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Background <p><sup>18</sup>F-FAPI-04 PET/CT shows promise in detecting peritoneal metastases (PM), but its superiority over <sup>18</sup>F-FDG PET/CT for lesion detection and predicting chemotherapy benefit remains unclear.</p> Purpose <p>To compare <sup>18</sup>F-FAPI-04 and <sup>18</sup>F-FDG PET/CT imaging features in PM and assess predictive value of <sup>18</sup>F-FAPI-04 for chemotherapy efficacy.</p> Methods <p>39 pathologically confirmed PM patients with digestive malignancies underwent concurrent <sup>18</sup>F-FAPI-04 and <sup>18</sup>F-FDG PET/CT. Semi-quantitative parameters, including SUV<sub>max</sub>, tumor/liver ratio (T/L), tumor/mediastinal blood pool ratio (T/B), were analyzed. The tracer uptake was compared via Wilcoxon tests. The relationships between <sup>18</sup>F-FAPI-04 uptake with FAP and α-SMA expression were analyzed using Pearson correlation. Patients were divided into different short-term outcome groups (responders vs. non-responders) according to RECIST criteria (v.1.1) after chemotherapy. Post-chemotherapy outcomes were evaluated using logistic regression.</p> Results <p>Patients (median age 62; 16 females, 23 males) included pancreatic (<i>n</i> = 17), cholangiocarcinoma (<i>n</i> = 8), gastric (<i>n</i> = 6), and colorectal cancers (<i>n</i> = 8). <sup>18</sup>F-FAPI-04 demonstrated significantly higher SUV<sub>max</sub>, T/L, and T/B than <sup>18</sup>F-FDG (<i>P</i> &lt; 0.05). Pancreaticobiliary cancers (pancreatic/cholangiocarcinoma) exhibited higher 18F-FAPI-04 uptake than gastroenteric cancers (gastric/colorectal) (<i>P</i> &lt; 0.05), though no differences existed within subgroups. <sup>18</sup>F-FAPI-04 parameters positively correlated with FAP and α-SMA expression. In univariate analysis, <sup>18</sup>F-FAPI-04 uptake differed significantly between responders and non-responders. Multivariate analysis identified SUV<sub>max</sub> as an independent predictor (OR = 1.354, 95%CI:1.025–1.788, <i>P</i> = 0.033). Optimal <sup>18</sup>F-FAPI-04 cut-offs for distinguishing outcomes were SUV<sub>max</sub>=11.05 (AUC = 0.783; sensitivity = 70.60%, specificity = 80.40%), T/L = 7.53 (AUC = 0.717; 58.82%, 81.82%), and T/B = 8.76 (AUC = 0.751; 64.71%, 86.37%).</p> Conclusion <p><sup>18</sup>F-FAPI-04 PET/CT outperforms <sup>18</sup>F-FDG in PM detection, with semi-quantitative parameters predicting chemotherapy response.</p>

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Characteristics of 18F-FAPI-04 PET/CT in patients with peritoneal metastasis and to predict treatment efficacy, a head-to-head comparison with 18F-FDG PET/CT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月2日

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  • Yafei Zhang,
  • Mimi Xu,
  • Yu Wang,
  • Fang Yu,
  • Xinxin Chen,
  • Guangfa Wang,
  • Kui Zhao,
  • Hong Yang,
  • Xinhui Su

摘要

Background

18F-FAPI-04 PET/CT shows promise in detecting peritoneal metastases (PM), but its superiority over 18F-FDG PET/CT for lesion detection and predicting chemotherapy benefit remains unclear.

Purpose

To compare 18F-FAPI-04 and 18F-FDG PET/CT imaging features in PM and assess predictive value of 18F-FAPI-04 for chemotherapy efficacy.

Methods

39 pathologically confirmed PM patients with digestive malignancies underwent concurrent 18F-FAPI-04 and 18F-FDG PET/CT. Semi-quantitative parameters, including SUVmax, tumor/liver ratio (T/L), tumor/mediastinal blood pool ratio (T/B), were analyzed. The tracer uptake was compared via Wilcoxon tests. The relationships between 18F-FAPI-04 uptake with FAP and α-SMA expression were analyzed using Pearson correlation. Patients were divided into different short-term outcome groups (responders vs. non-responders) according to RECIST criteria (v.1.1) after chemotherapy. Post-chemotherapy outcomes were evaluated using logistic regression.

Results

Patients (median age 62; 16 females, 23 males) included pancreatic (n = 17), cholangiocarcinoma (n = 8), gastric (n = 6), and colorectal cancers (n = 8). 18F-FAPI-04 demonstrated significantly higher SUVmax, T/L, and T/B than 18F-FDG (P < 0.05). Pancreaticobiliary cancers (pancreatic/cholangiocarcinoma) exhibited higher 18F-FAPI-04 uptake than gastroenteric cancers (gastric/colorectal) (P < 0.05), though no differences existed within subgroups. 18F-FAPI-04 parameters positively correlated with FAP and α-SMA expression. In univariate analysis, 18F-FAPI-04 uptake differed significantly between responders and non-responders. Multivariate analysis identified SUVmax as an independent predictor (OR = 1.354, 95%CI:1.025–1.788, P = 0.033). Optimal 18F-FAPI-04 cut-offs for distinguishing outcomes were SUVmax=11.05 (AUC = 0.783; sensitivity = 70.60%, specificity = 80.40%), T/L = 7.53 (AUC = 0.717; 58.82%, 81.82%), and T/B = 8.76 (AUC = 0.751; 64.71%, 86.37%).

Conclusion

18F-FAPI-04 PET/CT outperforms 18F-FDG in PM detection, with semi-quantitative parameters predicting chemotherapy response.