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However, diagnostic performance of conventional computed tomography in BC prior to radical cystectomy (RC) remains unsatisfactory. There is an increased interest in evaluating <jats:sup>18<\/jats:sup>F-FAPI PET\/CT for hybrid imaging due to their logistical advantages compared to [<jats:sup>68<\/jats:sup>Ga]Ga-based FAPI tracers in clinical routine. Recently, the potential diagnostic value of [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 PET\/CT was demonstrated in BC. Thus, we aimed to examine the diagnostic performance of [<jats:sup>18<\/jats:sup>F]F-FAPI- 74 and [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 PET\/CT for preoperative evaluation of locoregional lymph node metastases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Fifty-one patients underwent FAPI PET\/CT with either [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 (<jats:italic>n<\/jats:italic>\u2009= 23) or [<jats:sup>18<\/jats:sup>F]F-FAPI- 74 (<jats:italic>n<\/jats:italic>\u2009= 28) prior to RC and PLND. SUV<jats:sub>max<\/jats:sub>, SUV<jats:sub>mean<\/jats:sub> and the ratio between the SUV<jats:sub>max<\/jats:sub> of lymph nodes and the SUV<jats:sub>mean<\/jats:sub> of the background (SUV<jats:sub>max_lymph node<\/jats:sub>\/SUV<jats:sub>mean<\/jats:sub>_<jats:sub>background<\/jats:sub>) were assessed. Additionally, short axis diameter (SAD) for a representative lymph node were documented in each lymph node region (<jats:italic>n<\/jats:italic>\u2009= 123) and compared to histopathological findings. Each scan was interpreted visually and quantitatively. ROC-analyses were performed to determine cut-off values with highest diagnostic accuracy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>20\/123 (16.3%) lymph node regions showed UC lymph node metastases. Histopathologically positive lymph nodes were associated with a significantly higher FAPI uptake compared to negative lymph nodes regarding SUV<jats:sub>max<\/jats:sub>, SUV<jats:sub>mean<\/jats:sub> values and SUV<jats:sub>max_lymph node<\/jats:sub>\/SUV<jats:sub>mean<\/jats:sub>_<jats:sub>background<\/jats:sub> ratios. Visual analysis based on FAPI uptake showed a sensitivity and specificity, PPV and NPV of 63.6%, 95.8%, 77.7%, and 92.0% for [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 and 55.5%, 98.1%, 83.3%, and 93.1% for [<jats:sup>18<\/jats:sup>F]F-FAPI- 74, respectively. ROC analysis revealed an optimal cut-off for SUV<jats:sub>max<\/jats:sub>, SUV<jats:sub>mean<\/jats:sub> and SUV<jats:sub>max_lymph node<\/jats:sub>\/SUV<jats:sub>mean<\/jats:sub>_<jats:sub>background<\/jats:sub> of 1.35, 1.20 and 5.95 for [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 and 1.55, 1.25 and 4.15 for [<jats:sup>18<\/jats:sup>F]F-FAPI- 74 to discriminate between histopathologically proven lymph node metastases and non-malignant lymph nodes resulting for example using SUV<jats:sub>max<\/jats:sub> in a sensitivity and specificity, PPV and NPV of 81.8%, 89.5%, 64.2%, 95.5% for [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46 and 100%, 81.8%, 47.3%, 100% for [<jats:sup>18<\/jats:sup>F]F-FAPI- 74, respectively. CT visual analysis of locoregional lymph nodes showed a sensitivity, specificity, PPV and NPV of 30.0%, 97.0%, 66.6% and 87.7%, respectively. ROC analysis regarding SAD revealed a cutoff at 0.8 cm with a sensitivity, specificity, PPV and NPV of 75.0%, 84.4%, 48.3%, 94.5%, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Overall, FAPI PET imaging shows a significantly higher sensitivity than CT analysis for detection of locoregional lymph node metastases in UC. [<jats:sup>18<\/jats:sup>F]F-FAPI- 74 demonstrates a comparable diagnostic performance compared to [<jats:sup>68<\/jats:sup>Ga]Ga-FAPI- 46. Of note, the quantitative analysis with a pre-defined SUV<jats:sub>max<\/jats:sub> as well as SUV<jats:sub>mean<\/jats:sub> values, and SUV<jats:sub>max_lymph node<\/jats:sub>\/SUV<jats:sub>mean<\/jats:sub>_<jats:sub>background<\/jats:sub> ratio-based cut-offs provided a higher sensitivity compared to visual assessment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00259-025-07239-6","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T03:29:45Z","timestamp":1745465385000},"page":"3963-3974","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["68Ga-FAPI and 18F-FAPI PET\/CT for detection of nodal metastases prior radical cystectomy in high-risk urothelial carcinoma patients"],"prefix":"10.1007","volume":"52","author":[{"given":"Lena M.","family":"Unterrainer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1259-358X","authenticated-orcid":false,"given":"Hans P.","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie C.","family":"Kunte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Holzgreve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Toms","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Menold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens C.","family":"Cyran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Karl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Tschirdewahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan T.","family":"Ledderose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennert","family":"Eismann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Tamalunas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Scheifele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian G.","family":"Stief","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Unterrainer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jozefina","family":"Casuscelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald B.","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"issue":"1","key":"7239_CR1","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.eururo.2020.03.055","volume":"79","author":"JA Witjes","year":"2021","unstructured":"Witjes JA, et al. 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Unterrainer reports funding from Bayerisches Zentrum f\u00fcr Krebsforschung (BZKF) and from the Munich Clinician Scientist Program (MCSP). She reports fees from Novartis (speaker), Telix (consultant) and Astellas Pharma Inc. (speaker) outside of the submitted work. Johannes Toms reports funding from the Friedrich-Baur-Stiftung, which was used to establish the radiosynthesis of [18F]F-FAPI- 74 for clinical use. Stephan T. Ledderose reports funding from Bayerisches Zentrum f\u00fcr Krebsforschung (BZKF).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}