Skip to main content
Top
Published in: Cancer Imaging 1/2024

Open Access 01-12-2024 | Computed Tomography | Research article

Superiority of 18F-FAPI-42 PET/CT in the detection of primary tumor and management of appendiceal neoplasm to 18F-FDG PET/CT and CE-CT

Authors: Ye Dong, Shun Huang, Hubing Wu, Min Cao, Yanchao Huang, Ganghua Tang, Wenlan Zhou

Published in: Cancer Imaging | Issue 1/2024

Login to get access

Abstract

Background

In the present study, we investigated the value of 18F-fibroblast-activation protein inhibitor (FAPI) positron emission tomography/computed tomography (18F-FAPI-42 PET/CT) to preoperative evaluations of appendiceal neoplasms and management for patients.

Methods

This single-center retrospective clinical study, including 16 untreated and 6 treated patients, was performed from January 2022 to May 2023 at Southern Medical University Nanfang Hospital. Histopathologic examination and imaging follow-up served as the reference standard. 18F-FAPI-42 PET/CT was compared to 18F-fluorodeoxyglucose (18F-FDG) PET/CT and contrast-enhanced CT (CE-CT) in terms of maximal standardized uptake value (SUVmax), diagnostic efficacy and impact on treatment decisions.

Results

The accurate detection of primary tumors and peritoneal metastases were improved from 28.6% (4/14) and 50% (8/16) for CE-CT, and 43.8% (7/16) and 85.0% (17/20) for 18F-FDG PET/CT, to 87.5% (14/16) and 100% (20/20) for 18F-FAPI-42 PET/CT. Compared to 18F-FDG PET/CT, 18F-FAPI-42 PET/CT detected more regions infiltrated by peritoneal metastases (108 vs. 43), thus produced a higher peritoneal cancer index (PCI) score (median PCI: 12 vs. 5, P < 0.01). 18F-FAPI-42 PET/CT changed the intended treatment plans in 35.7% (5/14) of patients compared to CE-CT and 25% (4/16) of patients compared to 18F-FDG PET/CT but did not improve the management of patients with recurrent tumors.

