Superiority of 68Ga-DOTA-FAPI-04 PET/CT to 18F-FDG PET/CT in the evaluation of different cancers with bone metastases

Le résumé fourni par la source

68 Ga-DOTA-FAPI-04 is a new positron imaging agent, and its application in bone metastasis has been limited. The purpose of this retrospective study was to compare the diagnostic ability of 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT to detect bone metastases in patients with different types of cancer. A total of 293 patients with pathologically confirmed primary malignancies were examined with 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT within one week. Using pathological examination or follow-up CT or MRI scan as the gold standard, the diagnostic efficacy of the two methods in differentiating bone metastases was compared (p < 0.05, with statistical significance). The maximum standard uptake value (SUVmax) of the two methods for different types of bone metastasis was further compared. The SUVmax was used to compare the differences between the two methods in detecting bone metastases in different tumor types and different sites. A total of 48 patients were diagnosed with bone metastasis, and 245 patients without bone metastasis. There were 376 bone metastases and 243 benign bone lesions. 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT detected 376 and 228 metastases, respectively. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) and accuracy of 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT were 100.0 % vs 60.6 %, 93.8 % vs 99.2 %, 96.2 % vs 99.2 %, 100.0 % vs 62.0 % and 97.6 % vs 75.8 %, respectively. Compared with 18 F-FDG, 68 Ga-DOTA-FAPI-04 uptake was significantly increased in both benign bone lesions and metastases (p = 0.001). The uptake of 68 Ga-DOTA-FAPI-04 for osteoblastic metastasis was also significantly higher than that of 18 F-FDG (p < 0.001). In bone metastasis of lung cancer and gastric cancer, 68 Ga-DOTA-FAPI-04 uptake was higher than that of 18 F-FDG PET/CT (p < 0.05). Using SUVmax = 4.1 and SUVmax = 6.2 as the cutoff value by 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT, it was possible to predict the occurrence of metastases (AUC = 0.817,95 % CI: 0.791–0.923 vs AUC =0.751,95%CI:0.626–0.875). 68 Ga-DOTA-FAPI-04 as a novel imaging agent, can detect more bone metastases and has a higher tracer uptake level than 18 F-FDG. Especially for lung and gastric cancer, 68 Ga-DOTA-FAPI-04 PET/CT may be a more reliable means to detect bone metastases. • More bone metastases could be detected by 68 Ga-DOTA-FAPI-04 PET/CT than 18 F-FDG PET/CT. • Compared with 18 F-FDG, 68 Ga-DOTA-FAPI-04 uptake was significantly increased in both benign bone lesions and metastases, especially for osteoblastic metastasis. • 68 Ga-DOTA-FAPI-04 PET/CT has higher sensitivity in detecting bone metastases, but unfortunately has a higher false positive rate.

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