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06-02-2024 | Original Article

Clinical value of [¹⁸F]AlF-NOTA-FAPI-04 PET/CT for assessing early-stage liver fibrosis in adult liver transplantation recipients compared with chronic HBV patients

Authors: Wei Rao, Xiao-han Fang, Youwei Zhao, Ye Wang, Bei Zhang, Zhimin Wei, Xinjuan Kong, Jin-zhen Cai, Guangjie Yang, Man Xie

Published in: Japanese Journal of Radiology | Issue 5/2024

Abstract

Aims

To investigate the clinical value and performance of [¹⁸F]AlF-NOTA-FAPI-04 PET/CT in assessing early-stage liver fibrosis in liver transplantation (LT) recipients.

Methods

A prospective study including 17 LT recipients and 12 chronic Hepatitis B (CHB) patients was conducted. All patients received liver biopsy, transient elastography (TE), and [¹⁸F]AlF-NOTA-FAPI-04 PET/CT. On [¹⁸F]AlF-NOTA-FAPI-04 PET/CT scans, the liver parenchyma’s maximum standardized uptake values (SUV_max) were measured. The receiver operating characteristic (ROC) curve analysis was applied to determine the diagnostic efficacy of [¹⁸F]AlF-NOTA-FAPI-04 PET/CT in early-stage liver fibrosis (S1–S2) compared with the diagnostic performance of TE.

Results

Among those 29 patients enrolled in this study, 15(51.7%) had fibrosis S0, 10(34.5%) had S1, and 4(13.8%) had S2, respectively. The SUV_max of patients with early-stage liver fibrosis was significantly higher than those without liver fibrosis in LT recipients and CHB patients (P = 0.004, P = 0.02). In LT recipients, a SUV_max cut-off value of 2.0 detected early-stage liver fibrosis with an AUROC of 0.92 (P = 0.006), and a liver stiffness measurements (LSM) score cut-off value of 8.2 kPa diagnosed early-stage liver fibrosis with an AUROC of 0.80 (P = 0.012). In CHB patients, a SUV_max cut-off value of 2.7 detected early-stage liver fibrosis with an AUROC of 0.94 (P < 0.001) and an LSM scores cut-off value of 8.4 kPa diagnosed early-stage liver fibrosis with an AUROC of 0.91 (P < 0.001).

Conclusion

[¹⁸F]AlF-NOTA-FAPI-04 PET/CT could be applied to evaluate early-stage liver fibrosis in LT recipients and CHB patients properly, with the potential additional advantages in monitoring and predicting complications after LT.

Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol. 2020;46–47: 101684. https://doi.org/10.1016/j.bpg.2020.101684.CrossRefPubMed

Bhat M, Rollet-Kurhajec KC, Bhat A, et al. Incidence and predictors of advanced liver fibrosis by a validated serum biomarker in liver transplant recipients. Can J Gastroenterol Hepatol. 2017;2017:4381864. https://doi.org/10.1155/2017/4381864.CrossRefPubMedPubMedCentral

Galvin Z, Rajakumar R, Chen E, et al. Predictors of De novo nonalcoholic fatty liver disease after liver transplantation and associated fibrosis. Liver Transpl. 2019;25(1):56–67. https://doi.org/10.1002/lt.25338.CrossRefPubMed

Bosch W, Heckman MG, Pungpapong S, et al. Association of cytomegalovirus infection and disease with recurrent hepatitis C after liver transplantation. Transplantation. 2012;93(7):723–8. https://doi.org/10.1097/TP.0b013e3182472876.CrossRefPubMed

Bhat M, Ghali P, Rollet-Kurhajec KC, et al. Serum fibrosis biomarkers predict death and graft loss in liver transplantation recipients. Liver Transpl. 2015;21(11):1383–94. https://doi.org/10.1002/lt.24217.CrossRefPubMed

Lo RC, Kim H. Histopathological evaluation of liver fibrosis and cirrhosis regression. Clin Mol Hepatol. 2017;23(4):302–7. https://doi.org/10.3350/cmh.2017.0078.CrossRefPubMedPubMedCentral

Sun YM, Chen SY, You H. Regression of liver fibrosis: evidence and challenges. Chin Med J. 2020;133(14):1696–702. https://doi.org/10.1097/cm9.0000000000000835.CrossRefPubMedPubMedCentral

Baran B, Kale S, Patil P, et al. Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis. Surg Endosc. 2021;35(10):5546–57. https://doi.org/10.1007/s00464-020-08053-x.CrossRefPubMed

Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology (Baltimore, Md), 1994;20(1):15–20

10.

