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Войти в исследования European journal of nuclear medicine and molecular imaging · 2026
The value of 18F-FAPI-04 PET/CT in the assessment of unresectable hepatocellular carcinoma after selective internal radiation therapy: a preliminary exploratory study.
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Gong Huanyu, Cheng Yong, Liu Zhilong, Liu Kangshou, Liu Yulong, Li Yingxin, Shang Jingjie, Guo Bin, Cai Qijun, Ling Xueying, Li Chengzhi, Cao Mingrong, Wang Lu, Gong Jian, Xu Hao
Аннотация
OBJECTIVE: This study aimed to preliminarily evaluate the value of 18F-FAPI-04 PET/CT in assessing target lesions viability and treatment response in patients with unresectable hepatocellular carcinoma (uHCC) following Yttrium-90(90Y) microsphere selective internal radiation therapy (SIRT).
METHODS: Patients with uHCC who underwent 90Y-SIRT and subsequently received post-SIRT 18F-FDG and/or 18F-FAPI-04 PET/CT evaluations from February 2024 to June 2025 were retrospectively included. Visual assessments of post-SIRT target lesions were performed based on CECT/MRI, 18F-FDG PET/CT, and 18F-FAPI-04 PET/CT, and lesion detection efficacy was compared among the three methods. The SUVmax, peak standardized uptake value corrected for lean body mass (SULpeak), metabolic/FAPI-avid tumor volumetric parameters of target and whole-body lesions before and after SIRT were measured, and the percentage changes (Δ%) were calculated. Post-SIRT response was assessed using mRECIST 1.1, 18F-FDG, and 18F-FAPI-04 PERCIST criteria.
RESULTS: A total of 31 patients were included (mean age 51 ± 11, range: 38-75; males: 28). Post-SIRT 18F-FAPI-04 PET/CT showed comparable sensitivity to CECT/MRI for both target and all intrahepatic lesions (target lesions: 95.2% vs. 81.0%, all intrahepatic lesions: 80.0% vs. 88.2%, both P > 0.05), but lower specificity (target lesions: 64.3% vs. 100.0%, P = 0.063; intrahepatic lesions: 40.0% vs. 100.0%, P = 0.031). Compared with 18F-FDG PET/CT, 18F-FAPI-04 PET/CT had significantly higher sensitivity for detecting all intrahepatic lesions (78.9% vs. 55.3%, P = 0.023) but lower specificity (43.7% vs. 100.0%, P = 0.016). The concordance rates between 18F-FDG PERCIST and mRECIST were 69.2% and 71.4% for target and whole-body lesions, respectively; between 18F-FAPI-04 PERCIST and mRECIST, they were 73.3% and 75.0%, respectively. The mRECIST assessment results were significantly correlated with overall survival (OS), while 18F-FAPI-04 PET/CT PERCIST indicated that progressive patients had worse OS. Post-SIRT lesion uptake, FAPI-avid tumor volumetric parameters on 18F-FAPI-04 PET/CT, as well as ΔSULpeak-target%, may have prognostic value.
CONCLUSION: In uHCC patients undergoing 90Y-SIRT,18F-FAPI-04 PET/CT shows high sensitivity but limited specificity for detecting post-SIRT intrahepatic lesions. Post-SIRT 18F-FAPI-04 PET/CT parameters may carry prognostic value.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500107817), registered on 19 August 2025, retrospectively registered.
METHODS: Patients with uHCC who underwent 90Y-SIRT and subsequently received post-SIRT 18F-FDG and/or 18F-FAPI-04 PET/CT evaluations from February 2024 to June 2025 were retrospectively included. Visual assessments of post-SIRT target lesions were performed based on CECT/MRI, 18F-FDG PET/CT, and 18F-FAPI-04 PET/CT, and lesion detection efficacy was compared among the three methods. The SUVmax, peak standardized uptake value corrected for lean body mass (SULpeak), metabolic/FAPI-avid tumor volumetric parameters of target and whole-body lesions before and after SIRT were measured, and the percentage changes (Δ%) were calculated. Post-SIRT response was assessed using mRECIST 1.1, 18F-FDG, and 18F-FAPI-04 PERCIST criteria.
RESULTS: A total of 31 patients were included (mean age 51 ± 11, range: 38-75; males: 28). Post-SIRT 18F-FAPI-04 PET/CT showed comparable sensitivity to CECT/MRI for both target and all intrahepatic lesions (target lesions: 95.2% vs. 81.0%, all intrahepatic lesions: 80.0% vs. 88.2%, both P > 0.05), but lower specificity (target lesions: 64.3% vs. 100.0%, P = 0.063; intrahepatic lesions: 40.0% vs. 100.0%, P = 0.031). Compared with 18F-FDG PET/CT, 18F-FAPI-04 PET/CT had significantly higher sensitivity for detecting all intrahepatic lesions (78.9% vs. 55.3%, P = 0.023) but lower specificity (43.7% vs. 100.0%, P = 0.016). The concordance rates between 18F-FDG PERCIST and mRECIST were 69.2% and 71.4% for target and whole-body lesions, respectively; between 18F-FAPI-04 PERCIST and mRECIST, they were 73.3% and 75.0%, respectively. The mRECIST assessment results were significantly correlated with overall survival (OS), while 18F-FAPI-04 PET/CT PERCIST indicated that progressive patients had worse OS. Post-SIRT lesion uptake, FAPI-avid tumor volumetric parameters on 18F-FAPI-04 PET/CT, as well as ΔSULpeak-target%, may have prognostic value.
CONCLUSION: In uHCC patients undergoing 90Y-SIRT,18F-FAPI-04 PET/CT shows high sensitivity but limited specificity for detecting post-SIRT intrahepatic lesions. Post-SIRT 18F-FAPI-04 PET/CT parameters may carry prognostic value.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500107817), registered on 19 August 2025, retrospectively registered.