Clinical application of Al(18)F-NOTA-FAPI PET/CT in diagnosis and TNM staging of pancreatic adenocarcinoma, compared to (18)F-FDG

PURPOSE: This study aimed to investigate the ability of Al(18)F-NOTA-FAPI PET/CT to diagnose pancreatic carcinoma and tumor-associated inflammation with the comparison of (18)F-FDG PET/CT. METHODS: Prospective analysis of Al(18)F-NOTA-FAPI PET/CT and (18)F-FDG PET/CT scans of 31 patients from 05/2021 to 05/2022 were analyzed. Al(18)F-NOTA-FAPI imaging was performed in patients who had Ce-CT and FDG PET/CT and the diagnosis was still unclear. Follow-up histopathology or radiographic examination confirmed the findings. Radiotracer uptake, diagnostic performance, and TNM (tumor-node-metastasis) classifications were compared. RESULTS: A total of 31 patients with pancreatic carcinoma (all were adenocarcinoma) underwent Al(18)F-NOTA-FAPI-04 PET/CT, including 20 male and 11 female patients, with a mean age of 58.2 ± 8.5 years. FAPI-04 PET/CT imaging showed a higher value of SUV(max-15min/30min/60min), SUV(mean-15min/30min/60min), TBR(1), and TBR(2) in pancreatic carcinoma than FDG (all P < 0.01). The mean level of Al(18)F-NOTA FAPI-04 uptake values of the pancreatic ductal adenocarcinoma was higher than that of pancreatitis in both SUV(max-30min) (P < 0.01)(,) SUV(mean-30min) (P < 0.05), SUV(max-60min) (P < 0.01)(,) and SUV(mean-60min) (P < 0.01). The FAPI △SUV(max-1), △SUV(max-2), and △SUV(mean-2) uptake values of pancreatic carcinoma were higher than tumor-associated inflammation (all P < 0.01). TNM staging of 16/31 patients changed after Al(18)F-NOTA FAPI-04 PET/CT examination with all upstaging changes. CONCLUSION: Al(18)F-NOTA-FAPI-04 PET/CT at 15 and 30 min also demonstrated an equivalent detection ability of pancreatic lesion to (18)F-FDG PET/CT. Delayed-phase Al(18)F-NOTA-FAPI-04 PET/CT can help differentiate pancreatic carcinoma and tumor-associated inflammation. Al(18)F-NOTA FAPI-04 PET/CT also performed better than FDG PET/CT in TNM staging. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100051406. Registered 23 September 2021, https://www.chictr.org.cn/showproj.html?proj=133033