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Histopathological manifestations, typical imaging manifestations, follow-up imaging, and comprehensive clinical assessment were used as reference criteria. The uptakes of [\n 18<\/jats:sup>\n F]FDG and [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET were compared using the Wilcoxon signed-rank test. McNemar\u2019s test was employed to compare the diagnostic performance of the two imaging techniques.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 65 patients were included (26 male and 39 female; mean age, 54.03\u2009\u00b1\u200910.41 years), Among them, 10 were newly diagnosed, 46 underwent radical gastrectomy, and 9 received only chemotherapy prior to the study. Compared with [\n 18<\/jats:sup>\n F]FDG PET\/CT, [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET\/CT showed higher sensitivity in primary or recurrent tumors (100% vs. 64.52%,\n p<\/jats:italic>\n \u2009<\u20090.001)), lymph node metastases (88.89% vs. 38.89%,\n p<\/jats:italic>\n \u2009=\u20090.006), distant metastases (91.18% vs. 50%,\n p<\/jats:italic>\n \u2009<\u20090.001). From the semi-quantitative evaluation, the Maximum standardized uptake value (SUVmax) and target-to-background ratio of [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET\/CT were significantly higher than that of [\n 18<\/jats:sup>\n F]FDG PET\/CT in primary or recurrent tumors, lymph node metastases, and distant metastases (all\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Our study results indicate that [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET\/CT outperforms [\n 18<\/jats:sup>\n F]FDG PET\/CT in the detection of primary or recurrent tumors, lymph node metastasis, and distant metastasis in gastric cancer.\n <\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n Question<\/jats:italic>\n <\/jats:bold>\n Early diagnosis and precise staging of gastric cancer are crucial for patient prognosis; however, current imaging techniques still face significant limitations.<\/jats:italic>\n <\/jats:p>\n \n \n Findings<\/jats:italic>\n <\/jats:bold>\n [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET\/CT demonstrated significantly higher sensitivity than [\n 18<\/jats:sup>\n F]FDG PET\/CT in detecting primary or recurrent tumors and metastases in patients with gastric cancer.\n <\/jats:p>\n \n \n Clinical relevance<\/jats:italic>\n <\/jats:bold>\n [\n 18<\/jats:sup>\n F]ALF-NOTA-FAPI-04 PET\/CT is an advanced imaging diagnostic technique that significantly enhances the diagnostic accuracy for gastric cancer and its metastatic lesions. This technology provides robust support for clinical decision-making, thereby improving the management of patients with gastric cancer.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00330-024-11219-z","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T20:27:55Z","timestamp":1732739275000},"page":"3314-3323","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Evaluating the diagnostic performance of [18F]ALF-NOTA-FAPI-04 PET\/CT in gastric cancer: a comparative study with [18F]FDG PET\/CT"],"prefix":"10.1007","volume":"35","author":[{"given":"Jinghui","family":"Lv","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengzhi","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5804-4344","authenticated-orcid":false,"given":"Yanyin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"11219_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 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