{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T09:08:46Z","timestamp":1787994526821,"version":"build-2784847793"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum D\u00fcsseldorf. Anstalt \u00f6ffentlichen Rechts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["EJNMMI Rep."],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n The roll-out of FAP (fibroblast-activation-protein) imaging with small-molecule PET tracers marks one of the major breakthroughs in nuclear medicine. The majority of current evidence, however, has been generated by\n 68<\/jats:sup>\n Ga-labelled FAPI tracers, a reliance that presents serious economical and logistic challenges to the oncological community. Hence, current research focuses on development of\n 18<\/jats:sup>\n F-labelled FAPI tracers to overcome the limitations of\n 68<\/jats:sup>\n Ga-labelling. [\n 18<\/jats:sup>\n F]AlF-FAPI-74, a recently introduced radiotracer, emerges as a promising candidate to fulfill those unmet clinical needs. This single-center, exploratory study sought to investigate the biodistribution and tumor uptake of [\n 18<\/jats:sup>\n F]AlF-FAPI-74 across various tumor entities in a head-to-head comparison with [\n 18<\/jats:sup>\n F]FDG imaging.\n <\/jats:p>\n <\/jats:sec>\n \n Material and method<\/jats:title>\n \n A total of 19 patients (15 males and 4 females) were enrolled in this prospective study with a head-to-head analysis of [\n 18<\/jats:sup>\n F]FAPI-74 and [\n 18<\/jats:sup>\n F]FDG PET\/CT imaging between May 2021 and January 2024. According to inclusion criteria, patients underwent PET\/CT scans, when they had either a biopsy-proven or highly suspected malignancy with a prior FDG imaging, or highly suspected or proven recurrence by clinical or other imaging findings or therapy monitoring after neoadjuvant or also palliative radiochemotherapy. All patients had histologically proven malignancies of pancreatic adenocarcinoma (PDAC) in 8 patients, soft tissue sarcoma (STS) in 6 patients, colorectal carcinoma (CRC) in 4 patients and gastric carcinoma in 1 patient. The mean injected activity for [\n 18<\/jats:sup>\n F]FAPI-74 and [\n 18<\/jats:sup>\n F]FDG PET\/CT was 239 MBq (\u00b1\u200957) and 209 MBq (\u00b1\u200974) and the mean uptake time was 72\u00a0min (\u00b1\u200910) and 73\u00a0min (\u00b1\u200917), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n [\n 18<\/jats:sup>\n F]AlF-FAPI-74 demonstrated superior imaging characteristics compared to [\n 18<\/jats:sup>\n F]FDG, identifying a greater number of both primary and metastatic lesions across all tumor entities. Our SUV-metrics analysis revealed more favorable results for the detection of primary lesions with [\n 18<\/jats:sup>\n F]FAPI-74 imaging (e.g. SUV\n max<\/jats:sub>\n \u00b1 SD, 9.79\u2009\u00b1\u20094.2 vs. 6.41\u2009\u00b1\u20092.8, [\n 18<\/jats:sup>\n F]FAPI-74 vs. [\n 18<\/jats:sup>\n F]FDG, respectively), whereas only the TBR in relation to blood pool appeared to be statistically significant (5.08 vs. 3.15 (p: 0.03); [\n 18<\/jats:sup>\n F]FAPI-74 vs. [\n 18<\/jats:sup>\n F]FDG, respectively). We observed a similar tendency in the analysis of SUV-metrics (e.g. SUV\n max<\/jats:sub>\n \u00b1 SD, 7.42\u2009\u00b1\u20092.8 vs. 6.18\u2009\u00b1\u20092.7, [\n 18<\/jats:sup>\n F]FAPI-74 vs. [\n 18<\/jats:sup>\n F]FDG, respectively) in metastatic lesions as well.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In this prospective, exploratory study cohort, [\n 18<\/jats:sup>\n F]FAPI-74 appeared to display more favorable imaging characteristics such as lesion contrast and delineation compared with [\n 18<\/jats:sup>\n F]FDG. Given the advantages of\n 18<\/jats:sup>\n F-labeling, [\n 18<\/jats:sup>\n F]FAPI-74 warrants further investigation with larger cohorts to determine its diagnostic potential and clinical impact.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s41824-026-00295-7","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T23:01:54Z","timestamp":1772751714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The analysis of biodistribution and tumor uptake of [18F]AlF-FAPI-74 in patients with soft tissue sarcoma and gastro-intestinal tumors compared with [18F]FDG in a prospective, exploratory study"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1914-1332","authenticated-orcid":false,"given":"Emil","family":"Novruzov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik L.","family":"Giesel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduards","family":"Mamlins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Watabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Cardinale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Antke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuriko","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Schupps","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Soza-Ried","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Fernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio","family":"Amaral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasko","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Badinez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"295_CR6","doi-asserted-by":"publisher","first-page":"2480493","DOI":"10.1155\/2023\/2480493","volume":"2023","author":"JN Crane","year":"2023","unstructured":"Crane JN, Graham DS, Mona CE, Nelson SD, Samiei A, Dawson DW et al (2023) Fibroblast activation protein expression in sarcomas. 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Salvador 364, Santiago, Chile). The ethics approval was issued on 19 June 2020 with the protocol number of CEC SSM Oriente\/19062020. The study was carried out in accordance with the ethical standards of the institutional and\/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Oral and written informed consent for the enrollment to study were obtained from all patients on an individual-patient basis following national regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Oral and written informed consent for the publication of the study results were obtained from all patients on an individual-patient basis following national regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"FLG has a patent application for quinolone-based FAP-targeting agents for imaging and therapy in nuclear medicine and holds shares of a consultancy group for iTheranostics. FLG is also an advisor at ABX, Telix, Alpha Fusion and SOFIE Biosciences. The other authors declare no conflict of interest regarding this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"8"}}