Are We Approaching a Change in Paradigm in PET/CT Imaging of Solid Gastrointestinal (or Digestive) Tract Tumors With the Clinical Application of FAPI Imaging?

Bolton, Roberto C. Delgado; Terán, Adriana K. Calapaquí; Herrmann, Ken; Fanti, Stefano; Giammarile, Francesco

doi:10.1097/rlu.0000000000004602

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…FAPI imaging could soon be the standard of care in these cases, given its advantages over FDG imaging. However, generation of high-quality evidence is still warranted 40 …”

Section: Discussionmentioning

confidence: 99%

Role of 68Ga-FAPI PET/CT in Assessing Hepatobiliary Malignancies

et al. 2023

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Introduction and AimPreliminary studies showed good expression of fibroblast activating protein inhibitor (FAPI) in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Our aims were to study the diagnostic performance of 68Ga-FAPI PET/CT in diagnosing the primary hepatobiliary malignancies and to compare its performance with 18F-FDG PET/CT.Patients and MethodsPatients suspected to have HCC and CC were recruited prospectively. FDG and FAPI PET/CT studies were completed within 1 week. Final diagnosis of malignancy was achieved by tissue diagnosis (either histopathological examination or fine-needle aspiration cytology) and radiological correlation from conventional modalities. Results were compared with final diagnosis and expressed as sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.ResultsForty-one patients were included. Thirty-one were positive for malignancy and 10 were negative. Fifteen were metastatic. Of 31, 18 were CC and 6 were HCC. For overall diagnosis of the primary disease, FAPI PET/CT performed exceptionally compared with FDG PET/CT with sensitivity, specificity, and accuracy of 96.77%, 90%, and 95.12%, respectively, versus 51.61%, 100%, and 63.41% for FDG PET/CT. FAPI PET/CT clearly outperformed FDG PET/CT for the evaluation of CC with sensitivity, specificity, and accuracy of 94.4%, 100%, and 95.24%, respectively, whereas for FDG PET/CT sensitivity, specificity, and accuracy were 50%, 100%, and 57.14%, respectively. Diagnostic accuracy of FAPI PET/CT was 61.54% for metastatic HCC compared with 84.62% for FDG PET/CT.ConclusionsOur study highlights the potential role of FAPI-PET/CT in evaluating CC. It also ascertains its usefulness in the cases of mucinous adenocarcinoma. Although it showed a higher lesion detection rate than FDG in primary HCC, its diagnostic performance in the metastatic setting is questionable.

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“…FAPI imaging could soon be the standard of care in these cases, given its advantages over FDG imaging. However, generation of high-quality evidence is still warranted 40 …”

Section: Discussionmentioning

confidence: 99%

Role of 68Ga-FAPI PET/CT in Assessing Hepatobiliary Malignancies

et al. 2023

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“…Genetic profiles and other immunogenic parameters may help to select the appropriate radiotracer. The combination of clinicopathological parameters, imaging measurements, and radiomic features is another pathway being used for the development of new prognostic biomarkers [32,41,42].…”

Section: Discussionmentioning

confidence: 99%

Multitracer PET/CT with [18F]Fluorodeoxiglucose and [18F]Fluorocholine in the Initial Staging of Multiple Myeloma Patients Applying the IMPeTus Criteria: A Pilot Study

et al. 2023

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Initial staging of patients diagnosed with multiple myeloma (MM) can lead to negative results using conventional diagnostic imaging workup, including [18F]Fluorodesoxiglucose ([18F]FDG) PET/CT. The aim of this prospective pilot study was to evaluate the diagnostic efficacy of [18F]Fluorocholine ([18F]FCH) PET/CT in the initial staging of MM patients who were candidates for autologous bone marrow transplant. Materials and Methods: The inclusion criteria of our study were: (a) patients diagnosed with MM; (b) candidates for autologous bone marrow transplant (AT); and (c) studied with [18F]FCH PET/CT and [18F]FDG PET/CT for initial staging less than 4 weeks apart. Imaging analysis included the presence of: bone marrow infiltration, focal bone lesions, and para-medullary or extra-medullary disease, according to the proposed IMPeTus criteria. The analysis was performed per lesion, per patient, and per location. Results: The study population included ten patients. Globally, [18F]FCH PET/CT showed bone marrow uptake in all the patients and visualised 16 more focal lesions than [18F]FDG PET/CT. One patient presented a plasmacytoma, detected by both tracers. Extra-medullary and para-medullary disease was identified with different degrees of uptake by both tracers. In summary, [18F]FCH PET seemed to be superior to [18F]FDG PET/CT in detecting focal bone lesions. SUVmax values were slightly higher in [18F]FCH PET/CT than in [18F]FDG PET/CT. Conclusions: Taking into account the small study population, according to our results, [18F]FCH PET/CT could be a useful tool for staging MM patients.

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“…FAPI PET is achieving more clinical relevance by visualizing activated fibroblasts, which participate in essential pathophysiological processes of various diseases. 1,2 Thrombus formation and propagation also involve fibroblast activation 3 ; a recent case report showed increased FAPI uptake in cerebral venous sinus thrombosis, demonstrating a potential role of FAPI PET in the management of neuro-Behçet disease. 4 However, the constituents of the thrombi (eg, gray vs red thrombus) and the time from the thrombus initiation affect the amount and activity of the fibroblasts.…”

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confidence: 99%

“…However, no venous abnormality or thrombosis was detected on CTA. FAPI PET is achieving more clinical relevance by visualizing activated fibroblasts, which participate in essential pathophysiological processes of various diseases 1,2 . Thrombus formation and propagation also involve fibroblast activation 3 ; a recent case report showed increased FAPI uptake in cerebral venous sinus thrombosis, demonstrating a potential role of FAPI PET in the management of neuro-Behçet disease 4 .…”

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confidence: 99%

Discordant Uptake of Leg Thrombi Versus Pulmonary Emboli on 68Ga-FAPI-46 PET/CT

Cho,

Park,

Kim

et al. 2023

Clin Nucl Med

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Fibroblast activation protein inhibitor (FAPI) PET is gaining clinical relevance for visualizing activated fibroblasts in various diseases. Here, we report discordant FAPI uptake between venous thrombi of the lower extremities and pulmonary emboli. An 86-year-old man complained of left leg swelling and acute dyspnea; he was diagnosed with deep vein thrombosis involving the left femoral vein and acute pulmonary thromboembolism. Positive FAPI uptake was observed only in the thrombi of the left femoral vein, but not in the pulmonary emboli. Such discrepancies may indicate different thrombus constituents and chronologies even in the same patient.

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Are We Approaching a Change in Paradigm in PET/CT Imaging of Solid Gastrointestinal (or Digestive) Tract Tumors With the Clinical Application of FAPI Imaging?

Cited by 7 publications

References 18 publications

Role of 68Ga-FAPI PET/CT in Assessing Hepatobiliary Malignancies

Role of 68Ga-FAPI PET/CT in Assessing Hepatobiliary Malignancies

Multitracer PET/CT with [18F]Fluorodeoxiglucose and [18F]Fluorocholine in the Initial Staging of Multiple Myeloma Patients Applying the IMPeTus Criteria: A Pilot Study

Discordant Uptake of Leg Thrombi Versus Pulmonary Emboli on 68Ga-FAPI-46 PET/CT

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