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Gene Regulation and Targeted Therapy in Gastric Cancer Peritoneal Metastasis: Radiological Findings from Dual Energy CT and PET/CT

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Published on: January 22, 2018

Usefulness of [¹⁸F]FAPI-04 and [¹⁸F]FDG PET/CT for the Detection of Peritoneal Carcinomatosis: A Comparative Study

Chengzhi Jiang¹, Kai Zheng², Yanyin Zhang²

¹Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China (C.J., Y.C.); Department of PET-CT Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China (C.J., K.Z., Y.Z., X.P., J.Y., H.Y.); Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China (C.J., Y.C.); Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China (C.J., Y.C.).

Academic Radiology

|June 20, 2025

Abstract

Rationale And Objectives:

In this study, we aimed to compared the performance of [¹⁸F]FAPI-04 and [¹⁸F]fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET/CT) in the evaluation of peritoneal carcinomatosis.

Materials And Methods:

71 patients with suspected peritoneal malignancies were enrolled in our study. All the participants underwent both [¹⁸F]FAPI-04 and [¹⁸F]FDG PET/CT imaging within 7 days. The detection rates, diagnostic accuracies, semiquantitative parameters of the tracers, peritoneal cancer index (PCI) scores, and tumor markers were evaluated and compared.

Results:

Among the 71 patients, 40 patients were diagnosed with peritoneal carcinomatosis, and 31 were true-negative patients. The sensitivity and accuracy of [¹⁸F]FAPI-04 PET/CT were higher than those of [¹⁸F]FDG PET/CT (sensitivity: 92.50% vs. 72.50%, p=0.003; accuracy: 91.55% vs. 80.28%, p<0.001), particularly in patients with gastric cancer. The SUVmax, tumor-to-liver background ratio (TBR-L), tumor-to-descending aorta ratio (TBR-A), and PCI score were significantly higher for [¹⁸F]FAPI-04 PET/CT than [¹⁸F]FDG PET/CT (all p<0.05). In the [¹⁸F]FAPI-04 PET/CT group, the PCI score, TBR-L, TBR-A, TBR-M and SUVmax were higher in the high level group than the low level group (all p<0.05). The carbohydrate antigen 125 (CA 125) levels were strongly correlated with the PCI of both [¹⁸F]FAPI-04 and [¹⁸F]FDG PET/CT.

Conclusion:

[¹⁸F]FAPI-04 PET/CT outperformed [¹⁸F]FDG PET/CT in the evaluation of peritoneal carcinomatosis, particularly in patients with gastric cancer. Furthermore, [¹⁸F]FAPI-04 PET/CT may be used for the assessment of peritoneal carcinomatosis in patients, especially FAPI-PCI.

Keywords:

PET/CT Peritoneal cancer index Peritoneal carcinomatosis [(18)F]FAPI-04 [(18)F]FDG

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