Assessing the Value of ⁶⁸Ga-FAPI PET/CT in Gastric Mucinous Adenocarcinoma or Signet Ring Cell Carcinoma

Purpose To investigate the clinical impact and prognostic value of gallium 68 (⁶⁸Ga)-labeled fibroblast activation protein inhibitor (FAPI) PET/CT in gastric mucinous adenocarcinoma (MAC) and signet ring cell carcinoma (SRCC). Materials and Methods Eighty-six participants with newly diagnosed or recurrent gastric MAC or SRCC were prospectively enrolled from April 2021 to October 2021 and underwent both fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) PET/CT and ⁶⁸Ga-FAPI PET/CT. The sensitivity, specificity, and accuracy of the two scans in primary and metastatic tumors were evaluated using the McNemar test. Changes of treatment strategies were recorded to compare the treatment management value of the two PET/CT scans. The maximum standardized uptake value (SUV_max) and peritoneal cancer index (PCI) were recorded for survival analysis. Progression-free survival (PFS) was defined as the time interval from the date of PET/CT scans to the date of disease progression. Results Eighty-six participants (median age, 62 years [IQR, 45-78 years]; 49 female) were evaluated. ⁶⁸Ga-FAPI PET/CT showed higher diagnostic accuracy in detecting involved lymph nodes (87% [212 of 244] vs 71% [173 of 244], <i>P</i> < .001) and peritoneal metastases (96% [70 of 73] vs 55% [40 of 73], <i>P</i> < .001) than ¹⁸F-FDG PET/CT. Twenty-six participants (30% [26 of 86]) had treatment changes due to more accurate diagnosis with ⁶⁸Ga-FAPI PET/CT. Additionally, the ⁶⁸Ga-FAPI PCI was an independent predictor for PFS (hazard ratio, 6.9; 95% CI: 2.1, 23.1; <i>P</i> = .002). Conclusion ⁶⁸Ga-FAPI PET/CT had higher accuracy in diagnosis of gastric MAC/SRCC compared with ¹⁸F-FDG PET/CT and demonstrated the potential to improve treatment strategies and predict prognosis. <b>Keywords:</b> PET/CT, Mucinous Adenocarcinoma, Signet Ring Cell Carcinoma, Oncology, Abdomen/GI, Molecular Imaging <i>Supplemental material is available for this article.</i> © RSNA, 2024.