Objective To compare Al18F-1,4,7-trizacyclononane-1,4,7-triacetic acid(NOTA)-fibroblast activation protein inhibitor(FAPI)-04 PET/CT with 18F-FDG PET/CT in the evaluation of pa-tients with initial gastric cancer.Methods Twenty patients(13 males,7 females,age:27-77 years)with histologically proven gastric cancer were recruited prospectively between March 2021 and July 2022 in the First Affiliated Hospital of Zhengzhou University.Each patient underwent both 18F-FDG and Al18F-NOTA-FAPI-04 PET/CT within one week.SUVmax,tumor background ratio(TBR)and positive detection rate of the two methods were compared(Wilcoxon signed rank sum test,McNemar x2 test).Results Al18F-NOTA-FAPI-04 showed higher SUVmax and TBR than those of 18F-FDG in primary tumors(10.2(8.0,13.7)vs 5.2(3.3,7.7),z=-3.47,P=0.001;7.6(5.6,10.3)vs 2.4(1.8,3.0),z=-3.85,P＜0.001).For the detec-tion of primary gastric cancer,the positive detection rate of Al18F-NOTA-FAPI-04 PET/CT showed the trend of being higher than that of 18F-FDG PET/CT(95％(19/20)and 75％(15/20);x2=2.25,P=0.125).For assessing lymph node metastasis,the detection rate of Al18F-NOTA-FAPI-04 PET/CT was higher than that of 18F-FDG PET/CT(78.9％(101/128)vs 64.8％(83/128);x2=13.47,P＜0.001).The SUVmax and TBR of Al18F-NOTA-FAPI-04 in lymph node were higher than those of 18F-FDG(5.3(3.5,9.2)vs 2.8(1.8,4.7),z=-7.31,P＜0.001;4.6(2.6,6.5)vs 1.7(1.0,3.0),z=-8.44,P＜0.001).For the detection of per-itoneal carcinomatosis,Al18 F-NOTA-FAPI-04 PET/CT showed higher peritoneal cancer index(PCI),SUVmax,and TBR compared to 18F-FDG PET/CT(PCI:12.0(3.0,29.8)vs 5.5(0.5,17.5),z=-2.22,P=0.026;SUVmax:8.2(4.4,12.5)vs 2.7(1.9,4.0);z=-2.52,P=0.012;TBR:5.1(2.9,13.3)vs 1.1(0.9,2.0);z=-2.52,P=0.012).Conclusion A118F-NOTA-FAP1-04 PET/CT outperforms 18F-FDG PET/CT in primary and metastatic lesions of gastric cancer and might be a potential novel modality for imaging pa-tients with gastric cancer.
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