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Background  Fibroblast activation protein (FAP) is commonly expressed in activated stromal fibroblasts in various epithelial tumours. Recently,  68 Ga-FAPI-04 has been used for tumour imaging in positron emission tomography/computed tomography (PET/CT). This study aimed to compare the diagnostic performances of  68 Ga-FAPI-04 PET/CT and  18 F-FDG PET/CT in hepatocellular carcinoma (HCC), and to assess factors associated with  68 Ga-FAPI-04 uptake in HCC.    Materials and Methods  Twenty-nine patients with suspiciously HCC who received both  18 F-FDG and  68 Ga-FAPI-04 PET/CT were included in this retrospective study. The results were interpreted by two experienced nuclear medicine physicians independently. The maximum and mean standardized uptake values (SUV max  and SUV mean ) were measured in the lesions and liver background, respectively. The tumour-to-background ratio (TBR) was then calculated as lesion’s SUV max  divided by background SUV mean .    Results  A total of 35 intrahepatic lesions in 25 patients with HCC were finally involved in the statistical analysis.  68 Ga-FAPI-04 PET/CT showed a higher sensitivity than  18 F-FDG PET/CT in detecting intrahepatic HCC lesions (85.7%  vs . 57.1%,  P  = 0.002), including in small (≤ 2 cm in diameter; 68.8%  vs . 18.8%,  P  = 0.008) and well- or moderately-differentiated (83.3%  vs . 33.3%,  P  = 0.031) tumors. SUV max  was comparable between  68 Ga-FAPI-04 and  18 F-FDG (6.96 ± 5.01  vs . 5.89 ± 3.38,  P  > 0.05), but the TBR was significantly higher in the  68 Ga-FAPI-04 group compared with the  18 F-FDG group (11.90 ± 8.35  vs . 3.14 ± 1.59,  P  < 0.001). SUV max  and the TBR in  68 Ga-FAPI-04 positive lesions were associated with tumour size (both  P  < 0.05), but not the remaining clinical and pathological features (all  P  > 0.05).    Conclusions    68 Ga-FAPI-04 PET/CT is more sensitive than  18 F-FDG PET/CT in detecting HCC lesions, and  68 Ga-FAPI-04 uptake is correlated mainly with tumour size.

68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma