Superiority of FAPI-PET/CT for examining multiple malignant tumors: a retrospective study

To compare the diagnostic value of [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT and [¹⁸F]-FDG PET/CT for primary and metastatic lesions in different types of tumors. A retrospective analysis was conducted on 51 patients with 11 different types of tumors. Among them, 20 patients underwent PET/CT, and 31 patients underwent restaging. The patients were diagnosed using [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT and [¹⁸F]-FDG PET/CT scan techniques, and adverse reactions were recorded. Thickness of primary lesions, metastasis, and lymph node involvement were analyzed and confirmed by histological analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT and [¹⁸F]-FDG PET/CT were calculated. Neither [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT nor [¹⁸F]-FDG PET/CT scan techniques caused adverse reactions in the patients. [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT performed well in detecting recurrence, with a positive rate of 100%, higher than 71.0% of [¹⁸F]-FDG PET/CT. Compared with [¹⁸F]-FDG PET/CT, [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT identified 6 types of malignant tumors more clearly, and could improve the detection rate of primary and metastatic tumors (97.0% vs. 84.8%, P<0.001). [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT exhibited a higher sensitivity for detecting lymph node (81.8% vs. 50.0%, P<0.05) than [¹⁸F]-FDG PET/CT. Additionally, [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT demonstrated higher diagnostic sensitivity (67.39% vs. 58.7%, P=0.387) and accuracy (82.14% vs. 60.71%, P=0.377) for detecting metastatic lesions compared to [¹⁸F]-FDG PET/CT. [¹⁸F]-AlF-NOTA-FAPI-04 PET/CT outperforms [¹⁸F]-FDG PET/CT in diagnosing primary and metastatic lesions across various types of tumors, especially in identifying lymph node, visceral, and peritoneal metastases. It can improve diagnostic efficiency and accuracy, thereby positively influencing clinical decision-making for optimal patient management.