18F-FAPI-04 PET/CT in the evaluation of ground-glass nodules less than 3 cm in diameter comparing to 18F-FDG PET/CT

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Background This study aimed to evaluate the clinical usefulness of fluorine 18 F−FAPI-04 PET/CT in diagnosing ground-glass nodules that are less than 3 cm in diameter in comparison with fluorine 18 F-FDG PET/CT. Methods Prospective analysis of 18 F-FAPI-04 PET/CT and 18 F-FDG PET/CT scans for 74 patients with 96 GGNs less than 3 cm from 09/2021 to 10/2024 were analyzed. 18 F-FAPI-04 imaging was performed in patients with 18 F-FDG PET/CT within a week. The images, parameters, and histopathological invasiveness from participants were analyzed. Tumor uptake was quantified by the maximum standard uptake value (SUV max ), standard uptake value mean (SUV mean ), target-to-background ratio (TBR), and the ratio of SUV max of the lesion to SUV max of contralateral normal lung parenchyma (SUV index ). Results A total of 74 patients with 96 GGNs were evaluated. Different pathological subtypes of GGNs exhibited distinct uptake values on 18 F-FAPI-04 and 18 F-FDG PET/CT. The invasive pathological subtypes showed higher uptakes than noninvasive subtypes, of which 18 F-FAPI-04 PET/CT showed significantly higher uptake than 18 F-FDG PET/CT in all subtypes of GGNs (all P< 0.05). Notably, the optimal cut-off values for specificity of SUV max , SUV mean , SUV index , and TBR of 18 F-FAPI-04 PET/CT were notably higher than those of 18 F-FDG PET/CT. Conclusion 18 F-FAPI-04 PET/CT is useful for detecting GGNs, outperforming 18 F-FDG PET/CT in detecting their invasiveness. It could provide valuable guidance for early-stage adenocarcinoma diagnosis, potentially impacting patient management. Trial registration Chinese Clinical Trial Registry, ChiCTR2100051406. Registered 23 September 2021 ‘Retrospectively registered’, https://www.chictr.org.cn/showproj.html?proj=133033

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