ArticleEuropean journal of nuclear medicine and molecular imaging2026
Real-world evidence in a large cohort comparing FAPI and FDG PET/CT for hepatopancreatobiliary cancer diagnosis.
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDiagnosing hepatopancreatobiliary (HPB) malignancies remains challenging. Conventional imaging often lacks sensitivity for occult nodal and distant metastases, and FDG PET/CT has variable performance due to low uptake in several tumour subtypes and false-positive uptake in inflammation. Fibroblast activation protein inhibitor (FAPI) PET/CT has emerged as a promising alternative. This study compared the diagnostic accuracy of FDG PET/CT, FAPI PET/CT, and a dual-tracer approach in suspected HPB malignancies.
methodsThis retrospective analysis included patients who underwent both [
results176 patients were included. FAPI PET/CT demonstrated higher sensitivity than FDG PET/CT (93.0% vs. 76.5%, p = 0.002). Primary tumour diagnostic accuracy was 78.9% for FAPI versus 68.3% for FDG (p = 0.021). A dual-tracer approach did not outperform FAPI (76.7% vs. 78.9%, p = 0.711). For nodal disease, FAPI showed 86.8% diagnostic accuracy, compared with 71.1% for FDG (p = 0.004), driven by higher specificity. For distant metastases, accuracy was 83.9% for FAPI versus 80.0% for FDG (p = 0.625).
conclusionFAPI PET/CT outperformed FDG PET/CT in this retrospective analysis, with dual-tracer imaging offering no additional benefits. These results show great promise for clinical application of FAPI PET/CT for the detection of HPB tumours and their metastases to be confirmed by independent prospective studies.
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