通过比较[18F]氟代脱氧葡萄糖（[18F]FDG）PET/CT和[68Ga]Ga-FAPI（成纤维细胞激活蛋白抑制剂）PET/MR在卵巢癌诊断和手术切除程度评估中的临床应用价值，提供一种指导临床治疗的理论。从2021年7月至2022年10月，纳入了30名高度怀疑卵巢恶性肿瘤的患者，进行了[18F]FDG PET/CT和[68Ga]Ga-FAPI-04 PET/MR检查，检查时间间隔不超过5天。其中20名患者进行了[18F]FDG PET/MR检查，以完成[18F]FDG PET/CT的一致性检查。对图像进行SUV值比较和根据腹膜癌症指数（PCI）和SUIDAN评分系统评估不完全切除性肿瘤的判断。采用免疫组织化学染色分析FAP、HK2和Ki67的表达。PET/MR和PET/CT在不同部位的SUV-FDG之间无显著差异（p>0.05），其诊断准确率相似。[68Ga]Ga-FAPI-04 PET/MR在腹膜转移方面的诊断准确率有优势，因为SUVs-FAPI值较高（p＜0.01）。[68Ga]Ga-FAPI-04 PET/MR在诊断膈肌周围转移方面的敏感性更高，因为肝脏处的SUVmax值降低（p＜0.001）。在PCI评分分析中，[68Ga]Ga-FAPI-04 PET/MR可以部分纠正[18F]FDG PET/CT漏诊或低估的得分，但左侧肠系膜旁转移得分的匹配概率较低，容易高估。有趣的是，[68Ga]Ga-FAPI-04 PET/MR检测到的膈肌转移与预测不完全切除性的相关性最高（逻辑回归p=0.02）。通过免疫组织化学，FAP表达与SUVmax-FAPI值强相关（p＜0.001），而HK2表达与SUVmax-FDG值相关（p＜0.01）。此外，SUVmax-FDG与Ki67≥20％相比，Ki67＜20％更低（p＜0.05）。[68Ga]Ga-FAPI-04 PET/MR在诊断转移方面有明显优势，可以更准确地评估肿瘤负荷并预测不完全切除性。SUVmax-FDG有助于评估肿瘤的恶性程度。©2023年。作者（们）独家授权Springer-Verlag GmbH Germany，Springer Nature的一部分。

To provide a theory for guiding clinical treatment by comparing the clinical application value of [18F]fluorodeoxyglucose ([18F]FDG) PET/CT and [68Ga]Ga-FAPI (fibroblast activating protein inhibitor) PET/MR in the diagnosis and evaluation of resectability of ovarian cancer.Thirty patients with high clinical suspicion of ovarian malignancies were enrolled from July 2021 to October 2022 and underwent [18F]FDG PET/CT and [68Ga]Ga-FAPI-04 PET/MR within 5 days. Twenty patients underwent [18F]FDG PET/MR at once completing [18F]FDG PET/CT for consistency checking. Images were analysed for comparing SUVs and for judging incomplete resectability according to the peritoneal cancer index (PCI) and SUIDAN scoring system. The expression of FAP, HK2 and Ki67 was analysed by immunohistochemistry staining.There was no significant difference between PET/MR and PET/CT in SUVs-FDG at different locations (p > 0.05), and their diagnostic accuracies were similar. The diagnostic accuracy of [68Ga]Ga-FAPI-04 PET/MR had advantages for peritoneal metastasis since SUVsFAPI were higher (p < 0.01). The sensitivity of [68Ga]Ga-FAPI-04 PET/MR in the diagnosis of peridiaghragmatic metastases was higher because SUVmax in the liver was decreased (p < 0.001). [68Ga]Ga-FAPI-04 PET/MR might have advantages in diagnosing gastrointestinal invasion. In PCI score analysis, [68Ga]Ga-FAPI-04 PET/MR could partially correct missing or underestimated scores by [18F]FDG PET/CT, but the matching probability between left peri-intestinal metastasis scores was low and easy to overestimate. Interestingly, diaphragmatic metastasis detected by [68Ga]Ga-FAPI-04 PET/MR had the greatest correlation with the prediction of incomplete resectability (logistic regression p = 0.02). Through immunohistochemistry, the expression of FAP had a strong correlation with SUVmax-FAPI (p < 0.001), while the expression of HK2 was correlated with SUVmax-FDG (p < 0.01). In addition, SUVmax-FDG with Ki67 ≥ 20% was significantly higher than that with Ki67 < 20% (p < 0.05).[68Ga]Ga-FAPI-04 PET/MR had obvious advantages for metastases diagnosis and could more accurately assess tumour load and predict incomplete resectability. SUVmax-FDG was conducive to evaluating the degree of tumour malignancy.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.