Purpose

This study evaluates the value of [¹⁸F]AlF-NOTA-FAPI-04PET/CT in assessing the disease activity of thyroid eye disease (TED).

Methods

Twenty-three TED patients and ten healthy controls were prospectively recruited and underwent [¹⁸F]AlF-NOTA-FAPI-04 PET/CT scans. TED eyes were classified by Clinical Activity Score (CAS) as active (CAS +) or inactive (CAS-). PET analysis included qualitative and quantitative evaluations. Qualitative analysis categorized TED eyes as positive (FAPI +) or negative (FAPI-), while quantitative analysis including SUVmax and target-to-backgroud ratio (TBR) of each extraocular muscle (EOM). Pathological assessment of 16 EOM samples from 15 TED eyes was used as a gold standard to evaluate the diagnostic accuracy of CAS-driven and FAPI-driven assessments.

Results

Eye-based analysis included 42 TED eyes and 20 control eyes. SUVmax did not differ significantly between CAS-/FAPI + (n = 8) and CAS + /FAPI + (n = 17) eyes; though both groups had significantly higher SUVmax than CAS-/FAPI- (n = 16), CAS + /FAPI- (n = 1), and control eyes (n = 20) (all P < .05). Diffuse high FAPI uptake with excellent TBR was observed in pathologically active EOMs and had higher SUVmax and TBR than inactive EOMs (SUVmax: 9.57 ± 2.79 vs. 4.04 ± 1.02, TBR: 2.99 ± 1.00 vs. 1.00 ± 0.35, both P < .001). An SUVmax cutoff value of 5.95 yielded an area under the receiver operating characteristic curve of 0.98 for predicting active disease. Sensitivity and specificity of CAS-driven and FAPI-driven assessments for TED activity were 72.7% and 100%, 100% and 100%, respectively. SUVmax positively correlated with pathological fibroinflammatory score (r = 0.68, P = .004).

Conclusion

The diffuse high FAPI uptake with excellent TBR in the EOMs could illustrate the activity of TED, positively correlated with pathological fibroinflammatory scores. These findings suggest that [¹⁸F]AlF-NOTA-FAPI-04 PET/CT may serve as a promising reliable non-invasive approach for assessing disease activity in TED, potentially superior to the CAS.

中文翻译：

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使用 [18F]AlF-NOTA-FAPI-04 PET/CT 评估甲状腺眼病的纤维炎症活性：一项前瞻性研究

 目的

本研究评估了 [¹⁸F]AlF-NOTA-FAPI-04PET/CT 在评估甲状腺眼病 （TED） 疾病活动方面的价值。

 方法

前瞻性招募了 23 例 TED 患者和 10 例健康对照者，并接受了 [¹⁸F]AlF-NOTA-FAPI-04 PET/CT 扫描。TED 眼按临床活动评分 （CAS） 分为活动 （CAS +） 和非活动 （CAS-）。PET 分析包括定性和定量评估。定性分析将 TED 眼分为阳性 （FAPI +） 或阴性 （FAPI-），而定量分析包括 SUVmax 和每块眼外肌的目标与背景比 （TBR） （EOM）。对来自 15 只 TED 眼的 16 个 EOM 样本进行病理评估作为金标准，以评估 CAS 驱动和 FAPI 驱动评估的诊断准确性。

 结果

基于眼睛的分析包括 42 只 TED 眼和 20 只对照眼。SUVmax 在 CAS-/FAPI + （n = 8） 和 CAS + /FAPI + （n = 17） 眼之间无显著差异;尽管两组的 SUVmax 均显著高于 CAS-/FAPI- （n = 16） 、 CAS + /FAPI- （n = 1） 和对照眼 （n = 20） （均 P < .05）。在病理活动性 EOM 中观察到弥漫性高 FAPI 摄取和出色的 TBR，并且比非活动性 EOM 具有更高的 SUVmax 和 TBR（SUVmax：9.57 ± 2.79 vs. 4.04 ± 1.02，TBR：2.99 ± 1.00 vs. 1.00 ± 0.35，均 P < .001）。SUVmax 截断值为 5.95 时，受试者工作特征曲线下面积为 0.98，用于预测活动性疾病。CAS 驱动和 FAPI 驱动评估对 TED 活动的敏感性和特异性分别为 72.7% 和 100% 、 100% 和 100%。SUVmax 与病理纤维炎评分呈正相关 （r = 0.68，P = .004）。

 结论

EOMs 中弥漫性高 FAPI 摄取和出色的 TBR 可以说明 TED 的活性，与病理纤维炎评分呈正相关。这些发现表明 [¹⁸F]AlF-NOTA-FAPI-04 PET/CT 可能是一种有前途的可靠无创方法，用于评估 TED 中的疾病活动，可能优于 CAS。