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

doi:10.19401/j.cnki.1007-3639.2023.09.003

Abstract

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

CLC Number:

R730.44

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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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

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

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