PET imaging of tissue reactions in the implanted cochlea: results of a pilot study

Purpose: After cochlear implantation, molecular processes at the electrode-nerve interface significantly influence the variability in clinical outcomes. The present study investigates molecular processes in a guinea pig model of cochlear implant (CI) using positron emission tomography/computed tomography (PET/CT) and correlates the imaging findings with histological analyses. Methods: Ga]FAPI-46 as a marker for fibrosis. Tracer accumulation in the cochlea was determined from PET imaging based on the co-registered CT. Nine animals (seven with unilateral CI) were included. Uptake in non-implanted cochleae served as reference. Tissue growth around the implant was evaluated histologically. Results: Ga]FAPI-46 uptake was increased inside the cochlear. Cochlear volumes measured by CT did not show significant differences between compared groups. Tissue growth around the implant was observed in all animals, with a trend toward increased growth associated with insertion depth. However, no clear correlation was observed between the extent of tissue growth and the uptake intensities of FDG and FAPI. Discussion: The data indicate that increased accumulation of PET biomarkers in the cochlea after implantation can be detected in guinea pigs using a dedicated PET/CT. Given the high resolution of current clinical PET/CT devices, this method is expected to be suitable for use in patients, particularly for assessing the effect of anti-inflammatory or anti-fibrotic therapies.