Evaluation of Intestinal Fibrosis with 68Ga-FAPI PET/MR Enterography in Crohn Disease

被引：31

作者：

Scharitzer, Martina ^{[1
]}

Macher-Beer, Andrea ^{[2
]}

Mang, Thomas ^{[1
]}

Unger, Lukas W. ^{[3
,4
]}

Haug, Alexander ^{[1
]}

Reinisch, Walter ^{[5
]}

Weber, Michael ^{[1
]}

Nakuz, Thomas ^{[1
]}

Nics, Lukas ^{[1
]}

Hacker, Marcus ^{[1
]}

Bergmann, Michael ^{[3
,4
]}

Rasul, Sazan ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Biomed Imaging & Image Guided Therapy, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[2] Med Univ Vienna, Dept Pathol, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[3] Med Univ Vienna, Dept Gen Surg, Div Visceral Surg, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[4] Med Univ Vienna, Ctr Comprehens Canc, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[5] Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria

来源：

RADIOLOGY | 2023年 / 307卷 / 03期

关键词：

FIBROBLAST ACTIVATION PROTEIN; SMALL-BOWEL; INFLAMMATION; STRICTURES; BIOMARKERS;

D O I：

10.1148/radiol.222389

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Background: In Crohn disease, differentiation between active intestinal inflammation and fibrosis has implications for treatment, but current imaging modalities are not reliably accurate. Purpose: To evaluate the predictive value of gallium 68 (Ga-68)-labeled fibroblast activation protein inhibitor (FAPI) PET/MR enterography for the assessment of bowel wall fibrosis in Crohn disease. Materials and Methods: In this prospective single-center study, consecutive participants with Crohn disease and obstructive symptoms underwent preoperative Ga-68-FAPI PET/MR enterography from May 2021 to January 2022. Histopathologic analysis of resected bowel segments was performed to grade active inflammation (A0-A2) and fibrosis (F0-F2), which served as the reference standard. The fibroblast activation protein (FAP) expression in bowel wall layers was analyzed immunohistochemically for each layer. Ga-68-FAPI-derived maximum standardized uptake value (SUVmax) was compared with histopathologic results by using mixed-model analysis of variance and Bonferroni-corrected post hoc tests. Results: In 14 participants (mean age, 45 years +/- 9 [SD]; 10 men), fibrosis was diagnosed histopathologically in 28 of 51 bowel segments (grade F1, n = 14; grade F2, n = 14). Mean SUVmax was higher in segments with fibrosis than without (7.6 vs 2.0; P <.001). In severe fibrosis, mean SUVmax was higher than in mild to moderate fibrosis (8.9 +/- 0.9 vs 6.2 +/- 0.9; P =.045). Bowel segments with isolated active inflammation had lower mean Ga-68-FAPI uptake than segments with combined active inflammation and fibrosis (SUVmax, 3.2 +/- 0.4 vs 8.1 +/- 0.1; P =.005). With an SUVmax cutoff value of 3.5, the area under the receiver operating characteristic curve for the prediction of fibrosis was 0.94 (95% CI: 0.9, 1.0), with sensitivity of 26 of 28 segments (93%) and specificity of five of six segments (83%). 68Ga-FAPI-derived SUVmax correlated with FAP expression across all bowel layers (R-2 = 0.50, P <.001). Conclusion: Higher gallium 68 fibroblast activation protein inhibitor uptake at PET/MR enterography was associated with histopathologically assessed bowel wall fibrosis in participants with Crohn disease, suggesting diagnostic potential for treatment decisions. (c) RSNA, 2023

引用

页数：10

共 32 条

[1] Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn's disease [J].