Diagnostic Value of [¹⁸F]-FDG and [⁶⁸ Ga]-FAPI-04 PET/MRI for Lymph Node Metastasis in Papillary Thyroid Cancer.

IF 3 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Molecular Imaging and Biology Pub Date : 2025-06-24 DOI:10.1007/s11307-025-02028-x

Tingting Han, Zhiyong Quan, Hongliang Wei, Mingru Zhang, Jiajun Ye, Guiyu Li, Junling Wang, Taoqi Ma, Jing Wang, Fei Kang

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引用次数: 0

Abstract

Purpose: This study aimed to evaluate the diagnostic value of [¹⁸F]-FDG PET/MRI for the diagnosis of neck lymph node metastasis (LNM) in patients with initially diagnosed papillary thyroid cancer (PTC) and to compare it with [⁶⁸ Ga]-FAPI-04 PET/MRI.

Methods: Thirty patients with PTC confirmed by thyroid fine-needle aspiration biopsy were prospectively enrolled and underwent [¹⁸F]-FDG PET/MRI; of which, 6 additionally underwent [⁶⁸ Ga]-FAPI-04 PET/MRI within 3 days. According to surgical guidelines, the neck lymph node (LN) was divided into three macroscopic regions: central (VI) and left/right lateral neck (II-V). Images were semi-quantitatively and visually interpreted, and lesions' quantity, location, and uptake values were noted. Diagnostic performance of [¹⁸F]-FDG PET/MRI versus US and MRI in N-staging of PTC patients based on regional analysis using postoperative histopathology as the gold standard. Whether the BRAF_V600E mutation or not affects metastatic LN radioactivity uptake. Exploring the relevance of dual tracer imaging of metastatic LN radioactivity uptake and its head-to-head comparison for diagnostic efficacy.

Results: A total of 48 macroscopic regions were surgically dissected. In terms of predicting LNM, the diagnostic efficacy of [¹⁸F]-FDG PET/MRI for detecting LNM was higher than that of US and MRI, overall sensitivity, specificity, and accuracy were 71.1% vs. 60.5% vs. 65.8%, 90.0% vs.80.0% vs. 80.0%, and 75.0% vs. 64.6% vs. 68.8%, respectively (all P > 0.05). SUV_max of metastatic LNs on [⁶⁸ Ga]-FAPI-04 PET/MRI was positively correlated with [¹⁸F]-FDG PET/MRI (r = 0.8564, 95%CI: 0.7208-0.9289; P < 0.0001). BRAF_V600E mutation had no significant effect on the [¹⁸F]-FDG uptake level and TBR value in metastatic LN of PTC (SUV_max: 2.5 ± 2.3 vs. 2.2 ± 1.1; TBR: 2.9 ± 2.6 vs. 2.6 ± 1.4; all P > 0.05). The positive lesion detection rate of dual tracer imaging in 6 patients with PTC is consistent, and the degree of radioactivity uptake of [⁶⁸ Ga]-FAPI-04 was higher than that of [¹⁸F]-FDG in both primary lesion and LNM (12.3 ± 5.7 vs. 6.9 ± 5.3;4.5 ± 3.7 vs. 3.4 ± 1.8; all P > 0.05).

Conclusion: [¹⁸F]-FDG PET/MRI demonstrated marginally superior diagnostic performance for LNM detection compared to US and MRI, but all three modalities exhibited suboptimal sensitivity, particularly in the central region. Small sample populations revealed no significant differences in [⁶⁸ Ga]-FAPI-04 and [¹⁸F]-FDG uptake levels in primary lesion and LNM of PTC, but relatively lower nonspecific uptake of [⁶⁸ Ga]-FAPI-04 pharyngeal lymphatic ring may have the potential to reduce diagnostic error in specific diseases.

