Purpose: This study aimed to assess the diagnostic performance of [¹⁸F]FAPI-42 PET/CT and compare it with that of 2-[¹⁸F]FDG PET/CT in patients with differentiated thyroid cancer (DTC) with biochemical elevations in Tg or anti-Tg antibodies. Methods: A total of 42 patients with DTC with biochemical elevations in Tg or anti-Tg antibodies underwent [¹⁸F]FAPI-42 PET/CT as part of this study; of which, 11 additionally underwent 2-[¹⁸F]FDG PET/CT within 7 days. Images were semi-quantitatively and visually interpreted, and the quantity, location, and uptake values of lesions were noted. The diagnostic capacity of [¹⁸F]FAPI-42 PET/CT and biomarkers affecting the uptake of [¹⁸F]FAPI-42 were evaluated. In addition, the diagnostic performance and uptake of [¹⁸F]FAPI-42 and 2-[¹⁸F]FDG were compared, and the correlation between lesion diameter and quantitative parameters was investigated. Results: A total of 161 lesions were detected in 27 (64%) patients on [¹⁸F]FAPI-42 PET/CT. FAPI-positive local recurrence showed the highest uptake intensity, followed by lymphatic, other site-associated (bone and pleura), and pulmonary lesions (mean SUV_max, 4.7 versus 3.7 versus 3.0 versus 2.2, respectively; P < 0.0001). The levels of TSH, Tg, and Tg-Ab did not affect the uptake value of lesions (median SUV_max: 2.4 versus 3.2, P = 0.56; 2.9 versus 2.4, P = 0.0935; 2.8 versus 2.6, P = 0.0525, respectively). A total of 90 positive lesions were detected in 7 patients using both modalities. All positive lesions showed statistically higher uptake of 2-[¹⁸F]FDG than that of [¹⁸F]FAPI-42 (SUV_max, 2.6 versus 2.1; P = 0.026). However, the SUV_max of [¹⁸F]FAPI-42 was higher than that of 2-[¹⁸F]FDG in local recurrences and lymphatic lesions (SUV_max, 4.2 versus 2.9 and 3.9 versus 3.4, respectively; P > 0.05). Conclusion: [¹⁸F]FAPI-42 can be used for detecting lesions and reflecting FAP expression during local recurrence and metastasis in patients with DTC with biochemical elevations in Tg or anti-Tg antibodies. The diagnostic performance of [¹⁸F]FAPI-42 PET/CT is comparable with that of 2-[¹⁸F]FDG PET/CT in such patients.

Purpose This study assesses the reliability of deep learning models based on planar whole-body bone scintigraphy for diagnosing Skull base invasion (SBI) in nasopharyngeal carcinoma (NPC) patients. Methods In this multicenter study, a deep learning model was developed using data from one center with a 7:3 allocation to training and internal test sets, to diagnose SBI in patients newly diagnosed with NPC using planar whole-body bone scintigraphy. Patients were diagnosed based on a composite reference standard incorporating radiologic and follow-up data. Ten different convolutional neural network (CNN) models were applied to both whole-image and partial-image input modes to determine the optimal model for each analysis. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration, decision curve analysis (DCA), and compared with expert assessments by two nuclear medicine physicians. Results The best-performing model using partial-body input achieved AUCs of 0.80 (95% CI: 0.73, 0.86) in the internal test set, 0.84 (95% CI: 0.77, 0.91) in the external cohort, and 0.78 (95% CI: 0.73, 0.83) in the treatment test cohort. Calibration curves and DCA confirmed the models’ excellent discrimination, calibration, and potential clinical utility across internal and external datasets. The AUCs of both nuclear medicine physicians were lower than those of the best-performing deep learning model in external test set (AUC: 0.75 vs. 0.77 vs. 0.84). Conclusion Deep learning models utilizing partial-body input from planar whole-body bone scintigraphy demonstrate high discriminatory power for diagnosing SBI in NPC patients, surpassing experienced nuclear medicine physicians.

This study aimed to assess the biodistribution, detection rate, and uptake of the [¹⁸F]FAPI-42 at two distinct time intervals. This prospective study enrolled 60 consecutive patients (median age 59; range 35–74) referred to [¹⁸F]FAPI-42 PET/CT. [¹⁸F]FAPI-42 PET/CT was performed early and late timepoint after tracer injection for staging or restaging. Positive lesions specified for anatomic locations (primary or recurrent tumor, LN metastasis and other metastasis) by visual analysis at both timepoints. Semiquantitative analysis of the tracer activity in lesions as well as normal tissues at both time points were measured and compared. In a subgroup analysis, eleven patients underwent 2-[¹⁸F]FDG PET/CT within 1 week, the detection rate and uptake of lesion were compared between early [¹⁸F]FAPI-42 and 2-[¹⁸F]FDG. Uptake of [¹⁸F]FAPI-42 in the late timepoint was significantly lower than the early timepoint in most organs (all p < 0.05), except for bone (SUV_mean 0.88 vs. 0.85; p = 0.218). Tracer retention at biliary system showed less frequent at early timepoint than late timepoint. A total of 194 lesions were detected in 60 patients. One lesion was only seen at early timepoint but not at late timepoint. Lesions on early [¹⁸F]FAPI-42 PET/CT had higher visual score than that of late image(23 vs. 6). The uptake of lesion decreased significantly from early to late timepoint (all p < 0.05). In subgroup analysis, early [¹⁸F]FAPI-42 illustrated higher detection rate, visual score, and uptake of lesion than that of 2-[¹⁸F]FDG PET/CT. Early [¹⁸F]FAPI-42 PET/CT provided consistent detection rates and lesion uptake, but less tracer retention in the biliary system compared to late images. Therefore, acquisition at early timepoint could be a feasible strategy for improving acquisition protocols of [¹⁸F]FAPI-42 PET/CT. Trial registration: ChiCTR2200063441. Registered 28 September 2022—Retrospectively registered, https://www.chictr.org.cn/bin/project/edit?pid=149714.

A 16-year-old woman presented with an acute headache on the left side. A head CT scan revealed bone destruction in the skull. Subsequent ¹⁸F-FDG and ¹⁸F-FAPI PET/CT scans were performed within a week. The ¹⁸F-FDG PET/CT indicated mild uptake in the regions of bone destruction, whereas the ¹⁸F-FAPI PET/CT displayed significant tracer accumulation. The patient was ultimately diagnosed with fibrous dysplasia.