Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients

Purpose FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of Ga-68-FAPI versus standard-of-care F-18-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. Material and Methods This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both Ga-68-FAPI and F-18-FDG PET/CT within a median time interval of 10 days (range 1-89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). Results A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. Ga-68-FAPI uptake in primary tumors and metastases was comparable to F-18-FDG in most cases. The SUVmax was significantly lower for Ga-68-FAPI than F-18-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, Ga-68-FAPI TBRs were significantly higher than F-18-FDG TBRs in some sites, including liver and bone metastases. Conclusion Quantitative tumor uptake is comparable between Ga-68-FAPI and F-18-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for Ga-68-FAPI. Thus, Ga-68-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological F-18-FDG uptake.

Automated summary

The study aimed to compare Ga-68-FAPI and F-18-FDG in organ biodistribution and tumor uptake in PET/CT, showing that Ga-68-FAPI has lower uptake in most normal tissues compared to F-18-FDG, resulting in significantly higher TBRs at some sites for Ga-68-FAPI.