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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-12-2021 | Metastasis | Original Article

Head-to-head intra-individual comparison of biodistribution and tumor uptake of ⁶⁸Ga-FAPI and ¹⁸F-FDG PET/CT in cancer patients

Authors: Frederik L. Giesel, Clemens Kratochwil, Joel Schlittenhardt, Katharina Dendl, Matthias Eiber, Fabian Staudinger, Lukas Kessler, Wolfgang P. Fendler, Thomas Lindner, Stefan A. Koerber, Jens Cardinale, David Sennung, Manuel Roehrich, Juergen Debus, Mike Sathekge, Uwe Haberkorn, Jeremie Calais, Sebastian Serfling, Andreas L. Buck

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 13/2021

Abstract

Purpose

FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of ⁶⁸Ga-FAPI versus standard-of-care ¹⁸F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers.

Material and Methods

This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both ⁶⁸Ga-FAPI and ¹⁸F-FDG PET/CT within a median time interval of 10 days (range 1–89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ).

Results

A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. ⁶⁸Ga-FAPI uptake in primary tumors and metastases was comparable to ¹⁸F-FDG in most cases. The SUVmax was significantly lower for ⁶⁸Ga-FAPI than ¹⁸F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, ⁶⁸Ga-FAPI TBRs were significantly higher than ¹⁸F-FDG TBRs in some sites, including liver and bone metastases.

Conclusion

Quantitative tumor uptake is comparable between ⁶⁸Ga-FAPI and ¹⁸F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for ⁶⁸Ga-FAPI. Thus, ⁶⁸Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological ¹⁸F-FDG uptake.

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Title: Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients
Authors: Frederik L. Giesel
Clemens Kratochwil
Joel Schlittenhardt
Katharina Dendl
Matthias Eiber
Fabian Staudinger
Lukas Kessler
Wolfgang P. Fendler
Thomas Lindner
Stefan A. Koerber
Jens Cardinale
David Sennung
Manuel Roehrich
Juergen Debus
Mike Sathekge
Uwe Haberkorn
Jeremie Calais
Sebastian Serfling
Andreas L. Buck
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Metastasis
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 13/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-021-05307-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Head-to-head intra-individual comparison of biodistribution and tumor uptake of ⁶⁸Ga-FAPI and ¹⁸F-FDG PET/CT in cancer patients

Abstract

Purpose

Material and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Material and Methods

Results

Conclusion

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