PURPOSE This study aimed to investigate the diagnostic performance of [68Ga]Ga-FAPI PET/CT for primary and metastatic pancreatic carcinoma lesions and compare the results with those of [18F]-fluorodeoxyglucose ([18F]FDG) PET/CT. METHODS Patients with suspected or diagnosed pancreatic malignancy, who underwent contemporaneous [18F]FDG and [68Ga]Ga-FAPI PET/CT between June 2020 and January 2021, were retrospectively analyzed. Routine contrast-enhanced CT (CE-CT) is performed in all patients as standardized care. Findings were confirmed by histopathology or radiographic follow-up. We compared radiotracer uptake, diagnostic performance, and TNM (tumor-node-metastasis) classifications. RESULTS We evaluated 36 participants (25/36 men; median age, 60 years), including 26 patients with pancreatic malignancies and ten patients with pancreatic benign lesions. [68Ga]Ga-FAPI PET/CT showed higher radiotracer uptake and higher sensitivity than [18F]FDG PET/CT in evaluating primary tumors (SUVmax, 21.4 vs. 4.8; sensitivity, 100% vs. 73.1%), involved lymph nodes (SUVmax, 8.6 vs. 2.7; sensitivity, 81.8% vs. 59.1%), and metastases (SUVmax, 7.9 vs. 3.5; sensitivity, 91.5% vs. 44.0%); Compared with [18F]FDG, [68Ga]Ga-FAPI PET/CT upstaged six patients' TNM staging (6/23, 26.1%) and changed two patients' clinical management (2/23, 8.7%). Compared with CE-CT, [68Ga]Ga-FAPI PET/CT upgraded TNM staging in five patients (5/23, 21.7%) and changed the therapeutic regimen in only one patient (1/23, 4.3%). Intense [68Ga]Ga-FAPI uptake was observed throughout the pancreas in 12/26 pancreatic malignancies; dual-time point [68Ga]Ga-FAPI PET/CT may differentiate pancreatitis from malignancy. CONCLUSIONS Compared with [18F]FDG PET/CT, [68Ga]Ga-FAPI PET/CT shows higher sensitivity in detecting primary pancreatic tumors, involved lymph nodes, and metastases and is superior in terms of TNM staging. Prospective trials with larger patient population are needed to evaluate whether [68Ga]Ga-FAPI PET/CT could elicit treatment modification in pancreatic cancer when compared with standard of care imaging.

中文翻译：

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使用 [68Ga]Ga 成纤维细胞激活蛋白抑制剂的正电子发射断层扫描和计算机断层扫描可改善胰腺癌患者的肿瘤检测和分期。


目的本研究旨在探讨[68Ga]Ga-FAPI PET/CT对原发性和转移性胰腺癌病灶的诊断性能，并将结果与​​[18F]-氟脱氧葡萄糖([18F]FDG)PET/CT的结果进行比较。方法 对 2020 年 6 月至 2021 年 1 月期间同时接受 [18F]FDG 和 [68Ga]Ga-FAPI PET/CT 的疑似或诊断胰腺恶性肿瘤患者进行回顾性分析。作为标准化护理，对所有患者进行常规增强 CT (CE-CT)。结果通过组织病理学或放射学随访得到证实。我们比较了放射性示踪剂的摄取、诊断性能和 TNM（肿瘤-淋巴结-转移）分类。结果 我们评估了 36 名参与者（25/36 男性；中位年龄 60 岁），其中包括 26 名胰腺恶性肿瘤患者和 10 名胰腺良性病变患者。在评估原发性肿瘤时，[68Ga]Ga-FAPI PET/CT 显示出比 [18F]FDG PET/CT 更高的放射性示踪剂摄取和更高的敏感性（SUVmax，21.4 vs. 4.8；敏感性，100% vs. 73.1%），涉及淋巴结（ SUVmax，8.6 vs. 2.7；敏感性，81.8% vs. 59.1%）和转移（SUVmax，7.9 vs. 3.5；敏感性，91.5% vs. 44.0%）；与[18F]FDG相比，[68Ga]Ga-FAPI PET/CT提高了6名患者的TNM分期（6/23，26.1%），并改变了2名患者的临床管理（2/23，8.7%）。与CE-CT相比，[68Ga]Ga-FAPI PET/CT升级了5名患者的TNM分期（5/23，21.7%），仅改变了1名患者的治疗方案（1/23，4.3%）。在 12/26 的胰腺恶性肿瘤中，在整个胰腺中观察到强烈的 [68Ga]Ga-FAPI 摄取；双时间点[68Ga]Ga-FAPI PET/CT可以区分胰腺炎和恶性肿瘤。 结论 与[18F]FDG PET/CT相比，[68Ga]Ga-FAPI PET/CT在检测原发性胰腺肿瘤、累及淋巴结和转移灶方面表现出更高的敏感性，并且在TNM分期方面优于[68Ga]Ga-FAPI PET/CT。需要对更大的患者群体进行前瞻性试验，以评估与标准护理成像相比，[68Ga]Ga-FAPI PET/CT 是否可以引起胰腺癌治疗的修改。