Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Abstract

Background: Accurate clinical staging is crucial to managing gastrointestinal cancer, but fluorine 18 (18 F) fluorodeoxyglucose (FDG) PET/CT has limitations. Targeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and gallium 68 (68 Ga)-labeled fibroblast-activation protein inhibitors (FAPIs), hereafter 68 Ga-FAPIs, present a promising alternative to 18 F-FDG. Purpose: To compare the diagnostic efficacy of 68 Ga-FAPI PET/CT in primary and metastatic lesions of gastrointestinal malignancies with that of 18 F-FDG PET/CT. Materials and Methods: Images from patients with gastric, duodenal, and colorectal cancers who underwent contemporaneous 18 F-FDG and 68 Ga-FAPI PET/CT between October 2019 through June 2020 were retrospectively analyzed. 18 F-FDG and 68 Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. The McNemar test was used to compare the diagnostic performance between the two techniques. Results: Thirty-five patients (median age, 64 years [interquartile range, 53-68 years]; 18 men) were evaluated. In treatment-naive patients (n = 19), 68 Ga-FAPI PET/CT led to upstaging of the clinical TNM stage in four (21%) patients compared with 18 F-FDG PET/CT. Tracer uptake was higher with 68 Ga-FAPI PET/CT than with 18 F-FDG PET/CT in primary lesions (gastric cancer: 12.7 vs 3.7, respectively, P = .003; colorectal cancer: 15.9 vs 7.9, P = .03), involved lymph nodes (6.7 vs 2.4, P , .001), and bone and visceral metastases (liver metastases: 9.7 vs 5.2, P , .001; peritoneal metastases: 8.4 vs 3.6, P , .001; bone metastases: 4.3 vs 2.2, P , .001; lung metastases: 4.4 vs 1.9, P = .01). In addition, the sensitivity of 68 Ga-FAPI PET/CT was higher than that of 18 F-FDG PET/CT in the detection of primary tumors (100% [19 of 19] vs 53% [10 of 19], respectively; P = .004), lymph nodes (79% [22 of 28] vs 54% [15 of 28], P , .001), and bone and visceral metastases (89% [31 of 35] vs 57% [20 of 35], P , .001). Conclusion: Gallium 68 fibroblast-activation protein inhibitor PET/CT was superior to fluorine 18 fluorodeoxyglucose PET/CT in the detection of primary and metastatic lesions in gastric, duodenal, and colorectal cancers, with higher tracer uptake in most primary and metastatic lesions. Published under a CC BY 4.0 license.

A Head-to-Head Comparison of 68Ga-DOTA-FAPI-04 and 18F-FDG PET/MR in Patients with Nasopharyngeal Carcinoma: A Prospective Study

“…Pang reported 68 Ga-FAPI outperforms 18 F-FDG PET/CT in identifying bone metastasis in a patient with metastatic breast cancer [24]. A recent study also reported more bone metastases with higher uptake were observed on 68 Ga-FAPI PET/CT than 18 F-FDG in gastrointestinal cancers [25]. Therefore, 68 Ga-FAPI may be superior to 18 F-FDG in detecting small bone metastases.…”

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

“…[ 18 Ga]Ga-DOTA-FAPI-04 PET/CT imaging, the injected activity was 132-187 MBq. The image acquisition was performed 60 min post-injection with the PET/CT scanner (Biogragh 16 HR, Siemens Medical Systems, Erlangen, Germany).…”

“…[ 18 (3.7 MBq/Kg) and the blood glucose levels should be less than 10 mmol/L. For [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT imaging, the injected activity was 132-187 MBq.…”

“…Compared with CT or MRI, positron emission tomography/computed tomography (PET/CT) imaging with [ 18 F]FDG is not recommended with high priority in the guideline, but it has great advantages in clinical staging, therapeutic evaluation, and detection of recurrence. Some studies have also demonstrated that [ 18 F]FDG uptake of pancreatic tumors is associated with poor prognosis [5][6][7]. However, its speci city is relative low due to that the false positive uptake in in ammatory diseases.…”

“…And [ 18 F]FDG PET/CT has limited role in detecting LN involvement of PDAC [8]. Moreover, [ 18 F]FDG uptakes is generally low in some types of pancreatic NENs [9].…”