68Ga-FAPI PET/CT与CECT检测卵巢癌腹膜转移比较
本研究回顾性纳入36例卵巢癌患者，比较[68Ga]Ga-FAPI PET/CT与增强CT对腹膜转移的诊断效能。结果显示FAPI PET/CT的病灶级敏感度显著高于增强CT，且22.22%的患者因此改变治疗方案。FAPI PET/CT对复发卵巢癌的诊断敏感度也高于CA125。
要点
- FAPI PET/CT在病灶层面检测腹膜转移敏感度高于增强CT，可用于提高分期准确性。
- 对可疑复发卵巢癌，FAPI PET/CT敏感度显著高于CA125，有助早期发现复发。
- FAPI PET/CT新增腹膜转移发现可致约五分之一患者改变治疗方案，阅片时需重点核查腹膜区域。
核心结论
- [68Ga]Ga-FAPI PET/CT在检测卵巢癌腹膜转移方面优于增强CT，并能辅助临床治疗决策。
研究设计与样本
- 回顾性纳入2022年4月至2025年6月间36例两周内同时接受[68Ga]Ga-FAPI PET/CT与增强CT的卵巢癌患者。
- 参考标准为组织病理学或影像学随访；新诊断5例，既往接受过治疗31例。
- 通过模拟多学科会诊评估[68Ga]Ga-FAPI PET/CT对治疗方案的影响。
关键影像表现/征象
- [68Ga]Ga-FAPI PET/CT检测的PCI区域数中位数为3（2,8），高于增强CT的2（1,5），P<0.001。
- [68Ga]Ga-FAPI PET/CT的PCI评分中位数为6（4,16.8），高于增强CT的5（2,11.5），P=0.002。
- 病灶层面分析显示[68Ga]Ga-FAPI PET/CT对腹膜转移检出敏感度为95.56%（43/45），增强CT为60%（27/45），P=0.003。
- 患者层面分析中[68Ga]Ga-FAPI PET/CT对淋巴结转移敏感度为94.44%（17/18），显著高于增强CT的61.11%（11/18），P=0.031。
- 22.22%（8/36）的患者因[68Ga]Ga-FAPI PET/CT结果改变治疗方案，其中19.44%（7/36）因新发现腹膜转移。
诊断标准与关键数值
- 病灶层面腹膜转移检出敏感度：[68Ga]Ga-FAPI PET/CT为95.56%（43/45），增强CT为60%（27/45），P=0.003。
- 患者层面淋巴结转移敏感度：[68Ga]Ga-FAPI PET/CT为94.44%（17/18），增强CT为61.11%（11/18），P=0.031。
- 复发卵巢癌诊断敏感度：[68Ga]Ga-FAPI PET/CT为96.43%（27/28），CA125为67.86%（19/28），P=0.008。
- PCI区域数中位数：[68Ga]Ga-FAPI PET/CT为3（2,8），增强CT为2（1,5），P<0.001。
- PCI评分中位数：[68Ga]Ga-FAPI PET/CT为6（4,16.8），增强CT为5（2,11.5），P=0.002。
临床应用与阅片要点
- 阅片时对腹膜区域应逐区评估，FAPI PET/CT较增强CT可发现更多腹膜转移区域，避免漏诊。
- 对CA125升高但常规影像阴性或不确定的患者，可考虑FAPI PET/CT以评估复发。
- FAPI PET/CT新发现的腹膜转移或淋巴结转移可能改变治疗决策，报告中应明确标注新发可疑病灶。
局限性
- 回顾性单中心研究设计，样本量较小（36例），结果有待前瞻性大样本验证。
- 参考标准为组织病理学或影像学随访，并非所有病灶均经病理证实。
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
PURPOSE: To explore the diagnostic value of [68Ga]Ga-FAPI PET/CT for peritoneal metastases in ovarian cancer and its impact on clinical decisions, in comparison to contrast-enhanced computed tomography (CECT).
METHODS: We retrospectively enrolled consecutive patients with ovarian cancer who underwent both [68Ga]Ga-FAPI PET/CT and CECT within two weeks between April 2022 and June 2025. Histopathology or imaging follow-up served as the reference. The peritoneal cancer index (PCI)-region and PCI score were evaluated between [68Ga]Ga-FAPI PET/CT and CECT. The diagnostic efficacy was evaluated by comparing analyses based on patients and lesions. The impact of [68Ga]Ga-FAPI PET/CT on treatment was examined via simulated multidisciplinary consultation. In addition, the differences in diagnostic performance of [68Ga]Ga-FAPI PET/CT, CECT, and carbohydrate antigen 125 (CA125) for suspected recurrent ovarian cancer were also compared.
RESULTS: Of the 36 patients, 5 patients were newly diagnosed and 31 patients had received prior treatment. The PCI-regions and PCI score of [68Ga]Ga-FAPI PET/CT were higher than CECT [median PCI-regions: 3 (2, 8) vs. 2 (1, 5), P < 0.001 and median PCI score: 6 (4, 16.8) vs. 5 (2, 11.5), P = 0.002]. [68Ga]Ga-FAPI PET/CT demonstrated higher sensitivity for detecting peritoneal metastases based on the lesion-based analysis [95.56% (43/45) vs. 60% (27/45), P = 0.003]. In the patient-based analysis, the sensitivity of [68Ga]Ga-FAPI PET/CT for lymph node metastases was significantly higher [94.44% (17/18) vs. 61.11% (11/18), P = 0.031]. Compared to CECT, [68Ga]Ga-FAPI PET/CT results prompted treatment modifications in 22.22% (8/36) of patients, with 19.44% (7/36) patients due to new findings of peritoneal metastases. The sensitivity of [68Ga]Ga-FAPI PET/CT was significantly different from that of CA125 in diagnosing recurrent ovarian cancer [96.43% (27/28) vs. 67.86% (19/28), P = 0.008].
CONCLUSION: [68Ga]Ga-FAPI PET/CT was superior to CECT for the detection of peritoneal metastases, which aids in guiding clinical decision-making.
引用
- Liu, Jing, Chen, et al. Comparison of [68Ga]Ga-FAPI PET/CT with CECT in the detection of peritoneal metastases from ovarian cancers and impact on clinical treatment decisions. Abdom Radiol (NY). 2026. PMID: 42240647. doi:10.1007/s00261-026-05583-1
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。