Evaluation of fibroinflammatory activity in thyroid eye disease using [18F]AlF-NOTA-FAPI-04 PET/CT: A prospective study

Hui Li; Yi Wang; Jichao Zhou; Debo You; Le Song; Meng Wang; Meixin Zhao; Chun Zhang; Yinghong Zhang; Yansong Lin; Huanwen Wu; Zhaofei Liu; Ningli Wang; Weifang Zhang; Lingge Suo

doi:10.1007/s00259-024-07015-y

Evaluation of fibroinflammatory activity in thyroid eye disease using [¹⁸F]AlF-NOTA-FAPI-04 PET/CT: A prospective study

Eur J Nucl Med Mol Imaging. 2024 Dec 13. doi: 10.1007/s00259-024-07015-y. Online ahead of print.

Authors

Hui Li^#¹, Yi Wang^#^{2

3}, Jichao Zhou^{2

3}, Debo You^{2

3}, Le Song¹, Meng Wang¹, Meixin Zhao¹, Chun Zhang^{2

3}, Yinghong Zhang⁴, Yansong Lin⁵, Huanwen Wu⁶, Zhaofei Liu^{1

7}, Ningli Wang⁸, Weifang Zhang⁹, Lingge Suo^{10

11}

Affiliations

¹ Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China.
² Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
³ Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
⁴ Department of Otorhinolaryngology, Peking University Third Hospital, Beijing, China.
⁵ Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China.
⁶ Department of Pathology, Peking Union Medical College Hospital, Beijing, China.
⁷ Department of Radiation Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
⁸ Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing , Beijing, China.
⁹ Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China. tsy1997@126.com.
¹⁰ Department of Ophthalmology, Peking University Third Hospital, Beijing, China. suolingge_1019@126.com.
¹¹ Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China. suolingge_1019@126.com.

^# Contributed equally.

PMID: 39671100
DOI: 10.1007/s00259-024-07015-y

Abstract

Purpose: This study evaluates the value of [¹⁸F]AlF-NOTA-FAPI-04PET/CT in assessing the disease activity of thyroid eye disease (TED).

Methods: Twenty-three TED patients and ten healthy controls were prospectively recruited and underwent [¹⁸F]AlF-NOTA-FAPI-04 PET/CT scans. TED eyes were classified by Clinical Activity Score (CAS) as active (CAS +) or inactive (CAS-). PET analysis included qualitative and quantitative evaluations. Qualitative analysis categorized TED eyes as positive (FAPI +) or negative (FAPI-), while quantitative analysis including SUVmax and target-to-backgroud ratio (TBR) of each extraocular muscle (EOM). Pathological assessment of 16 EOM samples from 15 TED eyes was used as a gold standard to evaluate the diagnostic accuracy of CAS-driven and FAPI-driven assessments.

Results: Eye-based analysis included 42 TED eyes and 20 control eyes. SUVmax did not differ significantly between CAS-/FAPI + (n = 8) and CAS + /FAPI + (n = 17) eyes; though both groups had significantly higher SUVmax than CAS-/FAPI- (n = 16), CAS + /FAPI- (n = 1), and control eyes (n = 20) (all P < .05). Diffuse high FAPI uptake with excellent TBR was observed in pathologically active EOMs and had higher SUVmax and TBR than inactive EOMs (SUVmax: 9.57 ± 2.79 vs. 4.04 ± 1.02, TBR: 2.99 ± 1.00 vs. 1.00 ± 0.35, both P < .001). An SUVmax cutoff value of 5.95 yielded an area under the receiver operating characteristic curve of 0.98 for predicting active disease. Sensitivity and specificity of CAS-driven and FAPI-driven assessments for TED activity were 72.7% and 100%, 100% and 100%, respectively. SUVmax positively correlated with pathological fibroinflammatory score (r = 0.68, P = .004).

Conclusion: The diffuse high FAPI uptake with excellent TBR in the EOMs could illustrate the activity of TED, positively correlated with pathological fibroinflammatory scores. These findings suggest that [¹⁸F]AlF-NOTA-FAPI-04 PET/CT may serve as a promising reliable non-invasive approach for assessing disease activity in TED, potentially superior to the CAS.

Keywords: Clinical activity score; Extraocular muscles; Fibroblast activation protein inhibitor; Thyroid eye disease.

Abstract

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