18F-FAPI-42 PET/MR评估小（≤3 cm）肝脏病变的初步研究
18F-FAPI-42 PET的敏感度和准确率显著高于18F-FDG PET，尤其对≤1 cm病灶；18F-FAPI-42 PET/MR改变了20.0%患者的临床管理。
要点
- 18F-FAPI-42 PET对≤3 cm肝病灶敏感度97.6%、准确率96.9%，优于18F-FDG PET。
- 对≤1 cm病灶，18F-FAPI-42 PET敏感度96.6%、准确率96.8%，优势更明显。
- 18F-FAPI-42 PET/MR改变了20.0%患者的临床管理。
核心结论
- 18F-FAPI-42 PET/MR提高了以小转移灶为主的小肝病灶诊断敏感度和准确率，尤其≤1 cm病灶，可能成为一站式解决方案。
研究设计与样本
- 患者均行18F-FDG和18F-FAPI-42 PET/MR，记录SUVmax和TBR。
- 以组织病理学或影像学随访为参考标准，按病灶大小分层比较各成像集的诊断效能。
关键影像表现/征象
- 18F-FAPI-42与18F-FDG的SUVmax相当（5.08 ± 0.50 vs. 5.58 ± 0.39，P > 0.05）。
- 18F-FAPI-42的TBR显著高于18F-FDG（6.90 ± 0.49 vs. 2.43 ± 0.16，P < 0.001）。
诊断标准与关键数值
- 病灶分析显示18F-FAPI-42 PET敏感度97.6% vs. 18F-FDG PET 72.9%（P = 0.023），准确率96.9% vs. 75.0%（P = 0.021）。
- 对≤1 cm病灶，18F-FAPI-42 PET敏感度96.6% vs. 66.1%（P = 0.038），准确率96.8% vs. 68.3%（P = 0.042）。
- MRI诊断效能较低，而18F-FAPI-42 PET、18F-FDG PET/MR和18F-FAPI-42 PET/MR均显示更高敏感度和准确率，尤其对≤1 cm病灶（P < 0.05）。
临床应用与阅片要点
- 对小肝病灶（尤其≤1 cm）阅片时，可优先关注18F-FAPI-42 PET的高TBR特征以提高检出敏感度。
- 18F-FAPI-42 PET/MR可能改变患者临床管理，报告时应结合PET与MR信息综合判断。
局限性
- 原文未报告多中心验证及更大队列的结果。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: To evaluate the diagnostic performance of 18F-fibroblast activation protein inhibitor (FAPI)-42 PET/MR for small (≤3 cm) hepatic lesions and to compare it with MRI and 18F-fluorodeoxyglucose (FDG) PET/MR.
MATERIALS AND METHODS: This prospective study enrolled patients with suspected hepatic malignancies who underwent both 18F-FDG and 18F-FAPI-42 PET/MR. The maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) were recorded. Using histopathology or radiologic follow-up as reference standard, diagnostic performance was compared across imaging sets stratified by lesion size.
RESULTS: Twenty-five patients (17 males; median age 57.2 years) with 96 lesions were enrolled. SUVmax was comparable between 18F-FAPI-42 and 18F-FDG (5.08 ± 0.50 vs. 5.58 ± 0.39, P > 0.05), whereas TBR was significantly higher for 18F-FAPI-42 (6.90 ± 0.49 vs. 2.43 ± 0.16, P < 0.001). Lesion-based analysis showed that 18F-FAPI-42 PET exhibited higher sensitivity (97.6% vs. 72.9%, P = 0.023) and accuracy (96.9% vs. 75.0%, P = 0.021) than 18F-FDG PET, particularly for lesions ≤1 cm (96.6% vs. 66.1%, P = 0.038; 96.8% vs. 68.3%, P = 0.042). MRI showed lower diagnostic performance, while 18F-FAPI-42 PET, 18F-FDG PET/MR and 18F-FAPI-42 PET/MR all demonstrated superior sensitivity and accuracy, especially for lesions ≤1 cm (P < 0.05, all). In addition, 18F-FAPI-42 PET/MR altered clinical management in 20.0% of patients.
CONCLUSIONS: 18F-FAPI-42 PET/MR improved diagnostic sensitivity and accuracy for small hepatic lesions with predominant metastatic involvement, particularly those ≤1 cm. 18F-FAPI-42 PET/MR may represent a promising one-stop solution for small hepatic lesions.
引用
- Yang Y, Wang D, Zhou B, et al. 18F-FAPI-42 PET/MR for the Evaluation of Small (≤3 cm) Hepatic Lesions: A Preliminary Study. Acad Radiol. 2026. PMID: 42177146. doi:10.1016/j.acra.2026.04.047
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。