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Skeletal Radiology

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02-05-2023 | NSCLC | Scientific Article

Increased ¹⁸F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions

Authors: Xiaoli Liu, Shoumei Yan, Xueting Qin, Kai Cheng, Jinsong Zheng, Hongbo Wu, Yuchun Wei, Shuanghu Yuan

Published in: Skeletal Radiology | Issue 12/2023

Abstract

Objective

This study investigated the distribution and characteristics of various bone and joint lesions on ¹⁸F-FAPI PET/CT in lung cancer patients.

Methods

Seventy-four lung cancer patients who underwent ¹⁸F-FAPI PET/CT were reviewed. Bone and joint lesions with elevated ¹⁸F-FAPI uptake were recorded and analyzed. The distribution and maximum uptake value (SUV_max) of different benign lesions or bone metastases were presented. In addition, the SUV_max of bone metastases on ¹⁸F-FDG and ¹⁸F-FAPI-04 PET/CT were also compared.

Results

In 53 patients, a total of 262 lesions presented ¹⁸F-FAPI accumulation. Bone metastases were mainly in vertebrae, pelvis, and ribs, while benign lesions were in vertebral margins, alveolar bone, and shoulder joints. The SUV_max of bone metastases was significantly higher than that of benign lesions (\(6.6\pm 2.8\) vs. \(4.3\pm 1.6\), \(P<0.001\)), with NSCLC cases having higher SUV_max values than SCLC cases (\(7.3\pm 2.7\) vs. \(3.7\pm 1.1\), \(P<0.001\)). Among benign lesions, arthritis and periodontitis demonstrated higher SUV_max than degenerative lesions (arthritis: \(5.2\pm 2.3\); periodontitis: \(4.8\pm 1.5\); degenerative diseases: \(3.6\pm 0.9\); \(P<0.01\) and \(P<0.05\), respectively). The SUV_max of bone metastases was comparable between ¹⁸F-FDG and ¹⁸F-FAPI PET/CT. However, ¹⁸F-FAPI PET/CT was found to be superior in identifying cranial metastases compared to ¹⁸F-FDG PET/CT (TBR_met/brain: \(54.2\pm 13.5\) vs. \(0.6\pm 0.2\), \(P=0.02\)).

Conclusion

This study demonstrated that ¹⁸F-FAPI PET/CT is a valuable imaging modality for detecting bone and joint lesions in lung cancer patients. The SUV_max of malignant lesions was higher than that of benign lesions, but cannot accurately distinguish benign and malignant lesions. The uptake of FAPI differs among lesions with different pathological types.

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Popper HH. Progression and metastasis of lung cancer. Cancer Metastasis Rev. 2016;35(1):75–91. https://doi.org/10.1007/s10555-016-9618-0.CrossRefPubMedPubMedCentral

Bai SB, Liu DZ, Cheng Y, Cui H, Liu M, Cui MX, Zhang BL, Mei QB, Zhou SY. Osteoclasts and tumor cells dual targeting nanoparticle to treat bone metastases of lung cancer. Nanomedicine-Uk. 2019;21:102054. https://doi.org/10.1016/j.nano.2019.102054.CrossRef

Hernandez RK, Wade SW, Reich A, Pirolli M, Liede A, Lyman GH. Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States. BMC Cancer. 2018;18(1):44. https://doi.org/10.1186/s12885-017-3922-0.CrossRefPubMedPubMedCentral

Zhang L, Gong Z. Clinical characteristics and prognostic factors in bone metastases from lung cancer. Med Sci Monit. 2017;23:4087–94. https://doi.org/10.12659/msm.902971.CrossRefPubMedPubMedCentral

Cook G, Goh V. Molecular imaging of bone metastases and their response to therapy. J Nucl Med. 2020;61(6):799–806. https://doi.org/10.2967/jnumed.119.234260.CrossRefPubMed

Blake GM, Park-Holohan SJ, Cook GJ, Fogelman I. Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate. Semin Nucl Med. 2001;31(1):28–49. https://doi.org/10.1053/snuc.2001.18742.CrossRefPubMed

Guise TA, Mohammad KS, Clines G, Stebbins EG, Wong DH, Higgins LS, Vessella R, Corey E, Padalecki S, Suva L, Chirgwin JM. Basic mechanisms responsible for osteolytic and osteoblastic bone metastases. Clin Cancer Res. 2006;12(20 Pt 2):6213s–6s. https://doi.org/10.1158/1078-0432.CCR-06-1007.CrossRefPubMed

