Al^(18)F-NOTA-FAPI-04和^(18)F-FDG PET/CT显像在初诊胃癌患者中的应用比较

Comparison of Al^(18)F-NOTA-FAPI-04 and ^(18)F-FDG PET/CT in evaluating patients with initial gastric cancer

目的比较Al^(18)F-1,4,7-三氮杂环壬烷-1,4,7-三乙酸(NOTA)-成纤维细胞激活蛋白抑制剂(FAPI)-04与^(18)F-FDG PET/CT在初诊胃癌中的应用。方法前瞻性纳入2021年3月至2022年7月间郑州大学第一附属医院初诊胃癌的患者20例(男13例、女7例,年龄:27~77岁),患者均于1周内完成^(18)F-FDG及Al^(18)F-NOTA-FAPI-04 PET/CT显像。比较2种方法的SUVmax、肿瘤与背景比(TBR)和阳性检出率(Wilcoxon符号秩检验、McNemarχ^(2)检验)。结果Al^(18)F-NOTA-FAPI-04在胃癌原发灶的SUVmax及TBR均明显高于^(18)F-FDG[10.2(8.0,13.7)和5.2(3.3,7.7),z=-3.47,P=0.001;7.6(5.6,10.3)和2.4(1.8,3.0),z=-3.85,P<0.001]。Al^(18)F-NOTA-FAPI-04 PET/CT对胃癌原发灶的阳性检出率有高于^(18)F-FDG PET/CT的趋势[95%(19/20)和75%(15/20);χ^(2)=2.25,P=0.125]。Al^(18)F-NOTA-FAPI-04 PET/CT对转移性淋巴结的检出率高于^(18)F-FDG PET/CT[78.9%(101/128)与64.8%(83/128);χ^(2)=13.47,P<0.001]。Al^(18)F-NOTA-FAPI-04在淋巴结转移灶的SUVmax及TBR均高于^(18)F-FDG[5.3(3.5,9.2)和2.8(1.8,4.7),z=-7.31,P<0.001;4.6(2.6,6.5)和1.7(1.0,3.0),z=-8.44,P<0.001]。在检测腹膜转移方面,Al^(18)F-NOTA-FAPI-04显示出比^(18)F-FDG PET/CT更高的腹膜癌指数(PCI)、SUVmax及TBR[PCI:12.0(3.0,29.8)和5.5(0.5,17.5),z=-2.22,P=0.026;SUVmax:8.2(4.4,12.5)和2.7(1.9,4.0),z=-2.52,P=0.012;TBR:5.1(2.9,13.3)和1.1(0.9,2.0),z=-2.52,P=0.012]。结论Al^(18)F-NOTA-FAPI-04 PET/CT在胃癌原发灶和转移灶中的表现优于^(18)F-FDG PET/CT,是胃癌患者的一种潜在的新型显像方式。

Objective To compare Al^(18)F-1,4,7-trizacyclononane-1,4,7-triacetic acid(NOTA)-fibroblast activation protein inhibitor(FAPI)-04 PET/CT with ^(18)F-FDG PET/CT in the evaluation of patients with initial gastric cancer.Methods Twenty patients(13 males,7 females,age:27-77 years)with histologically proven gastric cancer were recruited prospectively between March 2021 and July 2022 in the First Affiliated Hospital of Zhengzhou University.Each patient underwent both ^(18)F-FDG and Al^(18)F-NOTA-FAPI-04 PET/CT within one week.SUVmax,tumor background ratio(TBR)and positive detection rate of the two methods were compared(Wilcoxon signed rank sum test,McNemarχ^(2) test).Results Al^(18)F-NOTA-FAPI-04 showed higher SUVmax and TBR than those of ^(18)F-FDG in primary tumors(10.2(8.0,13.7)vs 5.2(3.3,7.7),z=-3.47,P=0.001;7.6(5.6,10.3)vs 2.4(1.8,3.0),z=-3.85,P<0.001).For the detection of primary gastric cancer,the positive detection rate of Al^(18)F-NOTA-FAPI-04 PET/CT showed the trend of being higher than that of ^(18)F-FDG PET/CT(95%(19/20)and 75%(15/20);χ^(2)=2.25,P=0.125).For assessing lymph node metastasis,the detection rate of Al^(18)F-NOTA-FAPI-04 PET/CT was higher than that of ^(18)F-FDG PET/CT(78.9%(101/128)vs 64.8%(83/128);χ^(2)=13.47,P<0.001).The SUVmax and TBR of Al^(18)F-NOTA-FAPI-04 in lymph node were higher than those of ^(18)F-FDG(5.3(3.5,9.2)vs 2.8(1.8,4.7),z=-7.31,P<0.001;4.6(2.6,6.5)vs 1.7(1.0,3.0),z=-8.44,P<0.001).For the detection of peritoneal carcinomatosis,Al^(18)F-NOTA-FAPI-04 PET/CT showed higher peritoneal cancer index(PCI),SUVmax,and TBR compared to ^(18)F-FDG PET/CT(PCI:12.0(3.0,29.8)vs 5.5(0.5,17.5),z=-2.22,P=0.026;SUVmax:8.2(4.4,12.5)vs 2.7(1.9,4.0);z=-2.52,P=0.012;TBR:5.1(2.9,13.3)vs 1.1(0.9,2.0);z=-2.52,P=0.012).Conclusion Al^(18)F-NOTA-FAPI-04 PET/CT outperforms ^(18)F-FDG PET/CT in primary and metastatic lesions of gastric cancer and might be a potential novel modality for imaging patients with gastric cancer.