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[18F]-FDG和[68 Ga]-FAPI-04 PET/MRI对甲状腺乳头状癌淋巴结转移的诊断价值。

目的：本研究旨在评价[18F]-FDG PET/MRI对初诊乳头状甲状腺癌（PTC）患者颈部淋巴结转移（LNM）的诊断价值，并与[68 Ga]-FAPI-04 PET/MRI进行比较。方法：前瞻性纳入30例经甲状腺细针穿刺活检证实的PTC患者，进行[18F]-FDG PET/MRI检查；其中6例在3天内接受了[68 Ga]-FAPI-04 PET/MRI检查。根据手术指南，将颈部淋巴结（LN）分为三个宏观区域：中央（VI）和左/右颈部外侧（II-V）。对图像进行半定量和视觉解释，并记录病变的数量、位置和摄取值。[18F]-FDG PET/MRI相对于US和MRI在PTC患者n分期诊断中的表现，基于区域分析，以术后组织病理学为金标准。BRAFV600E突变是否影响转移性LN放射性摄取。探讨转移性LN放射性摄取的双重示踪成像的相关性及其头对头的诊断效果比较。结果：手术切除了48个宏观区域。在预测LNM方面，[18F]-FDG PET/MRI对LNM的诊断效能高于US和MRI，总体敏感性、特异性和准确性分别为71.1%比60.5%比65.8%、90.0%比80.0%比80.0%、75.0%比64.6%比68.8%（均P < 0.05）。[68 Ga]-FAPI-04 PET/MRI上转移性LNs的SUVmax与[18F]-FDG PET/MRI呈正相关(r = 0.8564, 95%CI: 0.7208 ~ 0.9289；pv600e突变对PTC转移性淋巴结[18F]-FDG摄取水平和TBR值无显著影响(SUVmax: 2.5±2.3 vs. 2.2±1.1；TBR: 2.9±2.6 vs. 2.6±1.4；P < 0.05)。6例PTC患者双示踪成像病变检出率一致，[68 Ga]-FAPI-04在原发病变和LNM的放射性摄取程度均高于[18F]-FDG(12.3±5.7 vs. 6.9±5.3;4.5±3.7 vs. 3.4±1.8；P < 0.05)。结论：与US和MRI相比，[1⁸F]-FDG PET/MRI在LNM检测方面表现出略微优越的诊断性能，但这三种方式的灵敏度都不理想，尤其是在中央区域。小样本人群显示PTC原发病变和LNM中[68 Ga]-FAPI-04和[18F]-FDG摄取水平无显著差异，但相对较低的[68 Ga]-FAPI-04咽淋巴环的非特异性摄取可能有可能减少特异性疾病的诊断错误。

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来源期刊

Molecular Imaging and Biology 医学-核医学

CiteScore

6.90

自引率

3.20%

发文量

审稿时长

3 months

期刊介绍： Molecular Imaging and Biology (MIB) invites original contributions (research articles, review articles, commentaries, etc.) on the utilization of molecular imaging (i.e., nuclear imaging, optical imaging, autoradiography and pathology, MRI, MPI, ultrasound imaging, radiomics/genomics etc.) to investigate questions related to biology and health. The objective of MIB is to provide a forum to the discovery of molecular mechanisms of disease through the use of imaging techniques. We aim to investigate the biological nature of disease in patients and establish new molecular imaging diagnostic and therapy procedures. Some areas that are covered are: Preclinical and clinical imaging of macromolecular targets (e.g., genes, receptors, enzymes) involved in significant biological processes. The design, characterization, and study of new molecular imaging probes and contrast agents for the functional interrogation of macromolecular targets. Development and evaluation of imaging systems including instrumentation, image reconstruction algorithms, image analysis, and display. Development of molecular assay approaches leading to quantification of the biological information obtained in molecular imaging. Study of in vivo animal models of disease for the development of new molecular diagnostics and therapeutics. Extension of in vitro and in vivo discoveries using disease models, into well designed clinical research investigations. Clinical molecular imaging involving clinical investigations, clinical trials and medical management or cost-effectiveness studies.