Article Figures & Data
Figures
- FIGURE 1.
Flowchart of study design.
- FIGURE 2.
18F-FDG PET/CT (A) and 68Ga-FAPI-46 PET/CT (B) images of 69-y-old woman with left oropharyngeal cancer, stage IVA, who underwent PET/CT for initial staging. 18F-FDG PET/CT detected involved lymph nodes on left side at levels IIA and IIB, whereas 68Ga-FAPI-46 PET/CT did not detect level IIB node (arrows). Left IIB node was confirmed as nodal metastasis by anatomic abnormality criteria.
- FIGURE 3.
18F-FDG PET/CT (A) and 68Ga-FAPI-46 PET/CT (B) images of 49-y-old woman with nasopharyngeal cancer after concurrent chemoradiation who underwent PET/CT for recurrence detection. 68Ga-FAPI-46 PET/CT showed focal uptake, without corresponding 18F-FDG uptake, in small sclerotic lesion at ninth right lateral rib, which was suspected of being bone metastasis (arrows).
- FIGURE 4.
18F-FDG PET/CT (A) and 68Ga-FAPI-46 PET/CT (B) images of 60-y-old man with glottic cancer who underwent PET/CT for recurrence detection. Recurrent tumor avid for 18F-FDG and 68Ga-FAPI-46 was seen at right side of oropharynx (arrows). MTV was 19.37 cm3. FTV was 33.75 cm3.
Tables
Patient no. Age (y) Sex Primary tumor Indication 1 48 M Tongue Recurrence detection 2 65 F Lip Recurrence detection 3 65 M Pyriform fossa Recurrence detection 4 57 M Tongue Recurrence detection 5 65 M Base of tongue Initial staging 6 57 F Nasopharynx Recurrence detection 7 49 F External ear canal Recurrence detection 8 35 F Nasal cavity Recurrence detection 9 54 F Nasopharynx Recurrence detection 10 62 M Nasopharynx Recurrence detection 11 69 F Oropharynx Initial staging 12 62 F Tongue Initial staging 13 58 M Pyriform fossa Initial staging 14 79 M Tongue Recurrence detection 15 67 M Pyriform fossa Recurrence detection 16 77 M Retromolar trigone Recurrence detection 17 45 F Oral mucosa Initial staging 18 51 M Nasopharynx Initial staging 19 59 M Nasopharynx Initial staging 20 55 M Base of tongue Recurrence detection 21 50 M Tongue Initial staging 22 32 F Nasopharynx Recurrence detection 23 60 M Base of tongue Recurrence detection 24 60 M Glottis Recurrence detection 25 61 M Pyriform fossa Recurrence detection 26 69 M Nasopharynx Recurrence detection 27 63 M Floor of mouth Recurrence detection 28 62 M Pyriform fossa Initial staging 29 74 M Nasopharynx Recurrence detection 30 86 M Nasopharynx Recurrence detection 31 55 M Nasopharynx Initial staging 32 49 F Nasopharynx Recurrence detection 33 53 M Nasopharynx Recurrence detection 34 47 M Nasopharynx Recurrence detection 35 23 M Nasopharynx Recurrence detection 36 42 F Tongue Recurrence detection 37 46 M Nasopharynx Recurrence detection 38 32 F Nasopharynx Recurrence detection 39 51 M Nasopharynx Initial staging 40 72 F Tongue Initial staging Patient no. Primary tumor TNM Stage 18F-FDG 68Ga-FAPI-46 18F-FDG 68Ga-FAPI-46 5 Base of tongue T2N2cM0 T2N2cM0 IVA IVA 11 Oropharynx T1N2bM0 T1N2bM0 IVA IVA 12 Tongue T3N2cM0 T3N2cM0 IVA IVA 13 Pyriform fossa T1N3bM0 T1N3bM0 IVB IVB 17 Oral mucosa T3N1M0 T3N1M0 III III 18 Nasopharynx T3N2M0 T3N2M0 III III 19 Nasopharynx T3N1M0 T3N1M0 III