Abstract
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Introduction: FDG high-uptake lesions indicate not only carcinoma but also benign lesions.The 68Ga-labelled FAPI was accumulated in various tumors. However, it's unclear about the capacity of FAPI-PET in identifying malignant tumors from benign leions.
Methods: Clinical and histology dada of 209 18F-FDG-avid colorectal lesions were collected. An AOM/DSS-induced rat colorectal tumor model was established. A double PET/CT tracer of 68Ga-FAPI-04 and 18F-FDG was used in the clinical trial and rat colorectal tumor model. Immunohistochemistry staining, enteroscopy, and radioautography were performed in this study.
Results: Eight out of 22 patients had 18F-FDG-avid colorectal lesions, but they were negative in 68Ga-FAP-04 PET imaging. An inflammatory lesion did not interfere with 68Ga-FAPI PET imaging. 68Ga-FAPI PET imaging distinguishes neoplasia from inflammatory lesions in an AOM/DSS-induced rat colorectal tumor model, and FAPI accumulation gradually uncrease along with tumor progression. Moreover, the clinical study demonstrated that in all of 18F-FDG-avid colorectal lesions, only 20.5% (16 out of 78) of premalignant/benign lesions were weak FAP-positive. However, most cancer patients (85.1%, 80 out of 94) were FAP-positive, which further supported the above findings.
Conclusions: The 68Ga-FAPI-04 PET distinguishes malignant tumors from inflammatory lesions by detecting FAP in a rat colorectal tumor model and the clinics, suggesting that 68Ga-FAPI-04 PET is a better diagnostic tool than 18F-FDG PET, at least to colorectal cancer patients.
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