Cook GJ, Goh V. Functional and hybrid imaging of bone metastases. J Bone Miner Res. 2018;33(6):961–72. https://doi.org/10.1002/jbmr.3444.CrossRefPubMed

Cook GJ, Azad G, Padhani AR. Bone imaging in prostate cancer: the evolving roles of nuclear medicine and radiology. Clin Transl Imaging. 2016;4(6):439–47. https://doi.org/10.1007/s40336-016-0196-5.CrossRefPubMedPubMedCentral

10.

Fitzgerald AA, Weiner LM. The role of fibroblast activation protein in health and malignancy. Cancer Metastasis Rev. 2020;39(3):783–803. https://doi.org/10.1007/s10555-020-09909-3.CrossRefPubMedPubMedCentral

11.

Dendl K, Koerber SA, Kratochwil C, Cardinale J, Finck R, Dabir M, Novruzov E, Watabe T, Kramer V, Choyke PL, Haberkorn U, Giesel FL. FAP and FAPI-PET/CT in malignant and non-malignant diseases: a perfect symbiosis? Cancers (Basel) 2021;13(19):4946. https://doi.org/10.3390/cancers13194946

12.

Stein S, Weber J, Nusser-Stein S, Pahla J, Zhang HE, Mohammed SA, Oppi S, Gaul DS, Paneni F, Tailleux A, Staels B, von Meyenn F, Ruschitzka F, Gorrell MD, Lüscher TF, Matter CM. Deletion of fibroblast activation protein provides atheroprotection. Cardiovasc Res. 2021;117(4):1060–9. https://doi.org/10.1093/cvr/cvaa142.CrossRefPubMed

13.

Windisch P, Zwahlen DR, Giesel FL, Scholz E, Lugenbiel P, Debus J, Haberkorn U, Adeberg S. Clinical results of fibroblast activation protein (FAP) specific PET for non-malignant indications: systematic review. Ejnmmi Res. 2021;11(1):18. https://doi.org/10.1186/s13550-021-00761-2.CrossRefPubMedPubMedCentral

14.

Song Y, Qin C, Liu F, Lan X. Fibrous dysplasia mimicking skeletal metastasis on 68Ga-FAPI PET imaging. Clin Nucl Med. 2021;46(9):774–5. https://doi.org/10.1097/RLU.0000000000003671.CrossRefPubMed

15.

Wang Y, Yang X, Tian M, Lv H, Liu H. Orbital granulomatous inflammation mimicking malignancy on 68Ga-FAPI PET/CT. Clin Nucl Med. 2022;47(4):380–1. https://doi.org/10.1097/RLU.0000000000003982.CrossRefPubMed

16.

Gungor S, Selçuk NA. Benign bone cyst mimicking bone metastasis demonstrated on 68Ga-FAPI. Clin Nucl Med. 2022;47(1):e95–7. https://doi.org/10.1097/RLU.0000000000003796.CrossRefPubMed

17.

Ji Y, Shao C, Cui Y, Shi D, Su N, Wang Y, Zheng J. Sacral insufficiency fracture after radiotherapy for cervical cancer: appearance and dynamic changes on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Contrast Media Mol Imaging. 2021;2021:5863530. https://doi.org/10.1155/2021/5863530.CrossRefPubMedPubMedCentral

18.

Xu X, Sun ZY, Wu HW, Zhang CP, Hu B, Rong L, Chen HY, Xie HY, Wang YM, Lin HP, Bai YR, Ye Q, Ma XM. Diffusion-weighted MRI and (18)F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma. Radiat Oncol. 2021;16(1):132. https://doi.org/10.1186/s13014-021-01852-z.CrossRefPubMedPubMedCentral

19.

Qin C, Song Y, Liu X, Gai Y, Liu Q, Ruan W, Liu F, Hu F, Lan X. Increased uptake of (68)Ga-DOTA-FAPI-04 in bones and joints: metastases and beyond. Eur J Nucl Med Mol Imaging. 2022;49(2):709–20. https://doi.org/10.1007/s00259-021-05472-3.CrossRefPubMed

20.

