18F-FDG和68Ga-FAPI PET/CT在不同恶性肿瘤肺转移诊断中的对比研究

doi:10.19401/j.cnki.1007-3639.2023.09.003

摘要/Abstract

摘要：

背景与目的：¹⁸F-氟代脱氧葡萄糖（¹⁸F-flurodeoxyglucose，¹⁸F-FDG）正电子发射计算机体层成像（positron emission tomography and computed tomography，PET/CT）是诊断恶性肿瘤伴远处转移的常用方法，但对肺部转移灶尤其是小病灶的检测仍不理想。⁶⁸Ga-成纤维细胞激活蛋白抑制剂（⁶⁸Ga-labeled fibroblast activation protein inhibitors，⁶⁸Ga-FAPI）已被用于靶向成纤维细胞激活蛋白和肿瘤基质的可视化。⁶⁸Ga-FAPI PET/CT对大多数癌症的原发灶及其转移灶的诊断价值均高于¹⁸F-FDG，但至今尚未见到对恶性肿瘤肺部转移性病变的对比研究。因此，本研究旨在探讨¹⁸F-FDG和⁶⁸Ga-FAPI PET/CT对不同恶性肿瘤肺转移病变的诊断价值。方法：回顾性分析复旦大学附属肿瘤医院2020年5月—2022年3月于1周内行¹⁸F-FDG和⁶⁸Ga-FAPI PET/CT检查的20例恶性肿瘤肺转移患者的临床、病理学及影像学资料，其中上皮源性恶性肿瘤（癌）11例，间叶源性恶性肿瘤（肉瘤）9例。采用配对t检验比较⁶⁸Ga-FAPI和¹⁸F-FDG的病灶最大标准摄取值（maximum standard uptake value，SUV_max)和肿瘤与本底比值（target-to-background ratio，TBR）参数之间的差异；采用线性相关性分析SUV_max和TBR与肺转移灶短径之间的相关性。结果：20例患者共81个肺转移灶（51个来自癌转移，30个来自肉瘤转移），¹⁸F-FDG检出阳性病灶72个，⁶⁸Ga-FAPI检查阳性病灶70个。与⁶⁸Ga-FAPI相比，肺转移灶¹⁸F-FDG摄取值更高，尤其是癌来源的肺转移病灶（P <0.001）。线性相关性分析结果显示，两种显像探针的半定量代谢参数值与肺转移病灶短径之间呈正相关（P <0.001）。结论：⁶⁸Ga-FAPI在检测恶性肿瘤肺转移病变时并无明显优势，尤其是在上皮组织来源的恶性肿瘤肺转移诊断中，¹⁸F-FDG摄取值往往更高。

关键词: 恶性肿瘤, 肺转移, 正电子发射计算机体层成像, ¹⁸F-氟代脱氧葡萄糖, ⁶⁸Ga-成纤维细胞激活蛋白抑制剂

Abstract:

Background and purpose: ¹⁸F-flurodeoxyglucose (¹⁸F-FDG) positron emission tomography and computed tomography (PET/CT) is a common method for the diagnosis of malignant tumors with distant metastases. However the detection of lung metastases, especially small lesions, is still unsatisfactory. ⁶⁸Ga-labeled fibroblast activation protein inhibitors (⁶⁸Ga-FAPI) have been used to target fibroblast activating proteins and visualize tumor stroma. The diagnostic value of ⁶⁸Ga-FAPI PET/CT is higher than that of ¹⁸F-FDG in the primary sites and metastases of most cancers, but no comparative study has been seen in lung metastases of malignant tumors. Therefore, this study aimed to investigate the diagnostic value of ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT in different malignant lung metastases. Methods: The clinical, pathological and imaging data of 20 patients with lung metastasis who underwent ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT examination within one week in Fudan University Shanghai Cancer Center from May 2020 to March 2022 were retrospectively analyzed. Among them, 11 cases were epithelial malignant tumors (carcinoma), and 9 cases were mesophyll malignant tumors (sarcoma). The semi-quantitative metabolic parameters including maximum standard uptake value (SUV_max) and target-to-background ratio (TBR) of ⁶⁸Ga-FAPI and ¹⁸F-FDG were compared by paired t test. The linear correlation between SUV_max and TBR and the short diameter of lung metastasis were analyzed. Results: A total of 81 lung metastases (51 carcinomas and 30 sarcomas) were detected in 20 patients, 72 positive lesions were detected by ¹⁸F-FDG and 70 positive lesions by ⁶⁸Ga-FAPI. Compared with ⁶⁸Ga-FAPI, ¹⁸F-FDG uptake was higher in lung metastases, especially those of carcinoma (P<0.001). The results of linear correlation analysis showed that the semi-quantitative metabolic parameters of the two imaging probes were positively correlated with the short diameter of lung metastases (P<0.001). Conclusion: ⁶⁸Ga-FAPI has no obvious advantage in the detection of lung metastases from malignant tumors. Especially in the diagnosis of lung metastases from epithelial tissues, the uptake of ¹⁸F-FDG tends to be higher.

Key words: Malignant tumor, Pulmonary metastasis, Positron emission tomography and computed tomography, ¹⁸F-flurodeoxyglucose, ⁶⁸Ga-labeled fibroblast activation protein inhibitors

中图分类号:

R730.44

杨梓怡, 顾丙新, 许晓平, 宋少莉. ¹⁸F-FDG和⁶⁸Ga-FAPI PET/CT在不同恶性肿瘤肺转移诊断中的对比研究[J]. 中国癌症杂志, 2023, 33(9): 829-833.

YANG Ziyi, GU Bingxin, XU Xiaoping, SONG Shaoli. Comparison of ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT in the diagnosis of lung metastasis in different malignant tumors[J]. China Oncology, 2023, 33(9): 829-833.

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参考文献 15

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Tumor	Lung metastases		¹⁸F-FDG			⁶⁸Ga-FAPI			P¹value	P²value
Tumor	Amount n	Diameter/cm	Positive lesions n	SUV_max	TBR	Positive lesions n	SUV_max	TBR	P¹value	P²value
Carcinomas	51	0.82±0.06 (0.30-2.20)	48	3.03±0.30 (0.40-8.20)	6.46±0.85 (0.80-36.00)	45	1.69±0.13 (0.40-4.10)	3.58±0.34 (0.67-13.67)	<0.001	<0.001
Sarcomas	30	1.09±0.18 (0.30-5.40)	24	4.22±0.80 (0.40-16.80)	8.16±1.41 (0.83-27.17)	25	4.44±1.29 (0.50-33.40)	6.09±1.58 (0.83-41.75)	0.817	0.144
Total	81	0.92±0.08 (0.30-5.40)	72	3.47±0.35 (0.40-16.80)	7.09±0.75 (0.80-36.00)	70	2.71±0.50 (0.40-33.40)	4.51±0.63 (0.67-41.75)	<0.046	<0.001

¹⁸F-FDG和⁶⁸Ga-FAPI PET/CT在不同恶性肿瘤肺转移诊断中的对比研究

Comparison of ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT in the diagnosis of lung metastasis in different malignant tumors

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