^(18)F-FAPI-42与^(18)F-FDG PET/CT在原发性肝癌诊断和分期中的应用比较  

Comparison of ^(18)F-FAPI-42 and ^(18)F-FDG PET/CT in Diagnosis and Staging of Primary Hepatic Tumours

作　　者：柯渺 张静[1] 吕杰 李友财 钟凯翔 侯鹏[1] 赵睿玥 王欣璐 KE Miao;ZHANG Jing;LV Jie;LI Youcai;ZHONG Kaixiang;HOU Peng;ZHAO Ruiyue;WANG Xinlu(Department of Nuclear Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第一医院核医学科,广东广州510000

出　　处：《中国医学影像学杂志》2024年第12期1248-1255,共8页Chinese Journal of Medical Imaging

基　　金：2024年广东省医学科研基金项目(B2024227);2024年度市校(院)企联合资助项目(2024A03J1160);国家自然科学基金(82402418)。

摘　　要：目的 比较^(18)F-FAPI-42和^(18)F-FDG PET/CT在原发性肝癌诊断和分期的价值。资料与方法 回顾性分析2020年10月—2023年5月于广州医科大学附属第一医院2周内同时接受^(18)F-FAPI-42和^(18)F-FDG PET/CT检查的原发性肝癌患者,以手术切除及穿刺活检的组织病理学或影像学随访(CT/MRI增强扫描)为最终诊断金标准,比较^(18)F-FAPI-42和^(18)F-FDG的最大标准化摄取值和肿瘤/背景比以及阳性病灶检出率的差异。结果 共纳入34例原发性肝癌,包括肝细胞癌27例,肝内胆管细胞癌5例,混合性肝细胞-胆管细胞癌2例。^(18)F-FAPI-42在诊断肝内病灶和淋巴结转移方面显著优于^(18)F-FDG(肝内病灶:93.33%比52.22%,P<0.001;淋巴结转移:100%比87.50%,P=0.021)。在远处转移方面两者检出率相当(100%比96.20%,P>0.05)。^(18)F-FAPI-42在肝内病灶、区域淋巴结转移及骨、腹膜转移中的最大标准化摄取值及肿瘤/背景比均高于^(18)F-FDG(Z=5.261~1.183,P均<0.05)。初始分期评估中,^(18)F-FAPI-42改变了20.8%(5/24)患者的T分期、8.3%(2/24)患者的N分期和8.3%(2/24)患者的M分期,与多模态影像结果一致。评估治疗后患者的结果显示,^(18)F-FAPI-42对肝癌复发灶的检出率为92.86%(13/14),高于^(18)F-FDG(64.28%,9/14);^(18)F-FAP-42发现更多复发原发灶和肝内转移子灶,较^(18)F-FDG更敏感。结论^(18)F-FAPI-42 PET/CT对原发性肝癌的诊断效能显著优于^(18)F-FDG,在肿瘤的分期及再分期方面表现优异,提示^(18)F-FAPI-42的应用有助于提高原发性肝癌患者的临床管理水平。Purpose To investigate the diagnosis and staging performance of ^(18)F-FAPI-42 PET/CT compared to ^(18)F-FDG PET/CT in primary hepatic tumours.Materials and Methods We performed a retrospective study including all primary hepatic tumours patients who underwent both ^(18)F-FAPI-42 and ^(18)F-FDG PET/CT scans within two weeks at the First Affiliated Hospital of Guangzhou Medical University from October 2020 to May 2023.With histopathologic proof(surgical resection and/or percutaneous biopsies)or multimodality radiographic follow-up(CT/MRI-enhanced)as the final diagnostic reference standard.The maximum standard uptake value,tumor-to-background ratio and diagnostic rates(positive lesion/total lesion)between ^(18)F-FAPI-42 and ^(18)F-FDG were compared.Results Thirty-four primary hepatic tumours patients were enrolled in this study,including 27 hepatocellular carcinoma,5 intrahepatic cholangiocarcinoma and 2 combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma.It was found that ^(18)F-FAPI-42 PET/CT significantly outperformed ^(18)F-FDG in diagnosing intrahepatic lesions and lymph node metastases(intrahepatic lesions:93.33%vs.52.22%,P<0.001;lymph node metastases:100%vs.87.50%,P=0.021).The detection rates for distant metastases were comparable between the two radioactive tracers(100%vs.96.20%,P>0.05).^(18)F-FAPI-42 showed higher maximum standard uptake value and tumor-to-background ratio in intrahepatic lesions,regional lymph node metastases,bone and peritoneal metastases compared to ^(18)F-FDG(Z=-5.261--1.183,all P<0.05).For primary hepatic tumours initial staging,^(18)F-FAPI-42 PET/CT upstaged the T stage in 20.8%(5/24)of patients,the N stage in 8.3%(2/24)and the M stage in 8.3%(2/24)of patients,consistent with multimodal imaging diagnostic results.The evaluation of post-treatment patient outcomes showed that ^(18)F-FAPI-42 had a detection rate of 92.86%(13/14)for hepatic tumours recurrence,higher than ^(18)F-FDG(64.28%,9/14).^(18)F-FAPI-42 identified more recurrent primary lesions and intrahepatic me

关 键 词：癌 肝细胞 正电子发射计算机断层摄影术 ^(18)F-FAPI-42 ^(18)F-FDG 肿瘤分期 诊断 

分 类 号：R735.7[医药卫生—肿瘤] R445.4[医药卫生—临床医学]