The comparative utility of FAPI-based PET radiotracers over [F]FDG in the assessment of malignancies

Document Type

Article

Publication Title

American journal of nuclear medicine and molecular imaging

Abstract

Fibroblast activation protein (FAP) is a type II transmembrane serine protease overexpressed in cancer-associated fibroblasts (CAFs) and has been associated with poor prognosis. PET/CT imaging with radiolabeled FAP inhibitors (FAPI) is currently being studied for various malignancies. This review identifies the uses and limitations of FAPI PET/CT in malignancies and compares the advantages and disadvantages of FAPI and F-fluorodeoxyglucose ([F]FDG). Due to high uptake, rapid clearance from the circulation, and limited uptake in normal tissue, FAPI tumor-to-background contrast ratios are equivalent to or better than [F]FDG in most applications. In several settings, FAPI has shown greater uptake specificity than [F]FDG and improved sensitivity in detecting lymph node, bone, and visceral tissue metastases. Therefore, FAPI PET/CT may be complementary in distinguishing pathological lesions with conventional imaging, determining the primary site of malignancy, improving tumor staging, and detecting disease recurrence, especially in patients with inconclusive [F]FDG PET/CT findings. Nevertheless, FAPI has limitations, including certain settings with non-specific uptake, modified uptake with age and menopause status, challenges with clinical access, and limited clinical evidence.

First Page

190

Last Page

207

DOI

10.62347/JXZI9315

Publication Date

1-1-2024

Identifier

39309420 (pubmed); PMC11411191 (pmc); 10.62347/JXZI9315 (doi)

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