Purpose

To assess the diagnostic performance of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging in the preoperative evaluation of pancreatic cancer and compare it with that of [¹⁸F]-FDG PET/CT plus contrast-enhanced CT (CECT).

Methods

Thirty-one patients with pancreatic cancer underwent preoperative [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR, [¹⁸F]-FDG PET/CT, and CECT imaging. Two nuclear medicine physicians independently reviewed two sets of images (set 1, [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR; set 2, [¹⁸F]-FDG PET/CT plus CECT) and reached a consensus on tumour resectability, N staging (N0 or N positive) and M staging (M0 or M1). Based on the above indices, the resectability of the tumour was determined according to a five-point scale. Clinical, operative, and pathological findings were used as a reference standard to compare the diagnostic performance of the two imaging sets via the McNemar test.

Results

The diagnostic performance of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging was not significantly different from that of [¹⁸F]-FDG PET/CT plus CECT imaging in the assessment of tumour resectability (area under the receiver operating characteristic curve: 0.854 vs. 0.775, p = 0.192), N staging [accuracy: 82.4% (14 of 17 patients) vs. 58.8% (10 of 17 patients), p = 0.125] and M staging [accuracy: 100% (31 of 31 patients) vs. 90.3% (28 of 31 patients), p = 0.250]. However, compared with [¹⁸F]-FDG PET/CT plus CECT imaging, [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging changed the M stage in three patients by upstaging from M0 to M1 in 2 patients and downstaging from M1 to M0 in 2 patients. In 13 patients with liver metastases, the number of liver metastases detected via [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging was greater than that detected via [¹⁸F]-FDG PET/CT plus CECT imaging (324 vs. 240). In 3 patients with peritoneal metastases, [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging detected more peritoneal metastases than did [¹⁸F]-FDG PET/CT plus CECT imaging.

Conclusions

[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR imaging has diagnostic accuracy comparable to [¹⁸F]-FDG PET/CT plus CECT in terms of preoperative staging and assessment of resectability in pancreatic cancer; additionally, it exhibits superior capability in detecting liver and peritoneal metastases. Consequently, [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR has the potential to become a one-stop imaging tool for the preoperative evaluation of pancreatic cancer.

中文翻译：

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[68Ga]Ga-DOTA-FAPI-04 PET/MR 与 [18F]-FDG PET/CT 加造影剂增强 CT 对胰腺癌的术前评估：一项前瞻性初步研究

 目的

评估 [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 成像在胰腺癌术前评估中的诊断性能，并将其与 [¹⁸F]-FDG PET/CT 加对比增强 CT （CECT） 进行比较。

 方法

31 例胰腺癌患者术前行 [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR、[¹⁸F]-FDG PET/CT 和 CECT 影像学检查。两名核医学医生独立审查了两组图像 （第 1 组，[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR;第 2 组，[¹⁸F]-FDG PET/CT 加 CECT），并就肿瘤可切除性、N 分期 （N0 或 N 阳性） 和 M 分期 （M0 或 M1） 达成共识。根据上述指标，根据五分制确定肿瘤的可切除性。临床、手术和病理结果用作参考标准，通过 McNemar 测试比较两个成像组的诊断性能。

 结果

[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 成像的诊断性能与 [¹⁸F]-FDG PET/CT 加 CECT 成像在评估肿瘤可切除性方面没有显著差异（受试者工作特征曲线下面积：0.854 vs. 0.775，p = 0.192），N 分期 [准确性：82.4%（17 名患者中的 14 名）对 58.8%（17 名患者中的 10 名）， p = 0.125] 和 M 分期 [准确性：100%（31 名患者中的 31 名）对 90.3%（31 名患者中的 28 名），p = 0.250]。然而，与 [¹⁸F]-FDG PET/CT 加 CECT 显像相比，[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 显像改变了 3 例患者的 M 分期，2 例患者从 M0 分期到 M1,2 例患者从 M1 降期到 M0。在 13 例肝转移患者中，通过 [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 成像检测到的肝转移数量大于通过 [¹⁸F]-FDG PET/CT 加 CECT 成像检测到的肝转移数量 （324 vs. 240）。在 3 例腹膜转移患者中，[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 成像检测到的腹膜转移比 [¹⁸F]-FDG PET/CT 加 CECT 成像多。

 结论

[⁶⁸加]Ga-DOTA-FAPI-04 PET/MR 成像在胰腺癌术前分期和可切除性评估方面的诊断准确性与 [¹⁸F]-FDG PET/CT 加 CECT 相当;此外，它在检测肝脏和腹膜转移方面表现出卓越的能力。因此，[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/MR 有可能成为胰腺癌术前评估的一站式成像工具。