Kessler L, Ferdinandus J, Hirmas N, Zarrad F, Nader M, Kersting D, Weber M, Kazek S, Sraieb M, Hamacher R, Lueckerath K, Umutlu L, Fendler WP, Rischpler C. Pitfalls and common findings in (68)Ga-FAPI PET: a pictorial analysis. J Nucl Med. 2022;63(6):890–6. https://doi.org/10.2967/jnumed.121.262808.CrossRefPubMedPubMedCentral

21.

Qin C, Song Y, Liu X, Gai Y, Liu Q, Ruan W, Liu F, Hu F, Lan X. Increased uptake of (68)Ga-DOTA-FAPI-04 in bones and joints: metastases and beyond. Eur J Nucl Med Mol Imaging. 2021. https://doi.org/10.1007/s00259-021-05472-3.CrossRefPubMedPubMedCentral

22.

Blüml S, Redlich K, Smolen JS. Mechanisms of tissue damage in arthritis. Semin Immunopathol. 2014;36(5):531–40. https://doi.org/10.1007/s00281-014-0442-8.CrossRefPubMed

23.

Hurnakova J, Filippucci E, Cipolletta E, Di Matteo A, Salaffi F, Carotti M, Draghessi A, Di Donato E, Di Carlo M, Lato V, Horvath R, Komarc M, Pavelka K, Grassi W. Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study. Rheumatology (Oxford). 2019;58(7):1206–13. https://doi.org/10.1093/rheumatology/key443.CrossRefPubMed

24.

Papadakis GZ, Millo C, Bagci U, Sadowski SM, Stratakis CA. Schmorl Nodes can cause increased 68Ga DOTATATE activity on PET/CT, mimicking metastasis in patients with neuroendocrine malignancy. Clin Nucl Med. 2016;41(3):249–50. https://doi.org/10.1097/RLU.0000000000001065.CrossRefPubMedPubMedCentral

25.

Chen YK, Chen HY, Kao CH. Schmorl’s node may cause an increased FDG activity. Clin Nucl Med. 2011;36(6):494–5. https://doi.org/10.1097/RLU.0b013e3182173967.CrossRefPubMed

26.

Mattei TA, Rehman AA. Schmorl’s nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurg Rev. 2014;37(1):39–46. https://doi.org/10.1007/s10143-013-0488-4.CrossRefPubMed

27.

Levine BD, Motamedi K, Chow K, Gold RH, Seeger LL. CT of rib lesions. AJR Am J Roentgenol. 2009;193(1):5–13. https://doi.org/10.2214/AJR.08.1216.CrossRefPubMed

28.

Smith PC, Martínez C, Martínez J, McCulloch CA. Role of fibroblast populations in periodontal wound healing and tissue remodeling. Front Physiol. 2019;10:270. https://doi.org/10.3389/fphys.2019.00270.CrossRefPubMedPubMedCentral

29.

Jeffery AK. Osteophytes and the osteoarthritic femoral head. J Bone Joint Surg Br. 1975;57(3):314–24.CrossRefPubMed

30.

van der Kraan PM, van den Berg WB. Osteophytes: relevance and biology. Osteoarthritis Cartilage. 2007;15(3):237–44. https://doi.org/10.1016/j.joca.2006.11.006.CrossRefPubMed

31.

Liu H, Wang Y, Zhang W, Cai L, Chen Y. Elevated [(68)Ga]Ga-DOTA-FAPI-04 activity in degenerative osteophyte in a patient with lung cancer. Eur J Nucl Med Mol Imaging. 2021;48(5):1671–2. https://doi.org/10.1007/s00259-020-05090-5.CrossRefPubMed

32.

Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, Sun L, Chen H. Comparison of (68)Ga-FAPI and (18)F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021;298(2):393–402. https://doi.org/10.1148/radiol.2020203275.CrossRefPubMed

Title: Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions
Authors: Xiaoli Liu
Shoumei Yan
Xueting Qin
Kai Cheng
Jinsong Zheng
Hongbo Wu
Yuchun Wei
Shuanghu Yuan
Publication date: 02-05-2023
Publisher: Springer Berlin Heidelberg
Keywords: NSCLC
Lung Cancer
Metastasis
Lung Cancer
Arthritis
NSCLC
SCLC
Lung Cancer
SCLC
Published in: Skeletal Radiology / Issue 12/2023
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-023-04335-2

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Increased ¹⁸F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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