Imaging fibroblast activation protein in liver cancer: a single-center post hoc retrospective analysis to compare [68Ga]Ga-FAPI-04 PET/CT versus MRI and [18F]-FDG PET/CT

Guo, Wei; Pang, Yizhen; Yao, Lanlin; Zhao, Liang; Fan, Chunlei; Ke, Jingpeng; Guo, Ping; Hao, Bin; Fu, Hao; Xie, Chengrong; Qi, Lin; Wu, Hua; Sun, Long; Chen, Haojun

doi:10.1007/s00259-020-05095-0

Cited by 128 publications

(184 citation statements)

References 33 publications

Supporting

Mentioning

170

Contrasting

Unclassified

Order By: Relevance

“…Moreover, increasing uptake of 68 Ga-FAPI-04 was observed in the postoperative area of the liver in one patient with recurrent HCC, which is consistent with a previous study that considered 68 Ga-FAPI-04 an inappropriate tracer for the discrimination between abnormal malignant progression and normal postoperative reaction (39). Nevertheless, negligible 68 Ga-FAPI-04 uptake has been observed in some other benign hepatic lesions such as adenoma (20,39), dysplastic nodule (20), granuloma (21), and haemangioma (21). Collectively, great caution should be exercised when regarding intrahepatic lesions with elevated uptake of 68 Ga-FAPI-04 as malignancy.…”

supporting

confidence: 90%

“…Recent investigations indicated that 68 Ga-labelled FAP inhibitor (FAPI) shows an equal or even improved tumour imaging with lower background uptake in the liver and the brain in comparison to 18 F-FDG in various cancers (17,18). 68 Ga-FAPI-04 PET/CT was also revealed to have high sensitivity in detecting hepatic malignancies (19)(20)(21). Therefore,…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma

et al. 2021

View full text Add to dashboard Cite

BackgroundFibroblast activation protein (FAP) is commonly expressed in activated stromal fibroblasts in various epithelial tumours. Recently, 68Ga-FAPI-04 has been used for tumour imaging in positron emission tomography/computed tomography (PET/CT). This study aimed to compare the diagnostic performances of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in hepatocellular carcinoma (HCC), and to assess factors associated with 68Ga-FAPI-04 uptake in HCC.Materials and MethodsTwenty-nine patients with suspiciously HCC who received both 18F-FDG and 68Ga-FAPI-04 PET/CT were included in this retrospective study. The results were interpreted by two experienced nuclear medicine physicians independently. The maximum and mean standardized uptake values (SUVmax and SUVmean) were measured in the lesions and liver background, respectively. The tumour-to-background ratio (TBR) was then calculated as lesion’s SUVmax divided by background SUVmean.ResultsA total of 35 intrahepatic lesions in 25 patients with HCC were finally involved in the statistical analysis. 68Ga-FAPI-04 PET/CT showed a higher sensitivity than 18F-FDG PET/CT in detecting intrahepatic HCC lesions (85.7% vs. 57.1%, P = 0.002), including in small (≤ 2 cm in diameter; 68.8% vs. 18.8%, P = 0.008) and well- or moderately-differentiated (83.3% vs. 33.3%, P = 0.031) tumors. SUVmax was comparable between 68Ga-FAPI-04 and 18F-FDG (6.96 ± 5.01 vs. 5.89 ± 3.38, P > 0.05), but the TBR was significantly higher in the 68Ga-FAPI-04 group compared with the 18F-FDG group (11.90 ± 8.35 vs. 3.14 ± 1.59, P < 0.001). SUVmax and the TBR in 68Ga-FAPI-04 positive lesions were associated with tumour size (both P < 0.05), but not the remaining clinical and pathological features (all P > 0.05).Conclusions68Ga-FAPI-04 PET/CT is more sensitive than 18F-FDG PET/CT in detecting HCC lesions, and 68Ga-FAPI-04 uptake is correlated mainly with tumour size.

show abstract

supporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Therefore, FAPI-PET/CT may have difficulties in differentiating between malignant and benign nodules in patients with cirrhotic disease [ 48 ] A further study presented a significantly elevated hepatic uptake in patients with cirrhosis compared with patients without cirrhosis. On the other hand, FDG-PET/CT showed no significant differences in the background liver activity [ 49 ]. Therefore, FAP overexpression in a benign fibrosis may challenge the diagnostic performance of FAPI-PET/CT in further clinical applications.…”

Section: Fap Expression and Fapi-pet/ct In Non-oncological Conditionsmentioning

confidence: 99%

FAP and FAPI-PET/CT in Malignant and Non-Malignant Diseases: A Perfect Symbiosis?