Conclusions

The present study revealed that 18F-FAPI-42 PET/CT can supplement CE-CT and 18F-FDG PET/CT to provide a more accurate detection of appendiceal neoplasms and improved treatment decision making for patients.
Literature
1.
go back to reference Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, et al. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging. 2013;13(1):14–25.CrossRefPubMedPubMedCentral Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, et al. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging. 2013;13(1):14–25.CrossRefPubMedPubMedCentral
3.
go back to reference Rossi RE, Luong TV, Caplin ME, Thirlwell C, Meyer T, Garcia-Hernandez J, et al. Goblet cell appendiceal tumors–management dilemmas and long-term outcomes. Surg Oncol. 2015;24(1):47–53.CrossRefPubMed Rossi RE, Luong TV, Caplin ME, Thirlwell C, Meyer T, Garcia-Hernandez J, et al. Goblet cell appendiceal tumors–management dilemmas and long-term outcomes. Surg Oncol. 2015;24(1):47–53.CrossRefPubMed
4.
go back to reference Mccusker ME, Cote TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer. 2002;94(12):3307–12.CrossRefPubMed Mccusker ME, Cote TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer. 2002;94(12):3307–12.CrossRefPubMed
5.
go back to reference Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, Gonzalez-Moreno S, et al. A Consensus for classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: the results of the Peritoneal Surface Oncology Group International (PSOGI) modified Delphi process. Am J Surg Pathol. 2016;40(1):14–26.CrossRefPubMed Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, Gonzalez-Moreno S, et al. A Consensus for classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: the results of the Peritoneal Surface Oncology Group International (PSOGI) modified Delphi process. Am J Surg Pathol. 2016;40(1):14–26.CrossRefPubMed
6.
go back to reference Matias-Garcia B, Mendoza-Moreno F, Blasco-Martinez A, Busteros-Moraza JI, Diez-Alonso M, Garcia-Moreno NF. A retrospective analysis and literature review of neoplastic appendiceal mucinous lesions. Bmc Surg. 2021;21(1):79.CrossRefPubMedPubMedCentral Matias-Garcia B, Mendoza-Moreno F, Blasco-Martinez A, Busteros-Moraza JI, Diez-Alonso M, Garcia-Moreno NF. A retrospective analysis and literature review of neoplastic appendiceal mucinous lesions. Bmc Surg. 2021;21(1):79.CrossRefPubMedPubMedCentral
7.
go back to reference Ruiz-Tovar J, Teruel DG, Castineiras VM, Dehesa AS, Quindos PL, Molina EM. Mucocele of the appendix. World J Surg. 2007;31(3):542–8.CrossRefPubMed Ruiz-Tovar J, Teruel DG, Castineiras VM, Dehesa AS, Quindos PL, Molina EM. Mucocele of the appendix. World J Surg. 2007;31(3):542–8.CrossRefPubMed
8.
go back to reference Menassel B, Duclos A, Passot G, Dohan A, Payet C, Isaac S, et al. Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms. Eur J Surg Oncol. 2016;42(4):558–66.CrossRefPubMed Menassel B, Duclos A, Passot G, Dohan A, Payet C, Isaac S, et al. Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms. Eur J Surg Oncol. 2016;42(4):558–66.CrossRefPubMed
9.
go back to reference Gundogar O, Kimiloglu E, Komut N, Cin M, Bektas S, Gonullu D, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol. 2018;29(5):533–42.CrossRefPubMed Gundogar O, Kimiloglu E, Komut N, Cin M, Bektas S, Gonullu D, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol. 2018;29(5):533–42.CrossRefPubMed
10.
go back to reference Brassil M, Lee R, O’Neill D, Woods G, Moloney BM, Dunne R, et al. Appendiceal tumours - a correlation of CT features and histopathological diagnosis. J Med Imaging Radiat Oncol. 2022;66(1):92–101.CrossRefPubMed Brassil M, Lee R, O’Neill D, Woods G, Moloney BM, Dunne R, et al. Appendiceal tumours - a correlation of CT features and histopathological diagnosis. J Med Imaging Radiat Oncol. 2022;66(1):92–101.CrossRefPubMed
