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Updated: Jun 12, 2026
![An Automated Radiosynthesis of [68Ga]Ga-FAPI-46 for Routine Clinical Use](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F66708.jpg&w=3840&q=50)
An Automated Radiosynthesis of [68Ga]Ga-FAPI-46 for Routine Clinical Use
Published on: May 24, 2024
Complementary roles of 68Ga-FAPI and 18 F-FDG PET/CT in evaluating IgG4-related disease: a systematic review and
Xue Cai1, Qin Wang2, Qingfan Hao3
1Department of Nuclear Medicine, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, No.16 Daling Road, Shiyan, 442008, China.
Background:
IgG4-related disease (IgG4-RD) lacks standardized imaging criteria. This study systematically reviewed head-to-head comparisons of 68Ga-FAPI and 18F-FDG PET/CT to clarify their complementary roles in diagnosing and staging IgG4-RD.
Main Body:
Three high-quality studies (n = 90) were pooled. 68Ga-FAPI showed significantly higher SUVmax and target-to-background ratios (TBR) in parenchymal organs (pancreas, salivary glands) vs. 18F-FDG (P < 0.001), offering superior lesion contrast. While 18F-FDG detected more lymph node activity, 68Ga-FAPI identified 136 vs. 78 total lesions, improving systemic burden assessment. Pathology correlated FAPI with fibrosis and FDG with inflammation, defining a "flip-flop" pattern. A FAPI/FDG ratio ≥ 1.5 predicted relapse risk.
Conclusion:
68Ga-FAPI excels in parenchymal organ involvement, while FDG highlights inflammatory lymphadenopathy. Combining both tracers enables multimodal evaluation of fibroinflammatory activity, guiding personalized management and prognostication in IgG4-RD.
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