.022). In the pneumoconiosis model, 18F-FAPI activity peaked one month earlier than relative collagen content (%) in Masson trichrome staining and the level of connective tissue growth factor in plasma, an indicator reflecting the fibroblast activation. The uptake of 18F-FAPI in the pirfenidone-treated group significantly decreased compared to the pneumoconiosis group. Additionally, in pneumoconiosis rats, 18F-FDG uptake peaked at Month 3, correlating with progressive inflammation (granuloma formation, elevated interleukin-6 [IL-6]/tumor necrosis factor-α [TNF-α]), while pirfenidone showed timepoint-specific metabolic reduction, no significant difference in the overall mean standardized uptake value (SUVmean) was observed.

Conclusions

18F-FAPI PET/CT imaging may hold promise for identifying active pulmonary fibrosis and monitoring its progression in pneumoconiosis, suggesting a potential clinical opportunity for targeted anti-fibrotic treatment. These preliminary findings warrant further investigation in larger studies.