11.
go back to reference Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM. Neoplasms of the appendix: Pictorial Review with Clinical and pathologic correlation. Radiographics. 2017;37(4):1059–83.CrossRefPubMed Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM. Neoplasms of the appendix: Pictorial Review with Clinical and pathologic correlation. Radiographics. 2017;37(4):1059–83.CrossRefPubMed
12.
go back to reference Rohani P, Scotti SD, Shen P, Stewart JH, Russell GB, Cromer M, et al. Use of FDG-PET imaging for patients with disseminated cancer of the appendix. Am Surg. 2010;76(12):1338–44.CrossRefPubMed Rohani P, Scotti SD, Shen P, Stewart JH, Russell GB, Cromer M, et al. Use of FDG-PET imaging for patients with disseminated cancer of the appendix. Am Surg. 2010;76(12):1338–44.CrossRefPubMed
13.
go back to reference Altmann A, Haberkorn U, Siveke J. The latest developments in imaging of fibroblast activation protein. J Nucl Med. 2021;62(2):160–7.CrossRefPubMed Altmann A, Haberkorn U, Siveke J. The latest developments in imaging of fibroblast activation protein. J Nucl Med. 2021;62(2):160–7.CrossRefPubMed
14.
go back to reference Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, et al. Comparison of (68)Ga-FAPI and (18)F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021;298(2):393–402.CrossRefPubMed Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, et al. Comparison of (68)Ga-FAPI and (18)F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021;298(2):393–402.CrossRefPubMed
15.
go back to reference Koerber SA, Staudinger F, Kratochwil C, Adeberg S, Haefner MF, Ungerechts G, et al. The role of (68)Ga-FAPI PET/CT for patients with malignancies of the Lower Gastrointestinal Tract: first clinical experience. J Nucl Med. 2020;61(9):1331–6.CrossRefPubMedPubMedCentral Koerber SA, Staudinger F, Kratochwil C, Adeberg S, Haefner MF, Ungerechts G, et al. The role of (68)Ga-FAPI PET/CT for patients with malignancies of the Lower Gastrointestinal Tract: first clinical experience. J Nucl Med. 2020;61(9):1331–6.CrossRefPubMedPubMedCentral
16.
go back to reference Al-Ibraheem A, Alyasjeen SF, Abdlkadir AS, Sheikha AA. [(68)Ga]Ga-DOTA-FAPI-04 PET/CT depicts metastases from medullary thyroid cancer that [(68)Ga]Ga-DOTATOC PET/CT missed. Eur J Nucl Med Mol Imaging. 2023;50(13):4112–3.CrossRefPubMed Al-Ibraheem A, Alyasjeen SF, Abdlkadir AS, Sheikha AA. [(68)Ga]Ga-DOTA-FAPI-04 PET/CT depicts metastases from medullary thyroid cancer that [(68)Ga]Ga-DOTATOC PET/CT missed. Eur J Nucl Med Mol Imaging. 2023;50(13):4112–3.CrossRefPubMed
17.
go back to reference Al-Ibraheem A, Al-Qasem S, El KM, Amarin R. 68 Ga-FAPI PET/CT provides a clear picture of a Klatskin Tumor that 18 F-FDG PET/CT missed. Clin Nucl Med. 2023;48(6):e313–5.CrossRefPubMed Al-Ibraheem A, Al-Qasem S, El KM, Amarin R. 68 Ga-FAPI PET/CT provides a clear picture of a Klatskin Tumor that 18 F-FDG PET/CT missed. Clin Nucl Med. 2023;48(6):e313–5.CrossRefPubMed
18.
go back to reference Rajaraman V, Meenakshi LA, Selvaraj AJ, Pottakkat B, Halanaik D. Role of 68 Ga-FAPI PET/CT in assessing Hepatobiliary malignancies: a prospective pilot study. Clin Nucl Med. 2023;48(6):e281–8.CrossRef Rajaraman V, Meenakshi LA, Selvaraj AJ, Pottakkat B, Halanaik D. Role of 68 Ga-FAPI PET/CT in assessing Hepatobiliary malignancies: a prospective pilot study. Clin Nucl Med. 2023;48(6):e281–8.CrossRef
19.
