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  11. [68ga]ga-fapi-04 Pet/mr Imaging Strategy In Management Of Krukenberg Tumors (kts) From Gastric Signet-ring-cell Carcinoma: To Overcome Limitation Of [68ga]ga-fapi-04 Pet Imaging In Kts

[68Ga]Ga-FAPI-04 PET/MR imaging strategy in management of Krukenberg tumors (KTs) from gastric signet-ring-cell carcinoma: to overcome limitation of [68Ga]Ga-FAPI-04 PET imaging in KTs

Tingting Wang1, Gan Huang1, Haitao Zhao1

  • 1Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.

European Journal of Nuclear Medicine and Molecular Imaging
|May 20, 2024

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A Practical Guide for the Production and PET/CT Imaging of 68Ga-DOTATATE for Neuroendocrine Tumors in Daily Clinical Practice
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View abstract on PubMed

Summary
This summary is machine-generated.

Gallium-68 (68Ga) FAPI-04 PET imaging is superior to Fluorine-18 (18F) FDG PET for detecting primary gastric signet-ring cell carcinoma and metastases. However, both tracers show limited value for Krukenberg tumors, necessitating integrated PET/MR imaging strategies.

Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiochemistry

Background:

  • Krukenberg tumors (KTs) are metastatic ovarian tumors, often originating from gastric signet-ring cell carcinoma (GSRCC).
  • Accurate detection of primary GSRCC, metastases, and KTs is crucial for effective patient management.
  • Current imaging modalities have limitations in fully characterizing the extent of GSRCC and its metastatic spread, including KTs.

Purpose of the Study:

  • To compare the performance of whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging in detecting KTs, primary GSRCC, and extra-ovarian metastases.
  • To evaluate the utility of a [68Ga]Ga-FAPI-04 PET/MR imaging strategy for KTs from GSRCC.
  • To assess the potential impact of this imaging strategy on patient management.

Main Methods:

  • Retrospective analysis of 12 patients with 23 KTs from GSRCC who underwent both [68Ga]Ga-FAPI-04 pelvic PET/MR and whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging.
Keywords:
Gastric signet-ring-cell carcinomaKrukenberg tumorPET/CTPET/MR

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  • Statistical comparison of tracer uptake and lesion detectability using Wilcoxon signed-rank test, paired t test, and McNemar's test.
  • Immunohistochemistry to assess fibroblast activation protein (FAP) expression in KTs.

    • Main Results:

    • [68Ga]Ga-FAPI-04 PET demonstrated superior detection rates for primary GSRCC, lymph nodes, and peritoneal metastases compared to [18F]FDG PET (p<0.05).
    • Both tracers showed limited efficacy in identifying KTs, with a 100% false-negative rate for [68Ga]Ga-FAPI-04 PET and 8.7% for [18F]FDG PET.
    • [68Ga]Ga-FAPI-04 PET/MR imaging significantly improved KT detection (87%), further enhanced by diffusion-weighted imaging (DWI). This strategy altered TNM staging and treatment plans in all patients.

    Conclusions:

    • [68Ga]Ga-FAPI-04 PET is more effective than [18F]FDG PET for primary GSRCC and most metastases, but less so for KTs.
    • Integrating pelvic MRI with [68Ga]Ga-FAPI-04 PET/MR imaging is essential to overcome the limitations in detecting KTs.
    • [68Ga]Ga-FAPI-04 PET/MR imaging strategy shows significant potential to influence treatment decisions for GSRCC patients with KTs.
    [18F]FDG
    [68Ga]Ga-FAPI-04