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@ARTICLE{Bartel:306359,
      author       = {T. Bartel$^*$ and K. M. Pabst$^*$ and C. Barg$^*$ and C. A.
                      Berliner$^*$ and R. Hamacher$^*$ and S. Bauer$^*$ and J.
                      Falkenhorst$^*$ and L. Kessler$^*$ and M. Nader$^*$ and F.
                      Barbato$^*$ and J. Siveke$^*$ and K. Herrmann$^*$ and W. P.
                      Fendler$^*$},
      title        = {[68{G}a]{G}a-{FAPI}-46 {PET}/{CT} of {P}atients with
                      {G}astrointestinal {S}tromal {T}umors in {C}omparison to
                      2-[18{F}]{FDG} {PET}/{CT} and {C}ontrast-{E}nhanced {CT}:
                      {R}esults from a {P}rospective {O}bservational {S}tudy.},
      journal      = {Journal of nuclear medicine},
      volume       = {nn},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2025-02571},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Gastrointestinal stromal tumors (GISTs) are the most common
                      mesenchymal neoplasms of the gastrointestinal tract.
                      Although contrast-enhanced CT (ceCT) and 2-[18F]FDG PET/CT
                      remain standard imaging modalities, both exhibit limitations
                      in detecting small peritoneal metastases and tumors with low
                      metabolic activity. 68Ga-labeled fibroblast activation
                      protein inhibitors (FAPIs) have shown promising results in
                      various malignancies; however, comparative data on GISTs are
                      limited. This study aimed to assess the diagnostic
                      performance of [68Ga]Ga-FAPI-46 PET/CT in comparison with
                      2-[18F]FDG PET/CT and ceCT, including evaluation of
                      interreader reproducibility and clinical impact. Methods:
                      This study retrospectively reviewed 25 patients with
                      histopathologically confirmed GISTs undergoing
                      [68Ga]Ga-FAPI-46 PET/CT as part of a prospective
                      observational study (NCT04571086). All patients (n = 25)
                      underwent additional clinical 2-[18F]FDG PET/CT; ceCT was
                      performed for 23 of 25 patients. Imaging was assessed per
                      patient and per region (primary tumor, lymph nodes, and
                      visceral and bone metastases), and a composite reference
                      standard that included histopathology, follow-up imaging,
                      and clinical data was applied. Interreader agreement,
                      stratified by experience level, was analyzed using Cohen κ
                      (κCohen). Referring physicians completed questionnaires
                      before and after imaging to determine clinical impact.
                      Results: In total, 28 validated regions (n = 20 patients)
                      were included in the diagnostic efficacy analysis. Per
                      region, ceCT and [68Ga]Ga-FAPI-46 PET/CT demonstrated
                      comparable sensitivity $(83\%$ vs. $81\%),$ followed by
                      2-[18F]FDG PET/CT $(65\%).$ [68Ga]Ga-FAPI-46 PET/CT
                      demonstrated the highest region-based positive predictive
                      value $(100\%).$ The liver tumor-to-background ratio was
                      significantly higher for [68Ga]Ga-FAPI-46 PET/CT than for
                      2-[18F]FDG PET/CT (median, 7.6 vs. 5.9; P = 0.034), whereas
                      overall tumor uptake showed no significant difference.
                      Changes in clinical management attributable to
                      [68Ga]Ga-FAPI-46 PET/CT were observed for 6 of 24 patients
                      $(25\%),$ including 1 major change. Interreader agreement
                      for [68Ga]Ga-FAPI-46 PET/CT varied with reader experience,
                      showing the highest concordance between high- and
                      intermediate-experience readers (κCohen = 0.87 per patient
                      and 0.47-1.00 across regions), whereas comparisons involving
                      less experienced readers yielded lower agreement (κCohen =
                      0.00-0.60). Conclusion: [68Ga]Ga-FAPI-46 PET/CT demonstrated
                      diagnostic sensitivity comparable to ceCT and superior to
                      2-[18F]FDG PET/CT for patients with GISTs. High diagnostic
                      performance, especially in hepatic and peritoneal
                      metastases, and relevant clinical impact support a role for
                      [68Ga]Ga-FAPI-46 PET/CT as complementary imaging modality.},
      keywords     = {2-[18F]FDG PET/CT (Other) / GIST (Other) / [68Ga]Ga-FAPI-46
                      PET/CT (Other) / detection efficacy (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41266252},
      doi          = {10.2967/jnumed.125.270850},
      url          = {https://inrepo02.dkfz.de/record/306359},
}