利用68Ga-FAPI PET/CT改善鼻咽癌大体肿瘤体积勾画，同时使危及器官受照剂量保持在安全范围内
Utilization of 68Ga-FAPI PET/CT improves the gross tumor volume delineation in nasopharyngeal carcinoma within a safe radiation dose to organs at risk.
文献信息
| PMID | 42861158 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yiqiao Luo |
| 作者单位 | Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China. |
| 期刊 | Quantitative imaging in medicine and surgery |
| SCI 分区 | Q2 |
| IF | 3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 准确勾画鼻咽癌（NPC）的鼻咽大体肿瘤体积（GTVnx）对需要放疗的患者至关重要，因为其与预后相关。当前的GTVnx勾画方法存在明显不足，常导致放疗靶区覆盖不充分。镓-68标记的成纤维细胞活化蛋白抑制剂（68Ga-FAPI）是一种新兴且有前景的肿瘤显像剂。本研究旨在评估联合68Ga-FAPI正电子发射断层显像/计算机断层显像（PET/CT）勾画NPC中GTVnx的有效性。
方法： 这项前瞻性研究纳入了19例于2022年8月至2023年8月期间接受68Ga-FAPI PET/CT检查的NPC患者。基于增强磁共振成像（MRI）、68Ga-FAPI PET/CT以及两种成像方式的融合分别勾画、量化并比较GTVnx，分别命名为并缩写为GTVnx-MRI、GTVnx-FAPI和GTVnx-MRI + FAPI。GTVnx-FAPI采用最大标准化摄取值（SUVmax）阈值自动勾画，最佳阈值由Jaccard指数和组内相关系数（ICC）确定。基于GTVnx-MRI和GTVnx-MRI + FAPI制定放疗计划，以评估危及器官（OARs）的受照剂量。采用配对t检验比较各组间变量。
结果： 共纳入19例经病理确诊的NPC患者[平均年龄48.84±12.12岁（范围24-70岁）；男性12例（63.16%）]。所有纳入的NPC患者原发肿瘤病灶均表现出较高的68Ga-FAPI摄取。原发肿瘤68Ga-FAPI PET/CT的20% SUVmax（GTVnx-FAPI20%）被确定为指导GTVnx-FAPI的最合适阈值，ICC为0.891。GTVnx-MRI + FAPI20%显著大于GTVnx-MRI和GTVnx-FAPI20%，平均测量值分别为24.92±17.31、17.44±13.12和16.29±11.15 cm3（P<0.001）。在基于GTVnx-MRI + FAPI20%的放疗计划中，与基于GTVnx-MRI的计划相比，所有OARs的受照剂量均未显著增加。
结论： 联合使用68Ga-FAPI PET/CT显示出增强NPC患者GTVnx勾画的潜力，同时使OAR剂量保持在可接受范围内。
英文摘要
BACKGROUND: Accurate delineation of the nasopharynx gross tumor volume (GTVnx) of nasopharyngeal carcinoma (NPC) is crucial for patients requiring radiotherapy, as it correlates with prognosis. Current GTVnx delineation methods have significant shortcomings, often resulting in insufficient coverage of the radiotherapy target area. Gallium-68-labeled fibroblast activation protein inhibitor (68Ga-FAPI) is an emerging and promising tumor imaging agent. This study aims to evaluate the effectiveness of combining 68Ga-FAPI positron emission tomography/computed tomography (PET/CT) for delineating GTVnx in NPC.
METHODS: This prospective study enrolled 19 patients with NPC who underwent 68Ga-FAPI PET/CT from August 2022 to August 2023. GTVnx were delineated, quantified, and compared based on enhanced magnetic resonance imaging (MRI), 68Ga-FAPI PET/CT, and the fusion of both imaging modalities, and were respectively named and abbreviated as GTVnx-MRI, GTVnx-FAPI, and GTVnx-MRI + FAPI. GTVnx-FAPI was automatically delineated using maximum standardized uptake value (SUVmax) thresholds, with the optimal threshold determined by the Jaccard index and intraclass correlation coefficient (ICC). Radiotherapy plans were developed based on GTVnx-MRI and GTVnx-MRI + FAPI to assess radiation doses to organs at risk (OARs). A paired t-test was employed to compare variables among groups.
RESULTS: Nineteen pathologically confirmed NPC patients [mean age, 48.84±12.12 years (range, 24-70 years); 12 men (63.16%)] were enrolled. All included NPC patients demonstrated high 68Ga-FAPI uptake in their primary tumor lesions. The 20% SUVmax on 68Ga-FAPI PET/CT of the primary tumor (GTVnx-FAPI20%) was determined to be the most suitable threshold for guiding GTVnx-FAPI with an ICC of 0.891. The GTVnx-MRI + FAPI20% was significant lager than both GTVnx-MRI and GTVnx-FAPI20%, with average measurements of 24.92±17.31, 17.44±13.12, and 16.29±11.15 cm3, respectively (P<0.001). In the radiotherapy plan based on GTVnx-MRI + FAPI20%, radiation dose to all OARs was not increased significantly compared to that based on GTVnx-MRI.
CONCLUSIONS: The combined use of 68Ga-FAPI PET/CT shows potential to enhance the delineation of GTVnx in NPC patients while maintaining OAR doses within acceptable limits.