Comparison of lesion detection rates between FAPI PET/CT and 18 F-FDG PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis of head-to-head studies.
Qin Wang, Xue Cai, Hao Liu et al.
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In 30 seconds
This systematic review and meta-analysis compared lesion detection by fibroblast activation protein inhibitor (FAPI) PET/CT and 18F-FDG PET/CT in hepatocellular carcinoma (HCC), using head-to-head studies. Eight reports were included in the qualitative review, with five studies or outcomes contributing HCC-specific paired data to the main analysis. FAPI PET/CT had a higher pooled lesion detection rate, with a risk difference of 0.41 (95% CI 0.28-0.53; I² = 75.5%). The advantage was also observed across lesion-size and treatment-status subgroups, although estimates varied and evidence was limited.
Key findings
- Across paired HCC data, the pooled detection-rate difference favoured FAPI PET/CT: RD 0.41 (95% CI 0.28-0.53; I² = 75.5%).
- For lesions ≤ 2 cm, the pooled RD was 0.57 (95% CI 0.47-0.67; I² = 18.7%); for lesions > 2 cm, it was 0.26 (95% CI 0.08-0.44; I² = 87.6%).
- The pooled RD favouring FAPI was 0.32 (95% CI 0.15-0.50) before treatment and 0.46 (95% CI 0.28-0.64) after treatment or during restaging.
- Descriptive site-specific findings suggested a more consistent FAPI detection advantage for intrahepatic lesions than for some extrahepatic metastatic sites.
Why it matters
Lesion detection can inform assessment of HCC extent and evaluation after treatment. These pooled comparisons suggest FAPI PET/CT may identify more lesions than 18F-FDG PET/CT, including small lesions, but the substantial heterogeneity and limited evidence mean the size and clinical consequences of this advantage remain uncertain.
What to keep in mind
The evidence included few studies and was methodologically heterogeneous, with lesion-level analysis constraints and insufficient specificity-related data. Heterogeneity was substantial in several pooled analyses.