{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:44:44Z","timestamp":1791585884108,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Radiolabeled fibroblast activation protein (FAP) ligands, a novel class of tracers for PET\/CT imaging, have demonstrated very promising results in various oncological, as well as in some benign, diseases with long-term potential to supplant the current pan-cancer agent [18F]FDG in some cancer types. Pancreatic ductal carcinoma (PDAC) belongs to the group of epithelial malignancies with a strong so-called \u201cdesmoplastic reaction\u201d, leading to a prominent tumor stroma with cancer-associated fibroblasts that exhibit a marked overexpression of fibroblast activation protein (FAP). The first clinical experiences in PDAC with 68Ga-labeled FAP ligands suggested superior sensitivity to [18F]FDG. However, there is limited data with 18F-labeled FAP derivatives, i.e. [18F]FAPI-74, yet prospective single- and multicenter trials are already ongoing. In this proof-of-concept study, we sought to evaluate the biodistribution, tumor uptake, and lesion detectability in patients with PDAC using [18F]FAPI-74 PET\/CT as compared to [18F]FDG PET\/CT scans for staging. Methods: This study includes 7 patients (median age 69) who underwent both [18F]FDG PET\/CT with contrast-enhancement and [18F]FAPI-74 PET with low-dose CT for primary staging (n = 3) and therapy response control after neoadjuvant (n = 1) or re-staging after palliative therapy (n = 3). The mean interval between PET scans was 11 \u00b1 4 days (range 1\u201315 days). The [18F]FDG and [18F]FAPI-74 PET\/CT scans were acquired at 64 \u00b1 4.1 min (range 61\u201391 min) and 66.4 \u00b1 6.3 min (range 60\u201376 min), respectively, after administration of 200 \u00b1 94 MBq (range 79\u2013318 MBq) and 235 \u00b1 88 MBq (range 90\u2013321 MBq), respectively. Quantification of tracer uptake was determined with SUVmax and SUVmean. Furthermore, the tumor-to-background ratio (TBR) was derived by dividing the SUVmax of tumor lesions by the SUVmax of adipose tissue, skeletal muscle, and blood pool. Results: Overall, 32 lesions were detected in 7 patients including primary (n = 7), lung (n = 7), bone (n = 3), lymph node (n = 13), and peritoneal metastases (n = 2). [18F]FAPI-74 detected 22% more lesions compared with [18F]FDG with a better TBR and visual lesion delineation. In one patient the primary lesion could be detected unequivocally with [18F]FAPI-74 but was missed by [18F]FDG imaging. Altogether, most of the lesions demonstrated markedly elevated uptake of [18F]FAPI-74 with a simultaneous lower uptake in the background, providing a very high visual contrast. Conclusion: To the best of our knowledge, this is the first, prospective, intra-individual investigation comparing [18F]FAPI-74 with [18F]FDG imaging in PDAC with encouraging results. These pivotalresults supporta larger, multicentric, prospective study to determine the value of [18F]FAPI-74 in detecting and staging PDAC in comparison with current standard of care imaging.<\/jats:p>","DOI":"10.3390\/cancers15102798","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T07:03:58Z","timestamp":1684393438000},"page":"2798","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Head-to-Head Intra-Individual Comparison of Biodistribution and Tumor Uptake of [18F]FAPI-74 with [18F]FDG in Patients with PDAC: A Prospective Exploratory Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1914-1332","authenticated-orcid":false,"given":"Emil","family":"Novruzov","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik L.","family":"Giesel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"},{"name":"Department of Nuclear Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuriko","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1086-8826","authenticated-orcid":false,"given":"Peter L.","family":"Choyke","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch, National Cancer Institute, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mardjan","family":"Dabir","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduards","family":"Mamlins","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Antke","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Pinto","sequence":"additional","affiliation":[{"name":"Departamento Anatomia Patologica, Hospital Sotero del Rio, Santiago 8207257, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9490-4083","authenticated-orcid":false,"given":"Cristian","family":"Soza-Ried","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine and PET\/CT Positronmed, Santiago 7501068, Chile"},{"name":"Positronpharma SA, Santiago 7501068, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine and PET\/CT Positronmed, Santiago 7501068, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio","family":"Amaral","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine and PET\/CT Positronmed, Santiago 7501068, Chile"},{"name":"Positronpharma SA, Santiago 7501068, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasko","family":"Kramer","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine and PET\/CT Positronmed, Santiago 7501068, Chile"},{"name":"Positronpharma SA, Santiago 7501068, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Badinez","sequence":"additional","affiliation":[{"name":"Instituto Radiooncol\u00f3gico Santiago INRAD, Santiago 7750000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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