⁶⁸Ga-FAPI-46 PET/CT Versus ¹⁸F-FDG PET/CT for Pancreatic Cancer: A Feasibility Study

To evaluate the feasibility of ⁶⁸Ga-FAPI PET/CT in pancreatic cancer by comparing radiotracer uptake, lesion detection, and diagnostic value with ¹⁸F-FDG PET/CT.

Ten participants (seven male, three female; mean age 68 years) with suspected or confirmed pancreatic cancer underwent both ⁶⁸Ga-FAPI and ¹⁸F-FDG PET/CT. Imaging was assessed for uptake, lesion detection, and diagnostic usefulness as determined by clinicians.

Ten participants (seven male, three female; mean age 68 years) underwent imaging. Mean SUVmax of the primary lesion was higher for ⁶⁸Ga-FAPI compared with ¹⁸F-FDG in participants with an identifiable primary lesion (n = 9) (13.8 [range 6.2-19.6] vs. 7.0 [range 0.0-12.5]). ⁶⁸Ga-FAPI identified additional lesions in three participants, resulting in imaging-based upstaging in three cases. Clinicians considered FAPI more diagnostically useful in five participants and equivalent in the remainder, based on comparison of lesion detection, delineation, and staging impact. Increased uptake was also seen in areas of presumed inflammation. No adverse events were reported.

This feasibility study shows that ⁶⁸Ga-FAPI PET/CT is safe, demonstrates higher uptake than FDG, and can reveal additional lesions that influence staging. Imaging-based upstaging was observed in three participants, supporting further investigation of FAPI as a complementary tool in pancreatic cancer imaging. Larger prospective studies are needed to determine the clinical impact of ⁶⁸Ga-FAPI PET/CT in pancreatic cancer.