68Ga-FAPI-04 PET/CT in the Diagnosis of Hepatocellular Carcinoma Associated with Cirrhosis: Diagnostic Value, Correlation Between PET Parameters of the Tumor and Its Size, and PIVKA-II Levels
Zholdybay Z. Zhakenova Z. Issamatov B. Gabdullina M. Filippenko Y. Yessentayeva S. Alisherov G. Amankulov J. Fakhradiyev I.
January 2026Multidisciplinary Digital Publishing Institute (MDPI)
Diagnostics
2026#16Issue 2
Background/Objectives: Hepatocellular carcinoma remains a major cause of death from cancer globally. While 18F-FDG PET/CT is commonly used for tumor imaging, its sensitivity is limited, especially due to high liver background uptake. Recently, 68Ga-FAPI PET/CT, which targets fibroblast activation protein in tumor stroma, has emerged as a promising diagnostic tool. In this study, we aimed to assess the diagnostic performance of 68Ga-FAPI-04 PET/CT in HCC patients with and without liver cirrhosis and to explore the relationship between PET metrics, tumor size, and PIVKA-II serum marker. Methods: In this prospective single-center study, 59 patients with confirmed HCC (37 with cirrhosis, 22 without) underwent 68Ga-FAPI-04 PET/CT. The standard dose (1.5–2.0 MBq/kg) was administered intravenously, and imaging was carried out 60 min post-injection. Semi-quantitative parameters including SUVmax, SUVmean, and tumor-to-background ratio were calculated. Diagnostic performance was assessed using histopathology and multimodal imaging. Statistical analyses included the Mann–Whitney U test and Spearman correlation. Results: The overall sensitivity for HCC detection was 89.8%, with a specificity of 60% and accuracy of 87%. Sensitivity and specificity showed a tendency to be lower in cirrhotic compared with non-cirrhotic patients, with a notably higher background liver uptake in cirrhosis (SUVmax 3.60 vs. 1.3, p < 0.001), resulting in lower TBR values (3.7 vs. 7.0, p < 0.001). A strong correlation between SUVmax and tumor size was seen in non-cirrhotic HCC, while a moderate association between SUVmax and PIVKA-II levels was observed in cirrhotic patients. Conclusions: 68Ga-FAPI-04 PET/CT demonstrates high sensitivity for HCC detection and may serve as a complementary imaging modality, particularly when interpreted through conventional cross-sectional imaging. Image interpretation in cirrhotic livers may be challenging due to increased background uptake and reduced TBR. Associations between PET-derived parameters, tumor size, and serum PIVKA-II levels should be considered hypothesis-generating and require validation in larger, multicenter studies with clinical outcome data.
68Ga-FAPI-04 PET/CT , diagnostic performance , hepatocellular carcinoma , liver cirrhosis , PIVKA-II , SUVmax , TBR
Text of the article Перейти на текст статьи
“Visual Diagnostics” Department, Asfendiyarov Kazakh National Medical University, Almaty, 050012, Kazakhstan
Oncology and Radiology Department, Kazakh-Russian Medical University, Almaty, 050004, Kazakhstan
Department of Nuclear Medicine, Limited Liability Company “HiLife”, Almaty, 050031, Kazakhstan
Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, 050022, Kazakhstan
College of Medicine, Korea University, Seoul, 02841, South Korea
“Visual Diagnostics” Department
Oncology and Radiology Department
Department of Nuclear Medicine
Department of Radiology and Nuclear Medicine
College of Medicine
10 лет помогаем публиковать статьи Международный издатель
Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026