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FAP-targeted PET Imaging in Peritoneal Carcinomatosis.

Ayça Arçay Öztürk1, Gabriel Liberale2, Patrick Flamen1

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Fibroblast activation protein inhibitor (FAPI) PET/CT offers superior imaging of peritoneal carcinomatosis compared to Fluorine-18([18F])-FDG PET/CT. This advanced imaging improves detection of peritoneal disease extent, aiding clinical decisions and potentially reducing understaging.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • Peritoneal carcinomatosis significantly impacts prognosis and surgical options for abdominopelvic cancers.
  • Conventional imaging like CT/MRI and Fluorine-18([18F])-FDG PET/CT often fail to accurately assess the full extent of peritoneal disease.
  • Small, flat, or low-FDG-avid peritoneal implants are particularly challenging to detect with current methods.

Purpose of the Study:

  • To evaluate the diagnostic performance of Fibroblast Activation Protein Inhibitor (FAPI) PET/CT for peritoneal carcinomatosis.
  • To compare FAPI PET/CT with conventional imaging modalities, specifically FDG PET/CT.
  • To assess the potential impact of FAPI PET/CT on clinical decision-making regarding patient management.

Main Methods:

  • Review of head-to-head studies and meta-analyses comparing FAPI PET/CT and FDG PET/CT.
  • Analysis of imaging characteristics, including tumour uptake and tumour-to-background ratios.
  • Assessment of diagnostic sensitivity and impact on the peritoneal cancer index.

Main Results:

  • FAPI PET/CT consistently shows higher tumour uptake and tumour-to-background ratios in peritoneal lesions compared to FDG PET/CT.
  • FAPI PET/CT demonstrates higher diagnostic sensitivity for detecting peritoneal carcinomatosis than FDG PET/CT.
  • Improved mapping of peritoneal disease via FAPI PET/CT leads to a more accurate peritoneal cancer index.

Conclusions:

  • FAPI PET/CT represents a significant advancement in imaging peritoneal carcinomatosis, outperforming FDG PET/CT.
  • Enhanced visualization of peritoneal metastases with FAPI PET/CT can refine patient selection for surgery and therapies.
  • Further prospective trials are needed to establish optimal indications and confirm outcome benefits, addressing current limitations like single-center data and heterogeneous standards.