Dendl

Koerber

Kratochwil

et al. 2021

Cancers

View full text Add to dashboard Cite

A fibroblast activation protein (FAP) is an atypical type II transmembrane serine protease with both endopeptidase and post-proline dipeptidyl peptidase activity. FAP is overexpressed in cancer-associated fibroblasts (CAFs), which are found in most epithelial tumors. CAFs have been implicated in promoting tumor cell invasion, angiogenesis and growth and their presence correlates with a poor prognosis. However, FAP can generally be found during the remodeling of the extracellular matrix and therefore can be detected in wound healing and benign diseases. For instance, chronic inflammation, arthritis, fibrosis and ischemic heart tissue after a myocardial infarction are FAP-positive diseases. Therefore, quinoline-based FAP inhibitors (FAPIs) bind with a high affinity not only to tumors but also to a variety of benign pathologic processes. When these inhibitors are radiolabeled with positron emitting radioisotopes, they provide new diagnostic and prognostic tools as well as insights into the role of the microenvironment in a disease. In this respect, they deliver additional information beyond what is afforded by conventional FDG PET scans that typically report on glucose uptake. Thus, FAP ligands are considered to be highly promising novel tracers that offer a new diagnostic and theranostic potential in a variety of diseases.

show abstract

“…68 Ga-FAPI-PET/CT proved to supplement standard diagnostics successfully in several tumor entities such as in pancreaticobiliary and gastrointestinal carcinomas, which also presented the highest uptake of all included subtypes in our analysis. A previously conducted study supports these ndings, as it indicates that FAPI scans of patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCC) seem to be equivalent to contrast enhanced computed tomography (CE-CT) and magnetic resonance imaging (MRI) and even superior to FDG-PET/CT (14). Moreover, FAPI-PET/CT imaging of liver lesions was capable of successfully distinguishing between HCC, non-HCC and normal liver parenchyma (15).…”

Section: Discussionmentioning

confidence: 69%

FAP-Imaging in Rare Cancer Entities - First Clinical Experience in a Broad Spectrum of Malignancies

Dendl

Finck

Giesel

et al. 2021

Preprint

View full text Add to dashboard Cite

Purpose: 68Ga-FAPI (fibroblast activation protein inhibitor) is a rapidly evolving and highly promising radiotracer for PET/CT imaging, presenting excellent results in a variety of tumor entities, particularly in epithelial carcinomas. This retrospective analysis sought to evaluate the potential and impact of FAPI-PET/CT in rare cancer diseases with respect to improvement in staging and therapy, based on tracer uptake in normal organs and tumors.Material and Methods: 55 patients with rare tumor entities, defined by a prevalence of 1 person out of 2000 or less, received a 68Ga-FAPI-PET/CT scan. 14 women and 41 men (median age 60) were included within the following subgroups: cancer of unknown primary (n=10), head-and-neck-cancer (n=13), gastro-intestinal and biliary-pancreatic cancer (n=17), urinary tract cancer (n=4), neuroendocrine cancer (n=4) and others (n=7). Tracer uptake was quantified by standardized uptake values SUVmax and SUVmean and the tumor-to-background ratio (TBR) was determined (SUVmax tumor/ SUVmean organ). Results: In 20 out of 55 patients the primary tumor was identified and 31 patients presented metastases (n=88), characterized by a high mean SUVmax in primary (10.1) and metastatic lesions (7.6). Highest uptake was observed by liver metastases (n=6) with a mean SUVmax of 9.8 and a high TBR of 8.7, closely followed by peritoneal carcinomatosis (n=16) presenting a mean SUVmax of 9.8 and an excellent TBR of 29.6. In terms of the included subgroups the highest uptake regarding mean SUVmax was determined in gastro-intestinal and biliary-pancreatic cancer with 9.8 followed closely by urinary tract cancer with 9.5 and head-and-neck cancer (9.1). Conclusion Due to excellent tumor visualization and, thereby, sharp contrasts in terms of high TBRs in primary and metastatic lesions in different rare malignancies, 68Ga-FAPI-PET/CT crystallizes as a powerful and valuable imaging tool, particularly with respect to epithelial carcinomas, and therefore an enhancement to standard diagnostics imaging methodologies. The realization of further and prospective studies is of large importance to confirm the potential of FAP-imaging in oncology.

show abstract

Imaging fibroblast activation protein in liver cancer: a single-center post hoc retrospective analysis to compare [68Ga]Ga-FAPI-04 PET/CT versus MRI and [18F]-FDG PET/CT

Cited by 128 publications

References 33 publications

68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma

68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma

FAP and FAPI-PET/CT in Malignant and Non-Malignant Diseases: A Perfect Symbiosis?

FAP-Imaging in Rare Cancer Entities - First Clinical Experience in a Broad Spectrum of Malignancies

Contact Info

Product

Resources

About