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Purpose We aimed to evaluate the value of [ 68  Ga]Ga-DOTA-FAPI-04 PET/CT for the diagnosis of recurrent soft tissue sarcoma (STS), compared with [ 18 F]FDG PET/CT. Methods A total of 45 patients (21 females and 24 males; median age, 46 years; range, 18–71 years) with 13 subtypes of STS underwent [ 18 F]FDG and [ 68  Ga]Ga-DOTA-FAPI-04 PET/CT examination within 1 week for assessment local relapse or distant metastasis. Positive lesions on PET/CT images were verified by biopsy or 3-month follow-up. Wilcoxon matched-pairs signed-rank test was used to compare the semiquantitative values (SUV max  and TBR) of [ 18 F]FDG and [ 68  Ga]Ga-DOTA-FAPI-04 in tumor lesions, and McNemar test was applied to test for differences of both tracers. Results Among the 45 patients, 282 local relapses and distant metastases were identified. Compared to [ 18 F]FDG, [ 68  Ga]Ga-DOTA-FAPI-04 PET/CT detected more lesions (275 vs. 186) and outperformed in sensitivity, specificity, PPV, NPV, and accuracy for the diagnosis of recurrent lesions ( P  &lt; 0.001). [ 68  Ga]Ga-DOTA-FAPI-04 demonstrated significantly higher values of SUV max  and TBR than [ 18 F]FDG PET/CT in liposarcoma ( P  = 0.011 and  P  &lt; 0.001, respectively), malignant solitary fibrous tumor (MSFT) ( P  &lt; 0.001 and  P  &lt; 0.001, respectively), and interdigitating dendritic cell sarcoma (IDCS) ( P  &lt; 0.001and  P  &lt; 0.001, respectively). While mean SUV max  and TBR presented favorable uptake of [ 18 F]FDG over [ 68  Ga]Ga-DOTA-FAPI-04 in undifferentiated pleomorphic sarcoma (UPS) ( P  = 0.003 and  P  &lt; 0.001, respectively) and rhabdomyosarcoma (RMS) ( P  &lt; 0.001 and  P  &lt; 0.001, respectively). Conclusion [ 68  Ga]Ga-DOTA-FAPI-04 PET/CT is a promising new imaging modality for recurrent surveillance of STS, and compares favorably with [ 18 F]FDG for identifying recurrent lesions of liposarcoma, MSFT, and IDCS.

Head-to-head evaluation of [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT in recurrent soft tissue sarcoma