Purposes This study aimed to evaluate the diagnostic value of 18F-FAPI-04 PET/CT in unresectable hepatocellular carcinoma(uHCC) and with a comparative analysis against 18F-FDG PET/CT. Methods Patients with uHCC who underwent paired 18F-FDG and 18F-FAPI-04 PET/CT for pre-treatment staging or post-treatment restaging were retrospectively included. The two tracers were compared in terms of their ability to detect intrahepatic and extrahepatic lesions, including sensitivity, maximum standardized uptake value (SUVmax), and tumour-to-background ratio (TBR). Results Eighty-five patients (mean age: 53.9 ± 10.0 years) were included. In patient-based analysis, 18F-FAPI-04 showed higher intrahepatic lesion detection sensitivity (98.8% vs. 85.9%, P = 0.003) and lesion uptake than 18F-FDG (median maximum SUVmax:9.1 vs. 7.6, P = 0.028). Contrast enhanced CT/MRI(CECT/MR) demonstrated comparable sensitivity to 18F-FAPI-04 PET and superior to 18F-FDG PET (96.5% vs. 85.9%, P = 0.004). In lesion-based analysis, 18F-FAPI-04 demonstrated significantly higher sensitivity (89.5% vs. 57.1%, P < 0.001), intrahepatic lesion SUVmax, (median:6.5 vs. 3.7, P < 0.001) and TBR (median:3.4 vs. 1.7, P < 0.001) than 18F-FDG, but lower sensitivity than CECT/MR (89.5% vs. 96.2%, P < 0.001). Among organ transplant recipients, 18F-FDG showed superior sensitivity to 18F-FAPI-04 for detecting intrahepatic lesions (87.5% vs. 37.5%, P = 0.002). 18F-FDG had a higher detection rate of portal vein tumour thrombosis (PVTT) (95.7% vs. 43.5%, P = 0.002), lymph node metastasis (95.7% vs. 82.8%, P = 0.004), and lung metastasis (69.3% vs. 58.4%, P = 0.007).18F-FAPI-04 was significantly better than 18F-FDG in detecting peritoneal metastasis (100% vs. 69.6%, P = 0.016). According to 18F-FAPI-04 PET/CT, Barcelona Clinic Liver Cancer (BCLC) and China Liver Cancer (CNLC) staging were changed in 16 (18.8%) and 22 (25.9%) patients, respectively. Conclusions 18F-FAPI-04 exhibits significant diagnostic advantages in uHCC patients, particularly in the detection of intrahepatic lesions, peritoneal metastases, and better contrast compared with 18F-FDG. Among organ transplant recipients,18F-FDG may offer higher sensitivity than 18F-FAPI-04 for intrahepatic lesion detection. 18F-FDG outperforms 18F-FAPI-04 in identifying PVTT. The rational selection of these two tracers may improve the accuracy of clinical staging.

The diagnostic value of 18 F-FAPI-04 PET/CT in unresectable hepatocellular carcinoma: a head-to-head comparison with 18 F-FDG PET/CT

期刊论文
发表日期：

2025年9月22日

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Huanyu Gong,
Yong Cheng,
Qiang Li,
Yingjun He,
Qijun Cai,
Yongjin Tang,
Yulong Liu,
Lu Kuang,
Yingxin Li,
Jingjie Shang,
Chengzhi Li,
Kangshou Liu,
Mingrong Cao,
Lu Wang,
Xueying Ling,
Hao Xu

摘要

Purposes

This study aimed to evaluate the diagnostic value of ¹⁸F-FAPI-04 PET/CT in unresectable hepatocellular carcinoma(uHCC) and with a comparative analysis against ¹⁸F-FDG PET/CT.

Methods

Patients with uHCC who underwent paired ¹⁸F-FDG and ¹⁸F-FAPI-04 PET/CT for pre-treatment staging or post-treatment restaging were retrospectively included. The two tracers were compared in terms of their ability to detect intrahepatic and extrahepatic lesions, including sensitivity, maximum standardized uptake value (SUV_max), and tumour-to-background ratio (TBR).

Results

Eighty-five patients (mean age: 53.9 ± 10.0 years) were included. In patient-based analysis, ¹⁸F-FAPI-04 showed higher intrahepatic lesion detection sensitivity (98.8% vs. 85.9%, P = 0.003) and lesion uptake than ¹⁸F-FDG (median maximum SUV_max:9.1 vs. 7.6, P = 0.028). Contrast enhanced CT/MRI(CECT/MR) demonstrated comparable sensitivity to ¹⁸F-FAPI-04 PET and superior to ¹⁸F-FDG PET (96.5% vs. 85.9%, P = 0.004). In lesion-based analysis, ¹⁸F-FAPI-04 demonstrated significantly higher sensitivity (89.5% vs. 57.1%, P < 0.001), intrahepatic lesion SUV_max, (median:6.5 vs. 3.7, P < 0.001) and TBR (median:3.4 vs. 1.7, P < 0.001) than ¹⁸F-FDG, but lower sensitivity than CECT/MR (89.5% vs. 96.2%, P < 0.001). Among organ transplant recipients, ¹⁸F-FDG showed superior sensitivity to ¹⁸F-FAPI-04 for detecting intrahepatic lesions (87.5% vs. 37.5%, P = 0.002). ¹⁸F-FDG had a higher detection rate of portal vein tumour thrombosis (PVTT) (95.7% vs. 43.5%, P = 0.002), lymph node metastasis (95.7% vs. 82.8%, P = 0.004), and lung metastasis (69.3% vs. 58.4%, P = 0.007).¹⁸F-FAPI-04 was significantly better than ¹⁸F-FDG in detecting peritoneal metastasis (100% vs. 69.6%, P = 0.016). According to ¹⁸F-FAPI-04 PET/CT, Barcelona Clinic Liver Cancer (BCLC) and China Liver Cancer (CNLC) staging were changed in 16 (18.8%) and 22 (25.9%) patients, respectively.

Conclusions

¹⁸F-FAPI-04 exhibits significant diagnostic advantages in uHCC patients, particularly in the detection of intrahepatic lesions, peritoneal metastases, and better contrast compared with ¹⁸F-FDG. Among organ transplant recipients,¹⁸F-FDG may offer higher sensitivity than ¹⁸F-FAPI-04 for intrahepatic lesion detection. ¹⁸F-FDG outperforms ¹⁸F-FAPI-04 in identifying PVTT. The rational selection of these two tracers may improve the accuracy of clinical staging.