The Imaging Value of 18F-FAPI PET/CT in Sorafenib-Induced Cardiac Dysfunction in Patients with Hepatocellular Carcinoma: Compared with 18F-FDG PET/CT.

Purpose: Evaluation of ¹⁸F-FAPI PET/CT imaging in sorafenib-induced cardiac dysfunction in hepatocellular carcinoma (HCC) patients, and compared with ¹⁸F-FDG PET/CT.

Procedures: This retrospective study enrolled 75 HCC patients treated with sorafenib at our institution from June 2021 to June 2023. All patients underwent ¹⁸F-FDG PET/CT six months after treatment, followed by ¹⁸F-FAPI PET/CT within the subsequent week. Patients were divided into cardiac dysfunction group and control group based on the definition of cancer therapy-related cardiac dysfunction (CTRCD). Myocardial uptake parameters on ¹⁸F-FDG and ¹⁸F-FAPI PET/CT were compared between the two groups. The primary endpoint was the occurrence of major adverse cardiac events (MACEs), and the secondary endpoint was all-cause mortality, with follow-up at 30, 90, and 180 days after the PET/CT examinations.

Results: This study ultimately enrolled 47 patients, with the cardiac dysfunction group (n = 9) and control group (n = 38) demonstrating significant differences in myocardial ¹⁸F-FAPI high uptake, left ventricular (LV) ¹⁸F-FDG SUV, LV/liver ¹⁸F-FDG SUV, myocardial ¹⁸F-FAPI SUV, myocardial/aorta ¹⁸F-FAPI SUV, and myocardial/liver ¹⁸F-FAPI SUV. One year after treatment, the incidence of MACEs was slightly higher in the group with high ¹⁸F-FAPI myocardial uptake compared to the low uptake group (19.5% vs. 14.0%, log-rank p = 0.621), and the overall survival rate was lower in the high uptake group compared to the low uptake group (57.9% vs. 65.8%, log-rank p = 0.503).

Conclusions: The myocardial uptake parameters of ¹⁸F-FDG and ¹⁸F-FAPI PET/CT are helpful in evaluating sorafenib-induced cardiac dysfunction in HCC patients. The level of ¹⁸F-FAPI myocardial uptake has potential value in predicting post-treatment cardiotoxicity and overall survival prognosis in HCC patients.