Molecular phenotyping with ¹⁸F-FDG and ¹⁸F-FAPI PET/CT: advancing risk stratification in in-stent restenosis.

Authors

Lei Jia, Ke Wang, Zhangyu Lin, Dong Yin, Wanjie Ren, Zongyao Zhang, Wei Fang, Lei Wang, Kefei Dou

Published in

European journal of nuclear medicine and molecular imaging. Jul 01, 2026. Epub Jul 01, 2026.

Abstract

To investigate the potential of ¹⁸F-FDG and ¹⁸F-FAPI PET/CT for characterizing the pathophysiological heterogeneity of in-stent stenosis (ISR) and to assess their ability to differentiate between its clinically subtypes.
This prospective study enrolled participants with ISR selected from a cohort registry between December 2024 to August 2025, which was categorized into rapid recurrent ISR (R-ISR) and ordinary ISR (O-ISR) based on recurrence time interval. For vessel-level analysis, coronary arteries without intervention served as control. All participants underwent both ¹⁸F-FDG and ¹⁸F-FAPI PET/CT to assess coronary uptake and evaluated the performance of maximum standardized uptake value (SUV_max) and maximum target-to-background ratio (TBR_max) in differentiating ISR from control vessels, as well as R-ISR from O-ISR. All patients were followed-up. The primary endpoint was a composite of cardiovascular death, target-vessel-related myocardial infarction, or target-vessel-related revascularization. Differences in the diagnostic performance of PET parameters and associations with outcomes were assessed.
Thirty-one participants and 84 vessels were included. ISR vessels (n = 39) demonstrated higher uptake in ¹⁸F-FDG and ¹⁸F-FAPI than control (n = 45). R-ISR exhibited higher uptake compared to O-ISR on both patient-level (TBR_max: ¹⁸F-FAPI, 4.10 ± 1.41 vs. 1.75 ± 0.50; ¹⁸F-FDG, 1.18 ± 0.32 vs. 0.86 ± 0.19) and vessel-level (TBR_max: ¹⁸F-FAPI, 4.07 ± 1.29 vs. 1.65 ± 0.50; ¹⁸F-FDG, 1.16 ± 0.31 vs. 0.90 ± 0.28) (all P ≤ 0.01). ¹⁸F-FAPI showed better diagnostic efficacy compared to ¹⁸F-FDG (AUC of TBR_max: 0.97 [0.92-1.00] vs. 0.75 [0.58-0.91], P = 0.01]. Six of 31 participants within R-ISR group reached the endpoint. Baseline PET uptake was associated with subsequent outcome (¹⁸F-FAPI SUV_max, HR, 2.28 [95%CI: 1.25-5.09], P = 0.02; ¹⁸F-FDG SUV_max, HR, 33.2 [95%CI: 4.93-509], P = 0.002).
¹⁸F-FAPI and ¹⁸F-FDG PET/CT reveals the molecular heterogeneity of ISR, with ¹⁸F-FAPI better identifying the rapid-recurrence subtype for advancing risk stratification.
NCT05437965. Registered 24 June 2022.

PMID:
42380497
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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