go back to reference Al-Ibraheem A, Abdlkadir AS, Alalawi H, Badarneh M. 68 Ga-FAPI PET/CT imaging: unveiling the hidden pitfalls. Clin Nucl Med. 2023;48(11):965–6.CrossRefPubMed Al-Ibraheem A, Abdlkadir AS, Alalawi H, Badarneh M. 68 Ga-FAPI PET/CT imaging: unveiling the hidden pitfalls. Clin Nucl Med. 2023;48(11):965–6.CrossRefPubMed
20.
go back to reference Bentestuen M, Al-Obaydi N, Zacho HD. FAPI-avid nonmalignant PET/CT findings: an expedited systematic review. Semin Nucl Med. 2023;53(5):694–705.CrossRefPubMed Bentestuen M, Al-Obaydi N, Zacho HD. FAPI-avid nonmalignant PET/CT findings: an expedited systematic review. Semin Nucl Med. 2023;53(5):694–705.CrossRefPubMed
21.
go back to reference Chen H, Pang Y, Li J, Kang F, Xu W, Meng T, et al. Comparison of [(68)Ga]Ga-FAPI and [(18)F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study. Eur Radiol. 2022;33(2):1329–41.CrossRefPubMed Chen H, Pang Y, Li J, Kang F, Xu W, Meng T, et al. Comparison of [(68)Ga]Ga-FAPI and [(18)F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study. Eur Radiol. 2022;33(2):1329–41.CrossRefPubMed
22.
go back to reference Qiu L, Chen Y. (68)Ga-FAPI PET/CT depicted Non-FDG-Avid Metastatic Appendiceal Mucinous Adenocarcinoma. Radiology. 2021;301(1):45.CrossRefPubMed Qiu L, Chen Y. (68)Ga-FAPI PET/CT depicted Non-FDG-Avid Metastatic Appendiceal Mucinous Adenocarcinoma. Radiology. 2021;301(1):45.CrossRefPubMed
23.
go back to reference Hu K, Wang L, Wu H, Huang S, Tian Y, Wang Q, et al. [(18)F]FAPI-42 PET imaging in cancer patients: optimal acquisition time, biodistribution, and comparison with [(68)Ga]Ga-FAPI-04. Eur J Nucl Med Mol Imaging. 2021;49(8):2833–43.CrossRefPubMed Hu K, Wang L, Wu H, Huang S, Tian Y, Wang Q, et al. [(18)F]FAPI-42 PET imaging in cancer patients: optimal acquisition time, biodistribution, and comparison with [(68)Ga]Ga-FAPI-04. Eur J Nucl Med Mol Imaging. 2021;49(8):2833–43.CrossRefPubMed
24.
go back to reference Spencer BA, Berg E, Schmall JP, Omidvari N, Leung EK, Abdelhafez YG, et al. Performance evaluation of the uEXPLORER Total-Body PET/CT scanner based on NEMA NU 2-2018 with additional tests to characterize PET scanners with a long Axial Field of View. J Nucl Med. 2021;62(6):861–70.CrossRefPubMedPubMedCentral Spencer BA, Berg E, Schmall JP, Omidvari N, Leung EK, Abdelhafez YG, et al. Performance evaluation of the uEXPLORER Total-Body PET/CT scanner based on NEMA NU 2-2018 with additional tests to characterize PET scanners with a long Axial Field of View. J Nucl Med. 2021;62(6):861–70.CrossRefPubMedPubMedCentral
25.
go back to reference Tan H, Sui X, Yin H, Yu H, Gu Y, Chen S, et al. Total-body PET/CT using half-dose FDG and compared with conventional PET/CT using full-dose FDG in lung cancer. Eur J Nucl Med Mol Imaging. 2021;48(6):1966–75.CrossRefPubMed Tan H, Sui X, Yin H, Yu H, Gu Y, Chen S, et al. Total-body PET/CT using half-dose FDG and compared with conventional PET/CT using full-dose FDG in lung cancer. Eur J Nucl Med Mol Imaging. 2021;48(6):1966–75.CrossRefPubMed
26.
go back to reference Wang L, Tang G, Hu K, Liu X, Zhou W, Li H, et al. Comparison of (68)Ga-FAPI and (18)F-FDG PET/CT in the evaluation of Advanced Lung Cancer. Radiology. 2022;303(1):191–9.CrossRefPubMed Wang L, Tang G, Hu K, Liu X, Zhou W, Li H, et al. Comparison of (68)Ga-FAPI and (18)F-FDG PET/CT in the evaluation of Advanced Lung Cancer. Radiology. 2022;303(1):191–9.CrossRefPubMed
27.
go back to reference Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMed Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMed
28.
go back to reference Gundogan C, Komek H, Can C, Yildirim OA, Kaplan I, Erdur E, et al. Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma. Nucl Med Commun. 2022;43(1):64–72.CrossRefPubMed Gundogan C, Komek H, Can C, Yildirim OA, Kaplan I, Erdur E, et al. Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma. Nucl Med Commun. 2022;43(1):64–72.CrossRefPubMed
