Potential of Dual-Phase 68Ga-FAPI PET/CT in the Differential Diagnosis of Focal Liver Lesions
A. A. Ivanova,
D. V. Ryzhkova,
K. E. Sanarova,
I. O. Rutkin,
A. A. Stanzhevskii,
A. A. Maystrenko,
D. N. Maystrenko https://doi.org/10.24884/1607-4181-2026-33-1-75-83
Abstract
Introduction. Recent studies have confirmed the effectiveness of positron emission tomography combined with computed tomography (PET/CT) using radiolabeled ligands of fibroblast activation protein inhibitors (FAPI) for the visualization of malignant lesions (ML) and benign lesions (BL).
The objective was to evaluate the diagnostic utility of dual-phase PET/CT with 68Ga-FAPI-04 in patients with focal liver lesions of varying etiology.
Methods and materials. The study enrolled 62 patients with focal liver lesions of diverse etiologies for the purpose of differential diagnosis (20/62 patients) and pretreatment staging (42/62 patients). 68Ga-FAPI-04 PET/CT imaging was performed in two phases: Phase I (PET/CT20) – imaging began 20 minutes after administration of 68Ga-FAPI-04 (limited to the abdominal region); Phase II (PET/CT60) – 60 minutes after injection, performed as a «Whole-body» scan. Image analysis included visual assessment and calculation of the maximum standardized uptake value (SUVmax) over the lesion areas.
Results. Comprehensive clinical and imaging evaluation identified a total of 128 focal liver lesions. At the early-phase PET/CT scan (PET/CT20), increased 68Ga-FAPI-04 uptake was observed in 109 of 128 lesions (85.2 %): 18 of 25 BL and 91 of 103 ML. A comparable uptake pattern was seen on the delayed-phase scan (PET/CT60): 18 of 25 BL and 93 of 103 ML.
Visual and quantitative analyses of dual-phase 68Ga-FAPI-04 PET/CT demonstrated no significant differences in sensitivity, specificity, and diagnostic accuracy between phase I and phase II for the differential diagnosis of focal liver lesions. Visual assessment yielded values of 88.3 %, 28 %, 76.6 % for phase I versus 90.3 %, 28 %, 78.1 % for phase II. Quantitative analysis of 68Ga-FAPI-04 uptake intensity in hepatic lesions showed corresponding values of 73.8 %, 64 %, 74.2 % for phase I and 68 %, 72 %, 71.6 % for phase II.
Conclusion: Elevated 68Ga-FAPI-04 uptake was observed in the majority of hepatic lesions during both early and delayed imaging phases, irrespective of lesion etiology. Given the absence of significant diagnostic gain between time points, dual-phase PET/CT acquisition appears unnecessary for differentiating the etiology of liver lesions. Quantitative assessment using SUVmax values contributes to improved specificity of 68Ga-FAPI-04 PET/CT in identifying malignant hepatic involvement.
About the Authors
A. A. Ivanova
Russian Scientific Center of Radiology and Surgical Technologies named after A. M. Granov
Russian Federation
Competing Interests:
Russian Federation
Ivanova Anna A., Cand. of Sci. (Med.), Head of the Department of Radioisotope Positron Emission Tomography, Radiologist
70, Leningradskaya str., Pesochny settlement, Saint Petersburg, 197758
Competing Interests:
The author declare no conflict of interest.
D. V. Ryzhkova
Almazov National Medical Research Centre; Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Ryzhkova Dariya V., Dr. of Sci. (Med.), Professor of the Russian Academy of Sciences, Head of the Department of Nuclear Medicine and Radiation Technologies with the Clinic of the Institute of Medical Education, Almazov National Medical Research Centre; Professor of the Department of Radiology and Radiation Medicine, Pavlov University
2, Akkuratova str., Saint Petersburg, 197341
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
The author declare no conflict of interest.
K. E. Sanarova
Almazov National Medical Research Centre; Saint Petersburg State Electrotechnical University «LETI» named after V. I. Ulyanov (Lenin)
Russian Federation
Competing Interests:
Russian Federation
Sanarova Kseniia E., Assistant of the Department of Biotechnical Systems, Saint Petersburg State Electrotechnical University «LETI» named after V. I. Ulyanov (Lenin); Senior Laboratory Assistant of the Department of Nuclear Medicine and Radiation Technologies with the Clinic of the Institute of Medical Education, Almazov National Medical Research Centre
2, Akkuratova str., Saint Petersburg, 19734
5, Professora Popova str., Saint Petersburg, 197022
Competing Interests:
The author declare no conflict of interest.
I. O. Rutkin
Russian Scientific Center of Radiology and Surgical Technologies named after A. M. Granov
Russian Federation
Competing Interests:
Russian Federation
Rutkin Igor O., Deputy Chief Physician for Surgery
70, Leningradskaya str., Pesochny settlement, Saint Petersburg, 197758
Competing Interests:
The author declare no conflict of interest.
A. A. Stanzhevskii
Russian Scientific Center of Radiology and Surgical Technologies named after A. M. Granov
Russian Federation
Competing Interests:
Russian Federation
Stanzhevskii Andrei A., Dr. of Sci. (Med.), Deputy Director for Scientific Work
70, Leningradskaya str., Pesochny settlement, Saint Petersburg, 197758
Competing Interests:
The author declare no conflict of interest.
A. A. Maystrenko
Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
Maystrenko Aleksey D., Cand. of Sci. (Med.), Cardiovascular Surgeon, Consulting and Diagnostic Center
2, Akkuratova str., Saint Petersburg, 197341
Competing Interests:
The author declare no conflict of interest.
D. N. Maystrenko
Russian Scientific Center of Radiology and Surgical Technologies named after A. M. Granov
Russian Federation
Competing Interests:
Russian Federation
Maystrenko Dmitry N., Dr. of Sci. (Med.), Director, Russian Scientific Center of Radiology and Surgical Technologies named after A. M. Granov
70, Leningradskaya str., Pesochny settlement, Saint Petersburg, 197758
Competing Interests:
The author declare no conflict of interest.
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For citations:
Ivanova A.A., Ryzhkova D.V., Sanarova K.E., Rutkin I.O., Stanzhevskii A.A., Maystrenko A.A., Maystrenko D.N. Potential of Dual-Phase 68Ga-FAPI PET/CT in the Differential Diagnosis of Focal Liver Lesions. The Scientific Notes of the Pavlov University. 2026;33(1):75-83. (In Russ.) https://doi.org/10.24884/1607-4181-2026-33-1-75-83
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