{
  "abstract": "Purpose: Diagnosing hepatopancreatobiliary (HPB) malignancies remains challenging. Conventional imaging often lacks sensitivity for occult nodal and distant metastases, and FDG PET/CT has variable performance due to low uptake in several tumour subtypes and false-positive uptake in inflammation. Fibroblast activation protein inhibitor (FAPI) PET/CT has emerged as a promising alternative. This study compared the diagnostic accuracy of FDG PET/CT, FAPI PET/CT, and a dual-tracer approach in suspected HPB malignancies.\n\nMethods: This retrospective analysis included patients who underwent both [18F]FDG and [68Ga]Ga-FAPI-46 PET/CT for suspected HPB cancer, including cholangiocarcinoma, gallbladder carcinoma, pancreatic carcinoma, periampullary carcinoma, and hepatocellular carcinoma. Histopathology and/or clinical follow-up served as reference standard. FDG PET/CT classification used an SUVmax cut-off derived from receiver-operating characteristic analysis, while FAPI PET/CT classification followed expert clinical interpretation. Sensitivity, specificity, and accuracy metrics were compared using paired statistics.\n\nResults: 176 patients were included. FAPI PET/CT demonstrated higher sensitivity than FDG PET/CT (93.0% vs. 76.5%, p = 0.002). Primary tumour diagnostic accuracy was 78.9% for FAPI versus 68.3% for FDG (p = 0.021). A dual-tracer approach did not outperform FAPI (76.7% vs. 78.9%, p = 0.711). For nodal disease, FAPI showed 86.8% diagnostic accuracy, compared with 71.1% for FDG (p = 0.004), driven by higher specificity. For distant metastases, accuracy was 83.9% for FAPI versus 80.0% for FDG (p = 0.625).\n\nConclusion: FAPI PET/CT outperformed FDG PET/CT in this retrospective analysis, with dual-tracer imaging offering no additional benefits. These results show great promise for clinical application of FAPI PET/CT for the detection of HPB tumours and their metastases to be confirmed by independent prospective studies.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08112-w.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nuclear Medicine, Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India",
    "Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands",
    "Rotterdam, 3015 GD The Netherlands",
    "Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands",
    "Department of Gastroenterology, Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India",
    "Department of Artificial Intelligence, Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India",
    "Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Suneetha Batchu",
      "orcid": "0009-0001-9241-6702"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Mara M.K. Veenstra",
      "orcid": "0000-0002-2562-8377"
    },
    {
      "affs": [
        3
      ],
      "name": "David M. de Jong",
      "orcid": "0000-0001-5068-8227"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohan Roop Jayanthi",
      "orcid": "0000-0003-0163-231X"
    },
    {
      "affs": [
        1
      ],
      "name": "Erik Vegt",
      "orcid": "0000-0001-7456-2258"
    },
    {
      "affs": [
        4
      ],
      "name": "Sana F. Memon",
      "orcid": "0000-0002-7929-4464"
    },
    {
      "affs": [
        5
      ],
      "name": "Abhishek Tyagi",
      "orcid": "0000-0002-0743-3824"
    },
    {
      "affs": [
        1,
        6
      ],
      "name": "Daniel Bos",
      "orcid": "0000-0001-8979-2603"
    },
    {
      "affs": [
        4
      ],
      "name": "Sundeep Lakhtakia",
      "orcid": "0000-0001-7562-8060"
    },
    {
      "affs": [
        3
      ],
      "name": "Marco J. Bruno",
      "orcid": "0000-0001-9181-5499"
    },
    {
      "affs": [
        4
      ],
      "name": "D. Nageshwar Reddy",
      "orcid": "0000-0001-7540-0496"
    },
    {
      "affs": [
        4
      ],
      "name": "Hardik Rughwani",
      "orcid": "0000-0001-7579-9986"
    },
    {
      "affs": [
        1
      ],
      "name": "Maarten G.J. Thomeer",
      "orcid": "0000-0003-4205-259X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7j9vv546wn3n3.bib",
  "cited_by": 0,
  "doi": "10.1007/s00259-026-08112-w",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13727803/",
  "id": "7j9vv546wn3n3",
  "issns": [
    "1619-7070",
    "1619-7089"
  ],
  "landing_url": "https://doi.org/10.1007/s00259-026-08112-w",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2730|Peptidase Inhibition and Analysis"
    ]
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  "openalex": "W7202297477",
  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s00259-026-08112-w.pdf",
  "pmcid": "PMC13727803",
  "pmid": "42584480",
  "published": "2026-08-12",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7j9vv546wn3n3.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:23:37Z",
      "native_id": "PMC13727803",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s00259-026-08112-w"
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  "subjects": [
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      "field": "medicine",
      "origin": "openalex:2730|Peptidase Inhibition and Analysis",
      "subfield": "oncology"
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  ],
  "title": "Real-world evidence in a large cohort comparing FAPI and FDG PET/CT for hepatopancreatobiliary cancer diagnosis",
  "title_text": "Real-world evidence in a large cohort comparing FAPI and FDG PET/CT for hepatopancreatobiliary cancer diagnosis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:55Z",
  "url": "https://research.draconitic.com/paper/7j9vv546wn3n3",
  "venue": "European Journal of Nuclear Medicine and Molecular Imaging",
  "versions": []
}