Evaluating the diagnostic performance of [F]ALF-NOTA-FAPI-04 PET/CT in gastric cancer: a comparative study with [F]FDG PET/CT.

PURPOSE

To compare the diagnostic value of [F]ALF-NOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) and F-fluorodeoxyglucose (FDG) PET/CT in gastric cancer.

METHODS

This single-center retrospective analysis included 65 patients with gastric cancer who received both [F]FDG and [F]ALF-NOTA-FAPI-04 PET/CT for initial staging or restaging. Histopathological manifestations, typical imaging manifestations, follow-up imaging, and comprehensive clinical assessment were used as reference criteria. The uptakes of [F]FDG and [F]ALF-NOTA-FAPI-04 PET were compared using the Wilcoxon signed-rank test. McNemar's test was employed to compare the diagnostic performance of the two imaging techniques.

RESULTS

A total of 65 patients were included (26 male and 39 female; mean age, 54.03 ± 10.41 years), Among them, 10 were newly diagnosed, 46 underwent radical gastrectomy, and 9 received only chemotherapy prior to the study. Compared with [F]FDG PET/CT, [F]ALF-NOTA-FAPI-04 PET/CT showed higher sensitivity in primary or recurrent tumors (100% vs. 64.52%, p < 0.001)), lymph node metastases (88.89% vs. 38.89%, p = 0.006), distant metastases (91.18% vs. 50%, p < 0.001). From the semi-quantitative evaluation, the Maximum standardized uptake value (SUVmax) and target-to-background ratio of [F]ALF-NOTA-FAPI-04 PET/CT were significantly higher than that of [F]FDG PET/CT in primary or recurrent tumors, lymph node metastases, and distant metastases (all p < 0.001).

CONCLUSION

Our study results indicate that [F]ALF-NOTA-FAPI-04 PET/CT outperforms [F]FDG PET/CT in the detection of primary or recurrent tumors, lymph node metastasis, and distant metastasis in gastric cancer.

KEY POINTS

Question Early diagnosis and precise staging of gastric cancer are crucial for patient prognosis; however, current imaging techniques still face significant limitations. Findings [F]ALF-NOTA-FAPI-04 PET/CT demonstrated significantly higher sensitivity than [F]FDG PET/CT in detecting primary or recurrent tumors and metastases in patients with gastric cancer. Clinical relevance [F]ALF-NOTA-FAPI-04 PET/CT is an advanced imaging diagnostic technique that significantly enhances the diagnostic accuracy for gastric cancer and its metastatic lesions. This technology provides robust support for clinical decision-making, thereby improving the management of patients with gastric cancer.