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[18F]F-FAPI PET/CT outperforms [18F]F-FDG PET/CT in predicting treatment response in lupus nephritis.

Min Zhao1, Chunqing Zhou1, Hao Fang1

  • 1Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.

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Summary

[18F]F-FAPI PET/CT imaging is a superior predictor of treatment success in lupus nephritis (LN) compared to [18F]F-FDG PET/CT. This noninvasive biomarker can help guide personalized therapy for LN patients.

Keywords:
Fibroblast activationImaging biomarkerLupus nephritisPET/CTTreatment response

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Area of Science:

  • Nuclear Medicine
  • Radiopharmacology
  • Nephrology

Background:

  • Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus, necessitating effective treatment monitoring.
  • Predicting short-term treatment response in LN is crucial for timely therapeutic adjustments.
  • Novel imaging biomarkers are needed to noninvasively assess treatment efficacy in LN.

Purpose of the Study:

  • To identify predictors of complete response (CR) after induction therapy in lupus nephritis (LN).
  • To compare the predictive value of baseline [18F]F-FAPI PET/CT versus [18F]F-FDG PET/CT for short-term treatment outcomes in LN.

Main Methods:

  • Twenty biopsy-proven LN patients prospectively underwent dual-tracer PET/CT imaging ([18F]F-FAPI and [18F]F-FDG) before induction therapy.
  • Treatment response (CR, partial response [PR], non-response [NR]) was assessed at 6 months.
  • Semiquantitative PET parameters (SUVmax, TBR) and clinical biomarkers were analyzed for associations with treatment response.

Main Results:

  • Baseline renal [18F]F-FAPI SUVmax correlated inversely with eGFR and positively with ESR.
  • Patients achieving CR had significantly lower baseline renal [18F]F-FAPI SUVmax and TBR compared to non-CR patients.
  • [18F]F-FAPI PET/CT demonstrated higher accuracy (85%), specificity (90%), and PPV (89%) than [18F]F-FDG PET/CT in predicting CR.

Conclusions:

  • [18F]F-FAPI PET/CT shows superior predictive performance for short-term treatment response in LN compared to [18F]F-FDG PET/CT.
  • Negative baseline [18F]F-FAPI uptake is an independent predictor of CR in LN.
  • [18F]F-FAPI PET/CT holds promise as a noninvasive biomarker for guiding LN treatment decisions.