Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers

Jayaprakasam, Vetri Sudar; Paroder, Viktoriya; Schöder, Heiko

doi:10.1053/j.semnuclmed.2021.04.001

Cited by 30 publications

(20 citation statements)

References 152 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it has a considerable intake in normal tissues, such as the brain, liver and intestine, and has limited use in low metabolic tumors, such as prostate cancer. The detection rate of [ 18 F]-FDG PET MRI/CT in gastric cancer is affected by pathological tumor type and high FDG uptake in the gastric wall, and the detection sensitivity is not ideal [4]. Fibroblast activating protein (FAP) is a type II transmembrane protease with dipeptidyl peptidase and endopeptidase activities [5].…”

Section: Introductionmentioning

confidence: 99%

[68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis

Wang

Luo

2023

Eur J Med Res

View full text Add to dashboard Cite

Objectives To compare the detection rates of [68Ga]Ga-FAPI-04 PET MRI/CT vs. [18F]-FDG PET MRI/CT in gastric cancer. Methods An extensive librarian-led literature search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov was performed. The primary outcomes were sensitivity in patient-based evaluations, detection of lymph node metastases, and peritoneal involvement. Results Five studies, including 148 participants, were analyzed. [68Ga]Ga-FAPI-04 PET MRI/CT has a comparatively high sensitivity in patient-based evaluations compared with [18F]-FDG PET MRI/CT (risk difference = 0.16, 95% CI 0.09–0.22, P < 0.00001). The [68Ga]Ga-FAPI-04 PET MRI/CT group has a comparatively higher sensitivity in detecting lymph node metastases (RR = 0.15, 95% CI 0.01–0.29, P = 0.04), peritoneal involvement (RR = 0.55, 95% CI 0.38–0.72, P < 0.00001) in gastric cancer than [18F]-FDG PET MRI/CT group. Conclusions This systematic review confirmed the advantage of [68Ga]Ga-FAPI-04 PET MRI/CT in gastric cancer. [68Ga]Ga-FAPI-04 PET MRI/CT was superior to [18F]-FDG PET MRI/CT in detecting the primary tumor, lymph node metastases, and peritoneal metastases. More studies are needed for the sensitivity and specificity of [68Ga]Ga-FAPI-04 PET MRI/CT in different pathological types of gastric cancer.

show abstract

Section: Introductionmentioning

confidence: 99%

[68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis

Wang

Luo

2023

Eur J Med Res

View full text Add to dashboard Cite

show abstract

“…Anatomical imaging of contrast-enhanced CT relies on morphologic changes and is limited by tumor size, making it challenging to detect early and small recurrences [3,6]. As a functional imaging modality, ¹⁸F-FDG PET/CT is sensitive to tumor recurrence, but it is still difficult to differentiate inflammation from cancer recurrence, often leading to false positive results [8,23]. Recently, fibroblast activation protein (FAP) targeted 68 Ga-FAPI-04 PET/CT imaging has exhibited promising results in detecting occult metastases in various solid tumor types.…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, ¹⁸F-FDG PET/CT has been widely used for periodic surveillance of recurrence in postoperative patients due to the advantages of whole-body imaging and metabolism-based detection of small lesions compared to traditional methods such as endoscopy and contrast-enhanced CT imaging [3,7]. However, it is challenging for PET/CT physicians to identify cancer recurrence in the presence of abnormal ¹⁸F-FDG accumulation at anastomotic sites since postoperative inflammation also yields intense ¹⁸F-FDG signals, which can compromise PET/CT reporting and challenge clinical physicians when they are making treatment decisions [6,8].…”

Section: Introductionmentioning

confidence: 99%

68Ga-FAPI-04 PET for surveillance of anastomotic recurrence in postoperative patients with gastrointestinal cancer: a comparative study with 18F-FDG PET