Sasaki R, Miyaaki H, Narita S, et al. Serum Mac-2 binding protein glycosylation isomer as a biomarker of fibrosis in living donor liver transplant graft. Clin Transplant. 2021;35(2): e14175. https://doi.org/10.1111/ctr.14175.CrossRefPubMed

11.

Nishikawa H, Enomoto H, Iwata Y, et al. Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein for patients with chronic hepatitis B and C: a comparative study. J Viral Hepatitis. 2016;23(12):977–84. https://doi.org/10.1111/jvh.12575.CrossRef

12.

Siddiqui MS, Idowu MO, Stromberg K, et al. Diagnostic performance of vibration-controlled transient elastography in liver transplant recipients. Clinical Gastroenterol Hepatol. 2021;19(2):367–74. https://doi.org/10.1016/j.cgh.2020.03.067.CrossRef

13.

Da BL, Surana P, Takyar V, et al. Vibration-controlled transient elastography for the detection of cirrhosis in chronic hepatitis D infection. J Viral Hepatitis. 2020;27(4):428–36. https://doi.org/10.1111/jvh.13235.CrossRef

14.

Imai H, Kamei H, Onishi Y, et al. Diagnostic usefulness of APRI and FIB-4 for the prediction of liver fibrosis after liver transplantation in patients infected with hepatitis C virus. Transpl Proc. 2018;50(5):1431–6. https://doi.org/10.1016/j.transproceed.2018.03.005.CrossRef

15.

Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705–13. https://doi.org/10.1016/j.ultrasmedbio.2003.07.001.CrossRefPubMed

16.

Nightingale K, Soo MS, Nightingale R, et al. Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med Biol. 2002;28(2):227–35. https://doi.org/10.1016/s0301-5629(01)00499-9.CrossRefPubMed

17.

Bota S, Herkner H, Sporea I, et al. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 2013;33(8):1138–47. https://doi.org/10.1111/liv.12240.CrossRefPubMed

18.

Lindner T, Loktev A, Altmann A, et al. Development of quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nuclear Med. 2018;59(9):1415–22. https://doi.org/10.2967/jnumed.118.210443.CrossRef

19.

Wang XM, Yu DM, McCaughan GW, et al. Fibroblast activation protein increases apoptosis, cell adhesion, and migration by the LX-2 human stellate cell line. Hepatology (Baltimore, MD). 2005;42(4):935–45. https://doi.org/10.1002/hep.20853.CrossRefPubMed

20.

Loktev A, Lindner T, Burger EM, et al. Development of fibroblast activation protein-targeted radiotracers with improved tumor retention. J Nuclear Med. 2019;60(10):1421–9. https://doi.org/10.2967/jnumed.118.224469.CrossRef

21.

Loktev A, Lindner T, Mier W, et al. A tumor-imaging method targeting cancer-associated fibroblasts. J Nuclear Med. 2018;59(9):1423–9. https://doi.org/10.2967/jnumed.118.210435.CrossRef

22.

Mannan R, Misra V, Misra SP, et al. A comparative evaluation of scoring systems for assessing necro-inflammatory activity and fibrosis in liver biopsies of patients with chronic viral hepatitis. J Clin Diagn Res JCDR. 2014;8(8):Fc08-12. https://doi.org/10.7860/jcdr/2014/8704.4718.CrossRefPubMed

23.

Wei Y, Cheng K, Fu Z, et al. [18F]AlF-NOTA-FAPI-04 PET/CT uptake in metastatic lesions on PET/CT imaging might distinguish different pathological types of lung cancer. Eur J Nucl Med Mol Imaging. 2021;49(5):1671–81. https://doi.org/10.1007/s00259-021-05638-z.CrossRefPubMedPubMedCentral

24.

Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol. 2015;41(5):1161–79. https://doi.org/10.1016/j.ultrasmedbio.2015.03.007.CrossRefPubMed

25.

Aydin MM, Akcali KC. Liver fibrosis. Turk J Gastroenterol. 2018;29(1):14–21. https://doi.org/10.5152/tjg.2018.17330.CrossRefPubMedPubMedCentral

26.

Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology (Baltimore, MD). 2003;38(2):518–26. https://doi.org/10.1053/jhep.2003.50346.CrossRefPubMed

27.

Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology (Baltimore, Md) 2007;46(1):32–6 https://doi.org/10.1002/hep.21669

28.

Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(6):1717–30. https://doi.org/10.1053/j.gastro.2019.01.042.CrossRefPubMed

29.

Lefebvre T, Wartelle-Bladou C, Wong P, et al. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol. 2019;29(12):6477–88. https://doi.org/10.1007/s00330-019-06331-4.CrossRefPubMed

30.

Verloh N, Einspieler I, Utpatel K, et al. In vivo confirmation of altered hepatic glucose metabolism in patients with liver fibrosis/cirrhosis by (18)F-FDG PET/CT. EJNMMI Res. 2018;8(1):98. https://doi.org/10.1186/s13550-018-0452-y.CrossRefPubMedPubMedCentral

31.

Fu L, Huang S, Wu H, et al. Superiority of [(68)Ga]Ga-FAPI-04/[(18)F]FAPI-42 PET/CT to [(18)F]FDG PET/CT in delineating the primary tumor and peritoneal metastasis in initial gastric cancer. Eur Radiol. 2022. https://doi.org/10.1007/s00330-022-08743-1.CrossRefPubMed

32.

Wang H, Zhu W, Ren S, et al. (68)Ga-FAPI-04 versus (18)F-FDG PET/CT in the detection of hepatocellular carcinoma. Front Oncol. 2021;11: 693640. https://doi.org/10.3389/fonc.2021.693640.CrossRefPubMedPubMedCentral

33.

Zhou Y, Yang X, Liu H, et al. Value of [(68)Ga]Ga-FAPI-04 imaging in the diagnosis of renal fibrosis. Eur J Nucl Med Mol Imaging. 2021;48(11):3493–501. https://doi.org/10.1007/s00259-021-05343-x.CrossRefPubMed

34.

Röhrich M, Leitz D, Glatting FM, et al. Fibroblast activation protein-specific PET/CT imaging in fibrotic interstitial lung diseases and lung cancer: a translational exploratory study. J Nuclear Med. 2022;63(1):127–33. https://doi.org/10.2967/jnumed.121.261925.CrossRef

35.

Pirasteh A, Periyasamy S, Meudt JJ, et al. Staging liver fibrosis by fibroblast activation protein inhibitor positron emission tomography in a human-sized swine model. J Nuclear Med. 2022. https://doi.org/10.2967/jnumed.121.263736.CrossRef

36.

Yoshino K, Taura K, Okuda Y, et al. Efficiency of acoustic radiation force impulse imaging for the staging of graft fibrosis after liver transplantation. Hepatol Res. 2019;49(4):394–403. https://doi.org/10.1111/hepr.13289.CrossRefPubMed

Title: Clinical value of [18F]AlF-NOTA-FAPI-04 PET/CT for assessing early-stage liver fibrosis in adult liver transplantation recipients compared with chronic HBV patients
Authors: Wei Rao
Xiao-han Fang
Youwei Zhao
Ye Wang
Bei Zhang
Zhimin Wei
Xinjuan Kong
Jin-zhen Cai
Guangjie Yang
Man Xie
Publication date: 06-02-2024
Publisher: Springer Nature Singapore
Published in: Japanese Journal of Radiology / Issue 5/2024
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI: https://doi.org/10.1007/s11604-024-01528-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical value of [¹⁸F]AlF-NOTA-FAPI-04 PET/CT for assessing early-stage liver fibrosis in adult liver transplantation recipients compared with chronic HBV patients

Abstract

Aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusion

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