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Abstract
Introduction. The diagnostic advantage of the fibroblast activation protein inhibitor (FAPI) radiopharmaceutical ⁶⁸Ga-FAPI-04 over the well-established tumor-targeting agent ¹⁸F-FDG (¹⁸F-fluorodeoxyglucose) remains inadequately studied in small patient cohorts, with available literature data showing conflicting results.
Aim. To compare the diagnostic performance of 68Ga-FAPI-04 and ¹8F-FDG positron emission tomography/computed tomography (PET/CT) for detecting malignant tumors and their metastases.
Materials and Methods. The study included 66 patients (30 men, 36 women; median age 54 years [range 22–83]) with histologically confirmed malignant neoplasms of various localizations. PET/CT with both tracers (68Ga-FAPI-04 and 18F-FDG PET/CT) was performed before antitumor therapy in 34 patients (52 %) for initial staging and in 32 patients (48 %) for suspected recurrence or metastatic disease. The interval between scans did not exceed seven days.
Results. 68Ga-FAPI-04 demonstrated significantly higher sensitivity than ¹8F-FDG for detecting primary tumors and assessing disease extent (93.9 vs. 77.3 %; p = 0.006). Pathological 68Ga-FAPI-04 uptake was identified in 33/34 primary tumors (97.1 %) compared to 24/34 (70.6 %) with ¹8F-FDG. Total FAP-expressing tumor volume was significantly larger than metabolic tumor volume measured by ¹8F-FDG PET/CT (34.7 [11–75.66] vs. 11.07 [0–49.5]; p=0.021). 68Ga-FAPI-04 showed superior sensitivity for detecting bone (92.6 vs. 85.2 %; p=0.046) and liver metastases (90.2 vs. 68.3 %; p = 0.014). Although lymph node detection sensitivity was higher with 68Ga-FAPI-04 (81.1 vs. 73 %; p = 0.044), it remained size-dependent.
Conclusions. 68Ga-FAPI-04 PET/CT demonstrates superior sensitivity to ¹8F-FDG PET/CT for identifying primary tumors, recurrences, metastatic dissemination, and quantifying total tumor burden.
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