Wang

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose: 68Ga-FAPI-04 PET imaging has shown clinical advantages for detecting and staging various solid tumor types, including gastrointestinal cancer. This study aims to compare the diagnostic efficacy of 68Ga-FAPI-04 PET and 18F-FDG PET for detecting anastomotic recurrence in postoperative patients with gastrointestinal cancer and to characterize the pattern of 68Ga-FAPI-04 uptake at surgical wounds post-surgery. Methods: This study involved 63 gastrointestinal cancer patients who underwent 68Ga-FAPI-04 and 18F-FDG PET/CT imaging, or 68Ga-FAPI-04 PET/CT imaging only for postoperative surveillance after curative surgical resection. The SUVmax at surgical wounds (anastomotic sites and abdominal incision sites) and its corresponding ratio compared to background were assessed. Endoscopic pathology confirmed anastomotic recurrence or it was ruled out by imaging and clinical follow-up. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of the two PET imaging in detecting anastomotic recurrence were compared based on the analysis of paired FAPI-FDG PET imaging. Relationships between tracer uptake at surgical wounds and postoperative time were also analyzed. Results: Sensitivity, specificity, PPV, NPV, and accuracy of detecting anastomotic recurrence were 100.0%, 87.3%, 41.7%, 100.0%, and 88.3% for 68Ga-FAPI-04 PET imaging, and 60.0%, 81.8%, 23.1%, 95.7%, and 80.0% for 18F-FDG PET imaging respectively. Compared with non-recurrent patients, the recurrent patients exhibited a significantly higher anastomotic SUVmax and ratio on FAPI-PET imaging (SUVmax : 9.92±4.36 vs. 2.81±1.86, P =0.002; Ratio: 5.11±1.99 vs. 2.23±1.17, P <0.001). 68Ga-FAPI-04 PET displayed a significantly higher SUVmax ratio at surgical wounds than 18F-FDG PET imaging (anastomotic sites: 2.57±1.61 vs. 1.76±0.74, P =0.001; abdominal incision sites: 2.14±1.47 vs. 1.65±1.12, P =0.029). Although 68Ga-FAPI-04 PET signal at surgical wounds showed a slight trend to decrease over time (anastomotic SUVmax : r=-0.2830, P =0.0223; incisional SUVmax : r=-0.4549, P <0.0001), no statistical difference was observed over months post-surgery ( P >0.05). Conclusion: The surveillance power of 68Ga-FAPI-04 PET is superior to 18F-FDG PET in postoperative anastomotic recurrence of gastrointestinal cancer, but the positive predictive value was limited due to wound healing inference. Therefore, combined surveillance methods were suggested instead of relying on 68Ga-FAPI-04 or 18F-FDG PET only.

show abstract

“…Physiologic large bowel uptake is most prominent in the cecum, ascending colon and rectosigmoid colon where the typical pattern of uptake is segmental with a mild to moderate intensity (3,4). A nodular pattern of uptake is more typical for the ascending colon (3).…”

Section: Normal Physiologic Variantsmentioning

confidence: 99%

F-18 FDG PET/CT Imaging in Normal Variants, Pitfalls and Artifacts in the Abdomen and Pelvis

Vangu

Momodu

2022

Front. Nucl. Med.

View full text Add to dashboard Cite

Since its introduction into clinical practice, multimodality imaging has revolutionized diagnostic imaging for both oncologic and non-oncologic pathologies. 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging which takes advantage of increased anaerobic glycolysis that occurs in tumor cells (Warburg effect) has gained significant clinical relevance in the management of most, if not all oncologic conditions. Because FDG is taken by both normal and abnormal tissues, PET/CT imaging may demonstrate several normal variants and imaging pitfalls. These may ultimately impact disease detection and diagnostic accuracy. Imaging specialists (nuclear medicine physicians and radiologists) must demonstrate a thorough understanding of normal and physiologic variants in the distribution of 18F-FDG; including potential imaging pitfalls and technical artifacts to minimize misinterpretation of images. The normal physiologic course of 18F-FDG results in a variable degree of uptake in the stomach, liver, spleen, small and large bowel. Urinary excretion results in renal, ureteric, and urinary bladder uptake. Technical artifacts can occur due to motion, truncation as well as the effects of contrast agents and metallic hardware. Using pictorial illustrations, this paper aims to describe the variants of physiologic 18F-FDG uptake that may mimic pathology as well as potential benign conditions that may result in misinterpretation of PET/CT images in common oncologic conditions of the abdomen and pelvis.

show abstract

Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers

Cited by 30 publications

References 152 publications

[68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis

[68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis

68Ga-FAPI-04 PET for surveillance of anastomotic recurrence in postoperative patients with gastrointestinal cancer: a comparative study with 18F-FDG PET

F-18 FDG PET/CT Imaging in Normal Variants, Pitfalls and Artifacts in the Abdomen and Pelvis

Contact Info

Product

Resources

About