Comparison of [18F]FAPI-42 and [18F]FDG PET/CT in the evaluation of systemic vasculitis

IF 8.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2024-11-27 DOI:10.1007/s00259-024-06986-2

Kaixiang Zhong, Haiming Chen, Peng Hou, Linling Cheng, Wenliang Guo, Youcai Li, Jie Lv, Miao Ke, Xiaofeng Wu, Yongxia Lei, Chunli Liu, Cheng Hong, Xinlu Wang

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引用次数: 0

Abstract

Purpose

The role of fibroblast activation protein (FAP)-targeted imaging in systemic vasculitis is currently unclear. We aimed to evaluate the clinical value of fluorine-18-labeled FAP inhibitor 42 ([¹⁸F]FAPI-42) in patients with systemic vasculitis and to compare with [¹⁸F]fluorodeoxyglucose (FDG) imaging.

Methods

Patients with systemic vasculitis who underwent dual-tracer PET/CT([¹⁸F]FDG and [¹⁸F]FAPI) imaging from September 2020 to March 2022 were retrospectively analyzed. Positive lesions are defined as vascular/extravascular lesions with increased tracer uptake above surrounding background, which cannot be attributed to the physiologic biodistribution of the radiotracer. The vascular/extravascular lesion detection rate and semiquantitative values (SUVmax, TBR_blood and TBR_liver) of [¹⁸F]FAPI and [¹⁸F]FDG were compared, and the correlation between the extent and range of tracer uptake and levels of inflammatory markers was investigated.

Results

Thirty patients (13 males and 17 females; mean age, 52.5 ± 17.2 years) with systemic vasculitis were included (17 large vessel vasculitis, 10 anti-neutrophil cytoplasmic antibody-associated vasculitis, 2 Behcet’s disease and 1 polyarteritis nodosa). [¹⁸F]FDG PET/CT had positive findings in 93.3% (28/30) of patients, while [¹⁸F]FAPI PET/CT had positive findings in all patients (100%, P = 0.500). Compared with [¹⁸F]FDG PET/CT, [¹⁸F]FAPI PET/CT detected more lesions (161/168 vs. 145/168, P = 0.005), and more extensive vascular involvement in 60% (18/30) of patients. Although SUVmax did not differ significantly between [¹⁸F]FAPI and [¹⁸F]FDG (median, 5.94 vs. 5.46, P = 0.517), [¹⁸F]FAPI had higher TBR_liver (median, 9.59 vs. 3.15, P < 0.001) and TBR_blood (median, 5.45 vs. 4.20, P = 0.006). The total number of positive lesions in FAPI PET/CT show a moderate correlation with erythrocyte sedimentation rate (r_s =0.478, P = 0.008) and C-reactive protein (r_s =0.486, P = 0.006). After treatment, follow-up FAPI PET/CT of 6 patients showed decreased SUVmax, TBR and number of detected lesions, paralleling the clinical remission.

Conclusion

[¹⁸F]FAPI PET/CT imaging is a promising imaging modality for the diagnosis and therapeutic monitoring of systemic vasculitis.

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比较[18F]FAPI-42和[18F]FDG PET/CT在系统性血管炎评估中的应用

目的目前尚不清楚成纤维细胞活化蛋白（FAP）靶向成像在系统性血管炎中的作用。我们旨在评估氟-18标记的FAP抑制剂42（[18F]FAPI-42）在系统性血管炎患者中的临床价值，并与[18F]氟脱氧葡萄糖（FDG）成像进行比较。方法回顾性分析2020年9月至2022年3月期间接受双示踪剂PET/CT（[18F]FDG和[18F]FAPI）成像的系统性血管炎患者。阳性病变定义为示踪剂摄取量高于周围背景的血管/血管外病变，这不能归因于放射性示踪剂的生理性生物分布。比较了[18F]FAPI和[18F]FDG的血管/血管外病变检出率和半定量值（SUVmax、TBRblood和TBRliver），并研究了示踪剂摄取的程度和范围与炎症标志物水平之间的相关性。结果纳入了 30 位全身性血管炎患者（13 位男性，17 位女性；平均年龄为 52.5 ± 17.2 岁）（17 位大血管炎患者，10 位抗中性粒细胞胞浆抗体相关性血管炎患者，2 位白塞氏病患者，1 位结节性多动脉炎患者）。93.3% 的患者（28/30）的[18F]FDG PET/CT 检查结果呈阳性，而所有患者（100%，P = 0.500）的[18F]FAPI PET/CT 检查结果均呈阳性。与[18F]FDG PET/CT 相比，[18F]FAPI PET/CT 发现的病灶更多（161/168 对 145/168，P = 0.005），60%（18/30）的患者血管受累范围更广。虽然[18F]FAPI和[18F]FDG的SUVmax没有显著差异（中位数，5.94 vs. 5.46，P = 0.517），但[18F]FAPI的TBRliver（中位数，9.59 vs. 3.15，P <0.001）和TBRblood（中位数，5.45 vs. 4.20，P = 0.006）更高。FAPI PET/CT 阳性病灶总数与红细胞沉降率（rs =0.478，P =0.008）和 C 反应蛋白（rs =0.486，P =0.006）呈中度相关。结论[18F]FAPI PET/CT 成像是诊断和治疗监测系统性血管炎的一种很有前途的成像方式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.