Diagnostic performance of Ga-68 FAPI 04 PET/CT in colorectal malignancies

Abstract

Aim To evaluate the role of Ga-68 fibroblast activation protein inhibitor 04 PET/computed tomography (FAPI) in colorectal cancers (CRCs) in terms of diagnostic accuracy and impact on clinical management. FAPI is compared with FDG PET/CT and conventional imaging in staging, restaging, recurrence detection, and response evaluation of CRC. Methods Twenty-nine consecutive patients of histopathologically confirmed primary or relapsed CRC were included in the study. Patients who underwent FAPI PET/CT along with either FDG PET/CT or conventional imaging were included. Primary lesions, recurrence sites, lymph nodes, and metastatic lesions were recorded on all the scans. Maximum standardized uptake value (SUVmax) was measured from both primary and metastatic lesions. Results The sensitivity of FAPI in primary and recurrence detection is 100% compared to 88% for FDG/conventional imaging. The overall sensitivity of FAPI stands at 98% with accuracy at 95% whereas for FDG/conventional imaging the sensitivity and accuracy are 78% and 77%, respectively, with P < 0.002. Significant difference was noted in the detection of peritoneal metastasis (96% vs. 66%). Conclusion FAPI PET/CT shows better sensitivity and accuracy in the evaluation of CRCs, especially in peritoneal disease compared to FDG PET/CT and conventional imaging. FAPI has the potential to replace FDG in CRCs.

Head-to-head comparison of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of primary digestive system cancer: a systematic review and meta-analysis

“…The included studies involved a total of 383 participants with primary gastrointestinal cancers. The studies were published between 2020 and 2023 and included patients with five different main types of cancer: six for GC ( 26 , 29 – 34 ), four for liver cancer ( 35 – 38 ), three for biliary tract carcinoma (BTC) ( 37 – 39 ), four for colorectal cancer ( 26 , 27 , 34 , 40 ), and one for pancreatic cancer ( 41 ). Of these 15 studies, eight were retrospective and seven were prospective.…”

Head-to-head comparison of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET in the detection of cancer recurrence: a systematic review and meta-analysis

“…The limited availability and difficulty in obtaining the gallium 68 generator required for production increases the cost of [ 68 Ga]Ga-FAPI-04 PET. On the other hand, FDG is more widely available and relatively cost-effective ( 33 ). However, when cost is not a concern, [ 68 Ga]Ga-FAPI-04 PET has clear benefits, including a higher tumor-to-background ratio, independence from blood glucose levels, and fast image acquisition ( 34 , 35 ).…”

Imaging Evaluation of Peritoneal Metastasis: Current and Promising Techniques

“…A high TBR is one of the most important prerequisites for the clear visualization of lesions, which is indispensable for evaluating tumor severity and optimizing treatment plans ( Fig. 1 ) [ 60 61 ]. 68 Ga/ 18 F-FAPI does not accumulate in the gastrointestinal tract and liver [ 62 63 ].…”