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The earliest optimal timing for total-body 68Ga-fibroblast activation protein inhibitor-04 PET scans: an evidence-based single-centre study

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the earliest optimal timing for positron emission tomography (PET) scans after 68Ga-fibroblast activation protein inhibitor-04 ([68Ga]Ga-FAPI-04) injection.

Methods

This prospective study enrolled patients who underwent 60-min dynamic 68Ga-FAPI-04 total-body PET/CT scans; the images were reconstructed at 10-min intervals (G0-10, G10-20, G20-30, G30-40, G40-50, and G50-60), and the [68Ga]Ga-FAPI-04 uptake patterns were evaluated. The standardised uptake value (SUV), liver signal-to-noise ratio (SNR), and lesion-to-background ratios (LBRs) for different time windows were calculated to evaluate image quality and lesion detectability. The period from 30 to 40 min was then split into overlapping 5-min intervals starting 1 min apart for further evaluation. G50-60 was considered the reference.

Results

A total of 30 patients with suspected malignant tumours were analysed. In the images reconstructed over 10-min intervals, longer acquisition times were associated with lower background uptake and better image quality. Some lesions could not be detected until G30-40. The lesion detection rate, uptake, and LBRs did not differ significantly among G30-40, G40-50, and G50-60 (all p > 0.05). The SUVmean and LBRs of primary tumours in the reconstructed images did not differ significantly among the 5-min intervals between 30 and 40 min; for metastatic and benign lesions, G34-39 and G35-40 showed significantly better SUVmean and LBR values than the other images. The G34-39 and G50-60 scans showed no significant differences in uptake, LBRs, or detection rates (all p > 0.05).

Conclusion

The earliest optimal time to start acquisition was 34 min after injection of half-dose [68Ga]Ga-FAPI-04.

Clinical relevance statement

This study evaluated 68Ga-fibroblast activation protein inhibitor-04 ([68Ga]Ga-FAPI-04) uptake patterns by comparing the image quality and lesion detection rate with 60-min dynamic [68Ga]Ga-FAPI-04 total-body PET/CT scans and identified the earliest optimal scan time after [68Ga]Ga-FAPI-04 injection.

Key Points

• A prospective single-centre study showed that the earliest optimal time point to start acquisition was 34 min after injection of half-dose [68Ga-fibroblast activation protein inhibitor-04 (68Ga]Ga-FAPI-04).

• There were statistically significant differences in standardised uptake value, lesion-to-background ratios, and lesion detectability between scans before and after 34 min from the injection of [68Ga]Ga-FAPI-04, but these values did not change further from 34 to 60 min after injection.

• With a reasonable acquisition time, the image quality could still meet diagnostic requirements.

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Abbreviations

18F-FDG:

F-18-Fluorodeoxyglucose

[68Ga]Ga-FAPI-04:

68Ga-fibroblast activation protein inhibitor-04

FAP:

Fibroblast activation protein

LBR:

Lesion-to-background ratio

MIP:

Maximum intensity projection

MRI:

Magnetic resonance imaging

OSEM:

Ordered subset expectation maximisation

p.i.:

Post-injection

PET/CT:

Positron emission tomography/computed tomography

PSF:

Point-spread function

ROI:

Region of interest

SD:

Standard deviation

SNR:

Signal-to-noise ratio

SUV:

Standardised uptake value

TAC:

Tumour activity curve

TBR:

Lesion-to-blood ratio

TLR:

Lesion-to-liver ratio

TMR:

Lesion-to-muscle ratio

TNR:

Lesion-to-non-tumour ratio

TOF:

Time-of-flight

VOI:

Volume of interest

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Funding

This study is supported by Clinical Research Plan of SHDC (No. SHDC2020CR3079B), Shanghai Municipal Key Clinical Specialty (shslczdzk03401), and Shanghai Municipal Commission of Economy and Informatization (201901014).

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Author notes

  1. Zhe Zheng, Huaping Gao, and Yu Lin contributed equally to this article.

Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Zhe Zheng, Huaping Gao, Yu Lin, Haojun Yu, Wujian Mao, Runjun Yang, Yibo He, Xueqi Chen, Ha Wu, Pengcheng Hu & Hongcheng Shi

  2. Shanghai Institute of Medical Imaging, Shanghai, 200032, China

    Zhe Zheng, Huaping Gao, Yu Lin, Haojun Yu, Wujian Mao, Runjun Yang, Yibo He, Xueqi Chen, Ha Wu, Pengcheng Hu & Hongcheng Shi

  3. Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China

    Zhe Zheng, Huaping Gao, Yu Lin, Haojun Yu, Wujian Mao, Runjun Yang, Yibo He, Xueqi Chen, Ha Wu, Pengcheng Hu & Hongcheng Shi

  4. Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Zhe Zheng, Huaping Gao, Yu Lin, Haojun Yu, Wujian Mao, Runjun Yang, Yibo He, Xueqi Chen, Ha Wu, Pengcheng Hu & Hongcheng Shi

Authors
  1. Zhe Zheng
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Corresponding authors

Correspondence to Pengcheng Hu or Hongcheng Shi.

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Guarantor

The scientific guarantor of this publication is Hongcheng Shi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The Institutional Review Board of the Zhongshan Hospital, Fudan University, approved this study (study number: B2022-098R2).

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

• Prospective

• Observational

• Performed at one institution

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Zheng, Z., Gao, H., Lin, Y. et al. The earliest optimal timing for total-body 68Ga-fibroblast activation protein inhibitor-04 PET scans: an evidence-based single-centre study. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10264-4

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