29.
go back to reference Kuten J, Levine C, Shamni O, Pelles S, Wolf I, Lahat G, et al. Head-to-head comparison of [(68)Ga]Ga-FAPI-04 and [(18)F]-FDG PET/CT in evaluating the extent of disease in gastric adenocarcinoma. Eur J Nucl Med Mol Imaging. 2022;49(2):743–50.CrossRefPubMed Kuten J, Levine C, Shamni O, Pelles S, Wolf I, Lahat G, et al. Head-to-head comparison of [(68)Ga]Ga-FAPI-04 and [(18)F]-FDG PET/CT in evaluating the extent of disease in gastric adenocarcinoma. Eur J Nucl Med Mol Imaging. 2022;49(2):743–50.CrossRefPubMed
30.
go back to reference Dong Y, Sun P, Wu H, Zhong J, Cao M, Tang G, et al. PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT. Nucl Med Commun. 2023;44(11):1011–9.CrossRefPubMed Dong Y, Sun P, Wu H, Zhong J, Cao M, Tang G, et al. PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT. Nucl Med Commun. 2023;44(11):1011–9.CrossRefPubMed
31.
go back to reference Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology. 2017;71(6):847–58.CrossRefPubMed Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology. 2017;71(6):847–58.CrossRefPubMed
32.
go back to reference Minhas A, Hendrickson J, Minhas SA. Frequency and risk factors for Metastasis in newly diagnosed Appendiceal Carcinoma. Cureus. 2021;13(7):e16341.PubMedPubMedCentral Minhas A, Hendrickson J, Minhas SA. Frequency and risk factors for Metastasis in newly diagnosed Appendiceal Carcinoma. Cureus. 2021;13(7):e16341.PubMedPubMedCentral
33.
go back to reference Akbulut S, Sahin TT. Comment on management and prognosis of low-grade appendiceal mucinous neoplasms: a clinicopathologic analysis of 50 cases. Eur J Surg Oncol. 2020;46(12):2338.CrossRefPubMed Akbulut S, Sahin TT. Comment on management and prognosis of low-grade appendiceal mucinous neoplasms: a clinicopathologic analysis of 50 cases. Eur J Surg Oncol. 2020;46(12):2338.CrossRefPubMed
34.
go back to reference Kehagias I, Zygomalas A, Markopoulos G, Papandreou T, Kraniotis P. Diagnosis and treatment of Mucinous Appendiceal Neoplasm presented as Acute Appendicitis. Case Rep Oncol Med. 2016;2016:2161952.PubMedPubMedCentral Kehagias I, Zygomalas A, Markopoulos G, Papandreou T, Kraniotis P. Diagnosis and treatment of Mucinous Appendiceal Neoplasm presented as Acute Appendicitis. Case Rep Oncol Med. 2016;2016:2161952.PubMedPubMedCentral
35.
go back to reference Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J, et al. Development of Quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nucl Med. 2018;59(9):1415–22.CrossRefPubMed Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J, et al. Development of Quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nucl Med. 2018;59(9):1415–22.CrossRefPubMed
36.
go back to reference Loktev A, Lindner T, Mier W, Debus J, Altmann A, Jager D, et al. A tumor-imaging Method Targeting Cancer-Associated fibroblasts. J Nucl Med. 2018;59(9):1423–9.CrossRefPubMedPubMedCentral Loktev A, Lindner T, Mier W, Debus J, Altmann A, Jager D, et al. A tumor-imaging Method Targeting Cancer-Associated fibroblasts. J Nucl Med. 2018;59(9):1423–9.CrossRefPubMedPubMedCentral
Metadata
Title
Superiority of 18F-FAPI-42 PET/CT in the detection of primary tumor and management of appendiceal neoplasm to 18F-FDG PET/CT and CE-CT
Authors
Ye Dong
Shun Huang
Hubing Wu
Min Cao
Yanchao Huang
Ganghua Tang
Wenlan Zhou
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Cancer Imaging / Issue 1/2024
Electronic ISSN: 1470-7330
DOI
https://doi.org/10.1186/s40644-024-00706-7

Other articles of this Issue 1/2024

Cancer Imaging 1/2024 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine