Related Experiment Video For Clinical staging
Updated: Jun 4, 2026
Multianimal Magnetic Resonance Imaging for Tumor Measurements in Pancreatic Cancer Mouse Models
Published on: February 3, 2026
[18F]AlF-NOTA-FAPI-04 PET/CT outperforms contrast-enhanced CT and contrast-enhanced MRI in clinical staging
Lili Lin1, Shuye Yang1, Wenxin Wang1
1Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Objectives:
Contrast-enhanced CT (CE-CT) and MRI (CE-MRI) are routine examinations for staging of pancreatic cancer (PC). This study aimed to directly compare the diagnostic performance of the novel [18F]AlF-NOTA-FAPI-04 PET/CT against these established modalities for initial clinical staging.
Methods:
A total of 127 patients with initial PC who had simultaneously undergone [18F]AlF-NOTA-FAPI-04 PET/CT, CE-CT and CE-MRI were enrolled in this retrospective study. Their clinical features and imaging data were evaluated and staged according to TNM classification. Histopathological findings or follow-up data or multidisciplinary team (MDT) discussion served as the reference standard for the final diagnosis.
Results:
For primary tumor (T) staging, CE-CT and CE-MRI demonstrated equivalent performance and outperformed [18F]AlF-NOTA-FAPI-04 PET/CT across all T stages except T1c. However, the PET/CT modality achieved significantly higher sensitivity, accuracy, and negative predictive value for both nodal (N) and distant metastasis (M) staging (all p < 0.05). It changed the N stage in 26 patients, altering management in 5 (3.93%), and revised the M stage in 16 and 18 patients compared to CE-CT and CE-MRI, respectively, leading to major treatment changes in 15 (11.81%) and 17 (13.38%) patients. A SUVmax cutoff of 4.85 for lymph node metastasis provided moderate sensitivity (67.1%) and high specificity (93.7%).
Conclusion:
[18F]AlF-NOTA-FAPI-04 PET/CT outperforms CE-CT and CE-MRI in evaluating N and M staging except T staging in initial pancreatic cancer, leading to a more accurate clinical staging and a more rational therapeutic decision-making. [18F]AlF-NOTA-FAPI-04 PET/CT should be considered a useful diagnostic tool for initial staging of pancreatic cancer.
