目的:为了研究[18F]成纤维细胞激活蛋白抑制剂(FAPI)正电子发射断层扫描/计算机断层扫描(PET/CT)评估肺动脉(PA)肿块的潜在用途,并与[18F]氟脱氧葡萄糖(FDG)PET/CT进行比较。
方法:前瞻性纳入临床怀疑PA恶性肿瘤的参与者,并接受双示踪剂PET/CT([18F]FAPI-42和[18F]FDG)成像。在两种类型的放射性示踪剂之间比较了视觉分析和半定量参数。对组织标本进行免疫组织化学染色以验证FAP在组织中的表达。
结果:纳入33例患者(男18例/女15例;平均年龄53.1±15.4岁)。所有21例恶性PA肿块患者均为FDG阳性(100%),而21例患者中有20例FAPI阳性(95.2%).所有12例良性PA肿块患者的FDG和FAPIPET均为阴性。恶性PA肿块中FAPI和FDG的平均最大标准化摄取值(SUVmax)和目标背景比(TBR)显着高于良性肿块。尽管恶性PA肿块中FDG和FAPI之间的SUVmax没有显着差异(11.36vs.9.18,p=0.175),TBR(肝脏)和TBR(左心室)对FAPI比对FDG更有利(13.04vs.5.17,p<0.001);(中位数:7.75vs.2.75,p=0.007)。免疫组织化学分析(n=16)证实FAP表达水平强烈对应于PET/CT扫描中FAPI的摄取(rs=0.712,p=0.002)。对于临床管理,FAPIPET在4例患者中发现比FDGPET更多的转移灶,2名患者升级,1名患者改变治疗决定。
结论:FAPIPET/CT对PA肿块的诊断是可行的。虽然不优于FDGPET/CT,FAPIPET/CT显示更好的目标背景对比。
结论:这项研究发现,FAPIPET/CT在诊断PA肿块方面并不优于FDGPET/CT,但FAPIPET/CT显示更好的靶-背景对比和更多的阳性病变,这可能有助于改善疾病管理。
结论:肺部恶性肿瘤的临床表现缺乏特异性,实验室测试,和常规影像学检查。FAPIPET/CT在诊断上不如FDGPET/CT,但显示出更好的目标背景对比和更多的阳性病变。双示踪剂PET/CT([18F]FAPI-42和[18F]FDG)成像可改善肺动脉肿块的临床管理。
OBJECTIVE: To investigate the potential utility of [18F]fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) for evaluating pulmonary artery (PA) masses, and compare it with [18F]fluorodeoxyglucose (FDG) PET/CT.
METHODS: Participants with clinically suspected PA malignancy were prospectively enrolled and underwent dual-tracer PET/CT ([18F]FAPI-42 and [18F]FDG) imaging. Visual analysis and semi-quantitative parameters were compared between the two types of radiotracers. The tissue specimen underwent immunohistochemical staining to verify FAP expression in the tissue.
RESULTS: Thirty-three patients (18 males/15 females; mean age 53.1 ± 15.4 years) were enrolled. All 21 patients with malignant PA masses were FDG-positive (100%), whereas 20 out of 21 patients were FAPI-positive (95.2%). All 12 patients with benign PA masses were both negative in FDG and FAPI PET. The mean maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR) of FAPI and FDG in malignant PA masses were significantly higher than those of benign masses. Although there was no significant difference in SUVmax between FDG and FAPI in malignant PA masses (11.36 vs. 9.18, p = 0.175), the TBR (liver) and TBR (left ventricle) were more favorable for FAPI than for FDG (13.04 vs. 5.17, p < 0.001); (median: 7.75 vs. 2.75, p = 0.007). Immunohistochemical analysis (n = 16) validated that the level of FAP expression corresponded strongly to the uptake of FAPI in PET/CT scans (rs = 0.712, p = 0.002). For clinical management, FAPI PET found more metastatic lesions than FDG PET in 4 patients, with 2 patients upgrading and 1 patient changing treatment decisions.
CONCLUSIONS: FAPI PET/CT is feasible in the diagnosis of PA masses. Although not superior to FDG PET/CT, FAPI PET/CT showed better target-to-background contrast.
CONCLUSIONS: This study found that FAPI PET/CT is not superior to FDG PET/CT in diagnosing PA masses, but FAPI PET/CT displays better target-to-background contrast and more positive lesions, which may help improve disease management.
CONCLUSIONS: Pulmonary malignancies lack specificity in clinical manifestations, laboratory tests, and routine imaging examinations. FAPI PET/CT is not diagnostically better than FDG PET/CT but displays better target-to-background contrast and more positive lesions. Dual-tracer PET/CT ([18F]FAPI-42 and [18F]FDG) imaging improves clinical management of pulmonary artery masses.