III 21 Tongue T3N0M0 T3N0M0 III III 28 Pyriform fossa T3N2bM0 T3N2bM1 IVA IVC 31 Nasopharynx T2N2M1 T2N1M1 IVB IVB 39 Nasopharynx T2N0M0 T2N0M0 II II 40 Tongue T2N0M0 T2N0M0 II II Patient no. Primary tumor Recurrence site 18F-FDG avidity 68Ga-FAPI-46 avidity PET/CT result 1 Tongue None Y Y FP 2 Lip Primary, LN Y Y TP 3 Pyriform fossa Primary, LN Y Y TP 4 Tongue Primary, LN Y Y TP 6 Nasopharynx None N N TN 7 External ear canal Primary, LN Y Y TP 8 Nasal cavity None N N TN 9 Nasopharynx Primary Y Y TP 10 Nasopharynx Lung Y Y TP 14 Tongue None Y Y FP 15 Pyriform fossa Primary Y Y TP 16 Retromolar trigone Primary, LN Y Y TP 20 Base of tongue Primary, LN, lung, thyroid Y Y TP 22 Nasopharynx LN, bone Y Y TP 23 Base of tongue None N N TN 24 Glottis Primary, LN Y Y TP 25 Pyriform fossa LN, liver, adrenal gland Y Y TP 26 Nasopharynx Primary, LN, lung Y Y TP 27 Floor of mouth Primary, LN, bone, muscle Y Y TP 29 Nasopharynx None N N TN 30 Nasopharynx LN, lung Y Y TP 32 Nasopharynx Bone N Y FN for 18F-FDG; TP for 68Ga-FAPI 33 Nasopharynx None N N TN 34 Nasopharynx LN, nasal turbinate Y Y TP 35 Nasopharynx None N N TN 36 Tongue None N N TN 37 Nasopharynx None N N TN 38 Nasopharynx LN, lung, pleura Y Y TP FP = false positive; LN = lymph node; TP = true positive; TN = true negative; FN = false negative.
Diagnostic accuracy (%) 18F-FDG 68Ga-FAPI-46 Sensitivity 100 100 Specificity 50 50 Positive predictive value 94.1 94.1 Negative predictive value 100 100 Accuracy 94.4 94.4 - TABLE 5.
Comparisons of Semiquantitative Parameters Between 18F-FDG and 68Ga-FAPI-46 PET/CT of Primary Tumor and Distant Metastasis
Parameter 18F-FDG 68Ga-FAPI-46 P Primary tumor SUVmax 18.59 ± 9.61 (7.15–43.11) 19.28 ± 7.45 (6.40–42.39) 0.65 SUVmean 10.82 ± 6.10 (2.54–24.64) 11.10 ± 4.83 (4.17–28.07) 0.78 T/B 10.21 ± 5.89 (1.54–26.37) 11.04 ± 5.03 (2.21–23.51) 0.45 MTV vs. FTV 7.36 ± 5.07 (1.34–21.66) 10.33 ± 9.44 (0.86–35.37) 0.03 TLG vs. TLF 94.91 ± 117.20 (7.14–517.65) 122.58 ± 132.85 (8.88–500.50) 0.06 Distant metastasis SUVmax 13.59 ± 7.64 (3.86–31.69) 16.89 ± 9.96 (3.09–34.22) 0.09 SUVmean 7.82 ± 4.45 (2.23–18.42) 9.74 ± 5.67 (1.80–18.18) 0.09 T/B 30.39 ± 55.85 (1.53–254.4) 20.54 ± 13.57 (1.69–52.63) 0.44 MTV vs. FTV 10.52 ± 19.41 (0.18–81.23) 9.02 ± 15.27 (0.25–54.42) 0.33 TLG vs. TLF 109.87 ± 255.52 (1.43–1151.59) 135.92 ± 260.12 (0.78–976.03) 0.36 TLF = total lesion FAP expression (68Ga-FAPI); TLG = total lesion glycolysis (18F-FDG).
Data are mean ± SD followed by range.
- TABLE 6.
Semiquantitative Comparisons Between 18F-FDG and 68Ga-FAPI-46 PET/CT for Nodal Metastasis
Site Median size (cm) No. of detected nodes SUVmax 18F-FDG 68Ga-FAPI-46 18F-FDG 68Ga-FAPI-46 P Neck 1.3 85 56 13.67 ± 7.38 16.91 ± 9.35 0.08 Supraclavicular 0.8 5 4 9.97 ± 3.47 7.16 ± 2.01 Mediastinal 0.8 30 22 9.21 ± 4.22 8.64 ± 4.54 Axillary 1.1 3 3 18.64* 10.98* Intraabdominal 0.9 5 9 15.83 ± 7.02 31.84 ± 9.00 All 1.1 128 94 12.55 ± 6.68 15.04 ± 10.25 ↵*No SD because the SUVmax was derived from 1 patient’s data.
P value is for SUVmax. SUVmax is mean ± SD.
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