FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

Sophie E. M. Veldhuijzen van Zanten, Kay J. Pieterman, Bas P. L. Wijnhoven, Ilanah J. Pruis, Bas Groot Koerkamp, Lydi M. J. W. van Driel, Frederik A. Verburg, Maarten G. J. Thomeer

Research output: Contribution to journalReview articleAcademicpeer-review

9 Citations (Scopus)


Introduction: There is a pressing demand for the development of cancer-specific diagnostic imaging tools, particularly for staging of pancreatic-, gastric- or cholangiocarcinoma, as current diagnostic imaging techniques, including CT, MRI and PET using FDG, are not fully adequate. The novel PET-tracer “FAPI” has the potential to visualize even small tumour deposits employing the tumour-specific expression of fibroblast-activating protein (FAP) in malignant cells. Methods: We performed a systematic review to select studies investigating the use of FAPI PET for staging pancreatic-, gastric- and cholangiocarcinoma (PROSPERO CRD42022329512). Patient-wise and lesion-wise comparisons were performed for primary tumour (T), lymph nodes (N), organ metastases (M) and peritoneal carcinomatosis (PC). Maximum standardized uptake values (SUVmax) and tumour-to-background ratios (TBR) were compared between PET using FAPI versus FDG (if reported). Results: Ten articles met the inclusion criteria. In all studies, FAPI PET showed superiority over FDG-PET/CT/MRI for the detection of T, N, M and PC, both in the patient-wise and in lesion-wise comparisons (when performed). Additionally, higher SUVmax and TBRmax values were reported for use of FAPI compared to FDG. Conclusions: The positive results of this review warrant prospective clinical studies to investigate the accuracy and clinical value of FAPI PET for diagnosing and staging patients with pancreatic-, gastric- and cholangiocarcinoma.
Original languageEnglish
Article number1958
JournalDiagnostics (Basel, Switzerland)
Issue number8
Publication statusPublished - 1 Aug 2022


  • cholangiocarcinoma
  • diagnostic performance
  • gastric carcinoma
  • pancreatic carcinoma

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