Enhancing restaging of a colorectal cancer patient: The advantage of [99mTc]Tc-FAPI-46 over conventional CT in detecting metastases

Document Type : Case Report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Science, Mashhad, Iran

2 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

 We report the case of a 73-year-old male with a history of colon adenocarcinoma, diagnosed 18 months prior. The patient underwent total colectomy and chemoradiotherapy 15 months previously. Due to recurrent abdominal pain, a metastatic workup was conducted utilizing both contrast-enhanced CT scan and [99mTc]Tc-FAPI-46 SPECT/CT. The latter imaging identified three metastatic lesions, while the contrast-enhanced CT scan detected only one peritoneal deposit. The two remaining metastases were small and hidden between the bowel loops and were not obvious on the conventional CT images. This case demonstrates that [99mTc]Tc-FAPI-46 SPECT/CT offers enhanced sensitivity for the detection of metastatic lesions in the post-operative patients with colorectal cancer when compared to conventional contrast-enhanced CT scans. The use of [99mTc]Tc-FAPI-46 SPECT/CT has the potential to significantly enhance the sensitivity of metastases detection, thereby influencing clinical decision-making in patients with colorectal cancer.

Keywords

Main Subjects


  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018 Jan;68(1):7-30.
  2. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D. ESMO guidelines working group. metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014 Sep;25 Suppl 3:iii1-9.
  3. Van Cutsem E, Verheul HM, Flamen P, Rougier P, Beets-Tan R, Glynne-Jones R, Seufferlein T. Imaging in colorectal cancer: progress and challenges for the clinicians. Cancers (Basel). 2016 Aug 31;8(9):81. 
  4. Caruso D, Polici M, Bellini D, Laghi A. ESR Essentials: Imaging in colorectal cancer-practice recommendations by ESGAR. Eur Radiol. 2024 Sep;34(9):5903-10. 
  5. van der Stok EP, Spaander MCW, Grünhagen DJ, Verhoef C, Kuipers EJ. Surveillance after curative treatment for colorectal cancer. Nat Rev Clin Oncol. 2017 May;14(5):297-315. 
  6. Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Farkas L, Garrido-Laguna I, Grem JL, Gunn A, Hecht JR, Hoffe S, Hubbard J, Hunt S, Johung KL, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Nurkin S, Overman MJ, Parikh A, Patel H, Pedersen K, Saltz L, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Gregory KM, Gurski LA. Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021 Mar 2;19(3):329-59.
  7. Neri E, Vagli P, Turini F, Cerri F, Faggioni L, Angeli S, Cini L, Bartolozzi C. Post-surgical follow-up of colorectal cancer: role of contrast-enhanced CT colonography. Abdom Imaging. 2010 Dec;35(6):669-75.
  8. Lee SS, Oh TS, Kim HJ, Chung JW, Park SH, Kim AY, Ha HK. Obscure gastrointestinal bleeding: diagnostic performance of multidetector CT enterography. Radiology. 2011 Jun;259(3):739-48. 
  9. Karaosmanoglu AD, Onur MR, Arellano RS. Imaging in gastrointestinal cancers. In: Yalcin S, Philip PA, editors. Textbook of gastrointestinal oncology. Springer International Publishing. 2019;445-64.
  10. Kwee RM, Kwee TC. Modern imaging techniques for preoperative detection of distant metastases in gastric cancer. World J Gastroenterol. 2015 Oct 7;21(37):10502-9.
  11. Herrera M, Islam AB, Herrera A, Martín P, García V, Silva J, Garcia JM, Salas C, Casal I, de Herreros AG, Bonilla F, Peña C. Functional heterogeneity of cancer-associated fibroblasts from human colon tumors shows specific prognostic gene expression signature. Clin Cancer Res. 2013 Nov 1;19(21):5914-26. 
  12. Mueller L, Goumas FA, Affeldt M, Sandtner S, Gehling UM, Brilloff S, Walter J, Karnatz N, Lamszus K, Rogiers X, Broering DC. Stromal fibroblasts in colorectal liver metastases originate from resident fibroblasts and generate an inflammatory microenvironment. Am J Pathol. 2007 Nov;171(5):1608-18. 
  13. Rupp C, Scherzer M, Rudisch A, Unger C, Haslinger C, Schweifer N, Artaker M, Nivarthi H, Moriggl R, Hengstschläger M, Kerjaschki D, Sommergruber W, Dolznig H, Garin-Chesa P. IGFBP7, a novel tumor stroma marker, with growth-promoting effects in colon cancer through a paracrine tumor-stroma interaction. Oncogene. 2015 Feb 12;34(7):815-25.
  14. Henry LR, Lee HO, Lee JS, Klein-Szanto A, Watts P, Ross EA, Chen WT, Cheng JD. Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007 Mar 15;13(6):1736-41.
  15. Altmann A, Haberkorn U, Siveke J. The latest developments in imaging of fibroblast activation protein. J Nucl Med. 2021 Feb;62(2):160-7. 
  16. Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, Adeberg S, Rathke H, Röhrich M, Winter H, Plinkert PK, Marme F, Lang M, Kauczor HU, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019 Jun;60(6):801-5. 
  17. Koerber SA, Staudinger F, Kratochwil C, Adeberg S, Haefner MF, Ungerechts G, Rathke H, Winter E, Lindner T, Syed M, Bhatti IA, Herfarth K, Choyke PL, Jaeger D, Haberkorn U, Debus J, Giesel FL. The Role of 68Ga-FAPI PET/CT for patients with malignancies of the lower gastrointestinal tract: first clinical experience. J Nucl Med. 2020 Sep;61(9):1331-6.
  18. Lin X, Li Y, Wang S, Zhang Y, Chen X, Wei M, Zhu H, Wu A, Yang Z, Wang X. Diagnostic value of [68Ga] Ga-FAPI-04 in patients with colorectal cancer in comparison with [18F] F-FDG PET/CT. Front Oncol. 2023 Jan 9;12:1087792.
  19. Cheng Z, Wang S, Xu S, Du B, Li X, Li Y. FAPI PET/CT in diagnostic and treatment management of colorectal cancer: review of current research status. J Clin Med. 2023 Jan 11;12(2):577.
  20. Kömek H, Can C, Kaplan İ, Gündoğan C, Kepenek F, Karaoglan H, Demirkıran A, Ebinç S, Güzel Y, Gündeş E. Comparison of [68 Ga] Ga-DOTA-FAPI-04 PET/CT and [18F] FDG PET/CT in colorectal cancer.  Eur J Nucl Med Mol Imaging. 2022 Sep;49(11):3898-909.
  21. Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, Sun L, Chen H. Comparison of 68Ga-FAPI and 18F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021 Feb;298(2):393-402. 
  22. Sun D, Ma L, Liu Y, Bao C, Jia G, Wang T, Wang Y. 99mTc-FAPI-04 SPECT/CT outperforms contrast-enhanced CT in detecting metastasis in postoperative patients with colorectal cancer. Front Med (Lausanne). 2024 Sep 23;11:1462870. 
  23. Jia X, Li X, Jia B, Yang Y, Wang Y, Liu Y, Ji T, Xie X, Yao Y, Qiu G, Deng H. The role of [99mTc] Tc-HFAPi SPECT/CT in patients with malignancies of digestive system: first clinical experience.  Eur J Nucl Med Mol Imaging. 2023 Mar;50(4):1228-39.