Per-Lesion Radiomics Analysis of 68Ga-DOTA FAPI-46 and 18F-FDG PET/CT in Non-Small Cell Lung Cancer: A pilot Study

Setareh Hasanabadi; Maryam Cheraghi; Hossein Behnam Manesh; Mohadeseh Bayat; Mehrdad Bakhshayesh Karam; Andrea Corsi; Yazdan Salimi; Mohammad Saber Azimi; Abtin Doroudinia; Arezu Karami; Hossein Arabi

arXiv · 2511.08812

Per-Lesion Radiomics Analysis of 68Ga-DOTA FAPI-46 and 18F-FDG PET/CT in Non-Small Cell Lung Cancer: A pilot Study

Setareh Hasanabadi·Maryam Cheraghi·Hossein Behnam Manesh·Mohadeseh Bayat·Mehrdad Bakhshayesh Karam·Andrea Corsi·Yazdan Salimi·Mohammad Saber Azimi·Abtin Doroudinia·Arezu Karami·Hossein Arabi

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Abstract

This pilot study compares per-lesion radiomics features of [68Ga]-DOTA FAPI-46 and [18F]-FDG PET/CT in non-small cell lung cancer (NSCLC) to explore complementary insights into intratumoral heterogeneity beyond conventional SUV metrics, aiming to enhance lesion characterization and clinical decision-making. A total of 28 PET/CT scans (14 [18F]-FDG and 14 [68Ga]-DOTA FAPI-46) were acquired for the initial staging of biopsy-confirmed NSCLC. A total of 81 co-localized lesions (lung: 21, mediastinal lymph nodes: 42, bone: 18) were segmented, with radiomics features extracted via PyRadiomics after IBSI-compliant preprocessing. Paired per-lesion comparisons used t-tests or Wilcoxon signed-rank tests with Benjamini-Hochberg FDR correction. Significant differences (adjusted P < 0.05) were identified across intensity, texture, and shape features. In lung lesions, FAPI showed lower first-order metrics but higher variance and GLCM contrast, suggesting stromal heterogeneity. Mediastinal lymph nodes had fewer differences, with FAPI exhibiting lower run percentage (GLRLM: -0.298, -6.196, P=1.45E-08). Bone lesions showed extensive variations, including reduced FAPI entropy (e.g., Entropy: -1.743, -5.798, P=6.95E-08). Feature overlaps highlighted complementary stromal (FAPI) and metabolic (FDG) insights. This pilot study demonstrates that per-lesion radiomics can capture complementary biological information from FAPI and FDG PET in NSCLC, highlighting intratumoral heterogeneity and stromal activity not fully appreciated by conventional SUV-based metrics.

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Setareh Hasanabadi, Maryam Cheraghi, Hossein Behnam Manesh, Mohadeseh Bayat, Mehrdad Bakhshayesh Karam, Andrea Corsi, Yazdan Salimi, Mohammad Saber Azimi, Abtin Doroudinia, Arezu Karami, Hossein Arabi. 2025-11-11. Per-Lesion Radiomics Analysis of 68Ga-DOTA FAPI-46 and 18F-FDG PET/CT in Non-Small Cell Lung Cancer: A pilot Study. https://arxiv.org/abs/2511.08812

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