Comparison of Al[18F]-NOTA-FAPI-04 PET/CT and [18F]-FDG PET/CT in a patient with lung cancer and pulmonary tuberculosis: a case report and literature review

Background The coexistence of lung cancer and pulmonary tuberculosis (TB) makes differential diagnosis even more complicated. The purpose of the study is to explore superiority of [ 18 F]-NOTA-FAPI-04 PET/CT in distinguishing TB from malignant lesions and accurately detecting inflammatory lymph nodes than [ 18 F]-FDG PET/CT. Case summary Herein, we described a case report of a patient with both lung cancer and tuberculosis underwent [ 18 F]-FDG and Al[ 18 F]-NOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) to determine staging. Additionally, a literature review was conducted to discuss the potential clinical applications of FAPI PET/CT. We reported a 70-year-old man with newly diagnosed lung squamous cell carcinoma underwent [ 18 F]-FDG and Al[ 18 F]-NOTA-FAPI-04 PET/CT to determine staging. The avid uptake of [ 18 F]-FDG in old pulmonary TB and the right hilar inflammatory lymph nodes (<1 cm) were not found on Al [ 18 F]-NOTA-FAPI-04 PET/CT. After 2 months of follow-up, the small lymph node was finally confirmed to be inflammatory. Conclusion Al[ 18 F]-NOTA-FAPI-04 PET/CT may perform better in distinguishing TB from malignancy and may offer greater specificity than [ 18 F]-FDG PET/CT for the diagnosis inflammatory lymph nodes.