Assessment of Al18F-NOTA-FAPI-04 PET/CT imaging for visualization and localization of ovarian and peritoneal endometriotic lesions in a rat model

Lijun Yin, Qianhe Xu, Ahmad Alhaskawi, Yongyi Yang, Jie Shi, Xinhui Zhou, Shi Feng, Yinying Zou, Guoliang Xie, Weihua He, Xinhui Su, Zhenfeng Liu, Zhongfan Liu, Hui Lü
In: Journal of Radiation Research and Applied Sciences · 2025 · vol. 18(3) , pp. 101679 · doi:10.1016/j.jrras.2025.101679 · W4411184693
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Al 18F-NOTA-FAPI-04 PET/CT effectively visualized and differentiated ovarian and peritoneal endometriotic lesions from normal tissues in a rat model.

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Abstract

Endometriosis, a prevalent chronic inflammatory gynecological disorder, is characterized by the ectopic implantation of functional endometrial tissue outside the uterine cavity and is increasingly recognized as a fibrotic condition. The fibroblast activation protein inhibitor ([ 18 F] FAPI) represents a novel radiotracer targeting fibroblast activation protein (FAP), demonstrating significant promise in imaging both benign and malignant pathologies. This study aimed to investigate the efficacy of [ 18 F] FAPI as a non-invasive tracer for detecting ovarian and peritoneal endometriosis. An endometriosis model was established in Sprague-Dawley rats via autologous transplantation of uterine endometrial tissue to the contralateral ovary and abdominal wall. Small-animal PET/CT imaging was performed 60 min post-injection of Al 18 F-NOTA-FAPI-04. Quantitative analysis revealed significantly higher tracer uptake in ovarian endometriotic lesions (OELs; SUV max = 2.53 ± 0.61) compared to adjacent non-lesional ovarian tissue (sOEL; 1.28 ± 0.46, P = 0.031) and contralateral ovarian tissue (CO; 1.15 ± 0.49, P = 0.016). Similarly, peritoneal endometriotic lesions (PELs) exhibited elevated uptake (SUV max = 1.74 ± 0.15) relative to surrounding peritoneal endometriotic lesions (sPEL; 0.97 ± 0.13, P = 0.001) and abdominal wall muscle (AWM; 0.83 ± 0.12, P = 0.0004). Histopathological and immunohistochemical analyses further validated the imaging findings. These results demonstrate that Al 18 F-NOTA-FAPI-04 PET/CT can effectively differentiate endometriotic lesions from normal tissues, highlighting its potential as a non-invasive diagnostic tool for endometriosis.

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