^(68)Ga-FAPI PET对肝脏及胆道恶性肿瘤的诊断及预后价值  

Diagnostic and prognostic value of ^(68)Ga-FAPI PET for malignant tumors of the liver and biliary tract

作　　者：覃春霞[1] 吕玉虎 宋杨美惠 盖永康 阮伟伟 张晓[1] 李梦婷[1] 刘芳[1] 兰晓莉[1] Qin Chunxia;Lyu Yuhu;Song Yangmeihui;Gai Yongkang;Ruan Weiwei;Zhang Xiao;Li Mengting;Liu Fang;Lan Xiaoli(Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科、分子影像湖北省重点实验室,武汉430022

出　　处：《中华核医学与分子影像杂志》2023年第6期337-342,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：湖北省自然科学基金重点项目(2021CFA008);湖北省科技创新团队(鄂科技通[2022]72号)。

摘　　要：目的探讨^(68)Ga-成纤维细胞激活蛋白抑制剂(FAPI)PET对肝胆恶性肿瘤的诊断和预后价值。方法回顾性分析2020年7月至2023年2月因怀疑或确诊肝脏或胆道恶性肿瘤于华中科技大学同济医学院附属协和医院进行^(68)Ga-FAPI PET检查的患者33例[男23例、女10例,年龄(55.4±13.5)岁]。PET图像由3位经验丰富的核医学医师评估,以穿刺活组织检查或术后病理、临床及影像随访结果为诊断"金标准"。采用单因素方差分析和最小显著差异t检验进行组间比较;采用Kaplan-Meier曲线进行生存分析,组间比较采用log-rank检验。结果33例患者中,初始诊断与分期14例、再分期19例;肝细胞癌(HCC)14例、胆管细胞癌(CCA)13例、胆囊癌(GBC)6例。HCC、CCA、GBC原发灶对^(68)Ga-FAPI均有明显摄取,组间SUV_(max)差异无统计学意义(F=1.58,P=0.250)。^(68)Ga-FAPI PET对肝胆恶性肿瘤初始诊断和再分期的灵敏度为14/14和15/15。与常规影像比较,^(68)Ga-FAPI PET改变了29.2%(7/24)患者的诊断和分期。30.3%(10/33)恶性肿瘤患者因^(68)Ga-FAPI PET检查结果改变治疗策略。随访显示22例生存、11例死亡,总生存期为355.56(80.00,516.97)d,1年和2年生存率分别为68.2%、57.9%。^(68)Ga-FAPI PET半定量参数SUV_(max)、病灶/肝脏比值(TLR)、病灶/血池比值(TBR)无预后价值,但^(68)Ga-FAPI PET诊断无远处转移组的预后优于有远处转移组(P=0.032)。结论^(68)Ga-FAPI PET对肝胆恶性肿瘤的诊断具有很高的灵敏度,有助于指导治疗决策和预后评估。Objective To investigate the diagnostic and prognostic value of ^(68)Ga-fibroblast activation protein inhibitor(FAPI)PET for hepatobiliary malignancies.Methods From July 2020 to February 2023,33 patients(23 males,10 females;age(55.4±13.5)years)with suspected or confirmed liver or biliary tract malignancies who underwent ^(68)Ga-FAPI PET in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.PET images were evaluated by 3 experienced nuclear medicine physicians,and the results of biopsy or postoperative pathology,clinical and imaging follow-up were used as the gold standard.One-way analysis of variance and least significant difference t test were used to compare the differences among groups.Survival analysis was performed using Kaplan-Meier curves and the log-rank test.Results Of 33 patients,14 performed PET for initial diagnosis and staging,and 19 for restaging.There were 14 patients with hepatocellular carcinoma(HCC),13 patients with cholangiocarcinoma(CCA),and 6 patients with gallbladder carcinoma(GBC).The primary tumor of HCC,CCA and GBC all showed significant ^(68)Ga-FAPI uptake,with no statistically significant difference in SUV_(max) among groups(F=1.58,P=0.250).The sensitivities of ^(68)Ga-FAPI PET for initial diagnosis and restaging of hepatobiliary malignancies were 14/14 and 15/15,respectively.Compared with conventional imaging,^(68)Ga-FAPI PET changed the diagnosis and staging in 29.2%(7/24)patients.The treatment strategy was changed in 30.3%(10/33)patients with malignant tumors due to ^(68)Ga-FAPI PET findings.Follow-up showed 22 cases survived and 11 cases died,with the overall survival of 355.56(80.00,516.97)d,and 1-and 2-year survival rates were 68.2%and 57.9%,respectively.Semi-quantitative ^(68)Ga-FAPI PET parameters such as SUV_(max),target-liver ratio(TLR),and target-blood ratio(TBR)had no significant prognostic value,but the prognosis of the group without distant metastases diagnosed by ^(68)Ga-FAPI PET was significantly better than

关 键 词：肝肿瘤 胆道肿瘤 喹啉类 镓放射性同位素 正电子发射断层显像术 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]