[68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis

Objectives To compare the detection rates of [ 68 Ga]Ga-FAPI-04 PET MRI/CT vs. [ 18 F]-FDG PET MRI/CT in gastric cancer. Methods An extensive librarian-led literature search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov was performed. The primary outcomes were sensitivity in patient-based evaluations, detection of lymph node metastases, and peritoneal involvement. Results Five studies, including 148 participants, were analyzed. [ 68 Ga]Ga-FAPI-04 PET MRI/CT has a comparatively high sensitivity in patient-based evaluations compared with [ 18 F]-FDG PET MRI/CT (risk difference = 0.16, 95% CI 0.09–0.22, P < 0.00001). The [ 68 Ga]Ga-FAPI-04 PET MRI/CT group has a comparatively higher sensitivity in detecting lymph node metastases (RR = 0.15, 95% CI 0.01–0.29, P = 0.04), peritoneal involvement (RR = 0.55, 95% CI 0.38–0.72, P < 0.00001) in gastric cancer than [ 18 F]-FDG PET MRI/CT group. Conclusions This systematic review confirmed the advantage of [ 68 Ga]Ga-FAPI-04 PET MRI/CT in gastric cancer. [ 68 Ga]Ga-FAPI-04 PET MRI/CT was superior to [ 18 F]-FDG PET MRI/CT in detecting the primary tumor, lymph node metastases, and peritoneal metastases. More studies are needed for the sensitivity and specificity of [ 68 Ga]Ga-FAPI-04 PET MRI/CT in different pathological types of gastric cancer.