18F-FAPI-04 PET/CT与18F-FDG PET/CT在胃癌、结直肠癌术后转移灶中的应用比较

Comparison of 18F-FAPI-04 PET/CT and 18F-FDG PET/CT in postoperative metastasis of gastric cancer and colorectal cancer

关键词:  胃癌  结直肠癌  正电子发射断层显像术  体层摄影术  氟脱氧葡萄糖F18  成纤维细胞激活蛋白

Key words:  Gastric cancer  Colorectal cancer  Positron-emission tomography  Tomography  Fluorodeoxyglucose F18  Fibroblast activation protein

摘要:

目的 比较18F-FAPI-04 PET/CT与18F-FDG PET/CT在胃癌、结直肠癌术后转移灶中的应用价值。方法 前瞻性分析2023年5月至2024年3月在江南大学附属医院行18F-FAPI-04 PET/CT与18F-FDG PET/CT显像的胃癌、结直肠癌术后患者22例（男性16例，女性6例，年龄49~71岁）临床及影像资料。以病灶的手术或穿刺活检组织病理结果作为诊断金标准。未能行组织病理学诊断，则以实验室检查、影像学检查随访结果及临床综合判断，作为诊断的参考标准。采用Wilcoxon signed-rank test分析比较18F-FAPI-04 PET/CT与18F-FDG PET/CT在胃癌、结直肠癌术后转移灶的 SUVmax、靶本比（Target to Background Ratio,TBR），采用McNemar检验比较18F-FAPI-04 PET/CT与18F-FDG PET/CT在胃癌、结直肠癌术后转移灶的检出率。结果 18F-FAPI-04 PET/CT在腹膜转移灶[6.9(4.4,8.0)与1.9(1.0,2.7)，z=-5.580，P＜0.001]，转移淋巴结[6.2(4.5,5.3)与 5.2(3.1,10.7)，z=-2.170，P=0.03]中的SUVmax明显高于18F-FDG PET/CT；在肝转移灶[7.8(5.3,9.0)与 8.1(5.3,10.8)，z=-1.57，P=0.875]，骨转移灶中[6.2(3.7,8.2)与5.2(3.0,7.9)，z=-1.244，P=0.214]的SUVmax差异均无统计学意义。18F-FAPI-04 PET/CT在腹膜转移灶[5.4(3.4,6.4)与1.2(0.7,1.7)，z=-5.580，P＜0.001]，转移淋巴结[5.4(2.8,7.2)与3.9(2.5,5.2)，z=-4.698，P＜0.001]，肝转移灶[6.3(2.5,9.4) 与 3.3(2.0,3.9)，z=-2.312，P=0.021]、骨转移灶[7.6(3.6,10.2) 与 4.3(2.9,5.9)，z=-2.194，P=0.028]中的TBR均明显高于18F-FDG PET/CT。18F-FAPI-04 PET/CT对腹膜转移[100%(41/41)与26.8%(11/41)，P＜0.001]，淋巴结转移[92.6%(50/54)与77.8%(42/54)，P=0.021]的检出率明显高于18F-FDG PET/CT；而对肝转移[100%(9/9)与100%(9/9)]、骨转移的检出率[100%(12/12)与 100%(12/12)]，差异均无统计学意义。结论 18F-FAPI-04 PET/CT对于胃癌、结直肠癌术后患者在淋巴结转移、腹膜转移中的表现优于18F-FDG PET/CT，18F-FAPI-04 PET/CT在胃癌、结直肠癌术后患者再分期中具有优势，有助于制定临床决策。

Abstract:

To compare the application value of 18F-FAPI-04 PET/CT and 18F-FDG PET/CT in detecting postoperative metastatic lesions of gastric cancer and colorectal cancer. METHODS The clinical and imaging data of 22 patients(16 males and 6 females,aged 49-71 years)with gastric and colorectal cancer who underwent 18F-FAPI-04 PET/CT and 18F-FDG PET/CT imaging in the Affiliated Hospital of Jiangnan University from May 2023 to March 2024 were prospectively analyzed.The pathological results of surgery or needle biopsy were used as the gold standard for diagnosis.If histopathological diagnosis was not performed,the results of laboratory examination,imaging follow-up and clinical comprehensive judgment were used as the reference standard for diagnosis.Wilcoxon signed-rank test was used to compare the SUVmax and Target to Background Ratio(TBR)of 18F-FAPI-04 PET/CT and 18F-FDG PET/CT in postoperative metastatic lesions of gastric and colorectal cancer.McNemar test was used to compare the detection rate of metastatic lesions between 18F-FAPI-04 PET/CT and 18F-FDG PET/CT. RESULTS 18F-FAPI-04 PET/CT showed significantly higher SUVmax in peritoneal metastatic lesions[6.9(4.4,8.0) vs 1.9(1.0,2.7), z=-5.580, P<0.001], and lymph node metastases[6.2(4.5,5.3) vs 5.2(3.1,10.7), z=-2.170, P=0.03] compared to 18F-FDG PET/CT;however,there was no statistically significant difference in SUVmax in liver metastatic lesions[7.8(5.3,9.0) vs 8.1(5.3,10.8), z=-1.57, P=0.875] and bone metastatic lesions[6.2(3.7,8.2) vs 5.2 (3.0,7.9), z=-1.244,P=0.214].The TBR was significantly higher in peritoneal metastatic lesions[5.4(3.4,6.4) vs 1.2(0.7,1.7),z=-5.580,P<0.001],lymph node metastases[5.4(2.8,7.2) vs 3.9(2.5,5.2),z=-4.698,P<0.001],liver metastatic lesions [6.3(2.5,9.4) vs 3.3(2.0,3.9),z=-2.312,P=0.021] and bone metastatic lesions[7.6(3.6,10.2) vs 4.3(2.9,5.9),z=-2.194,P=0.028] compared to 18F-FDG PET/CT.The detection rates of peritoneal metastasis [100%(41/41) vs 26.8%(11/41),P<0.001] and lymph node metastasis[92.6%(50/54) vs 77.8%(42/54),P=0.021] were significantly higher with 18F-FAPI-04 PET/CT compared to 18F-FDG PET/CT. CONCLUSION 18F-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in the detection of lymph node metastasis and peritoneal metastasis in postoperative patients with gastric and colorectal cancer.18F-FAPI-04 PET/CT has advantages in the re-staging of postoperative patients with gastric and colorectal cancer,which is helpful to make clinical decisions.