本文旨在比较18-氟脱氧葡萄糖([18F]FDG)PET/CT和成纤维细胞活化蛋白（FAPI）PET/CT在肺癌患者原发肿瘤、淋巴结和远处转移评估中的诊断性能。我们通过对Cochrane图书馆、Embase和PubMed/MEDLINE数据库进行系统检索，检索时间从2022年11月1日至近期。纳入研究评估了FAPI PET/CT和[18F]FDG PET/CT在肺癌患者中的应用。使用“诊断准确性研究质量评价-2”（QUADAS-2）工具评估偏倚风险。采用随机效应模型对两种成像模式的诊断测试进行分析。FAPI PET/CT检测原发性肺癌病灶的敏感性为0.98（95% CI：0.88-1.00），而[18F]FDG PET/CT的敏感性为0.99（95% CI：0.74-1.00）。对于转移病灶（淋巴结转移和远处转移）的检测，FAPI PET/CT的敏感性为0.99（95% CI：0.90-1.00），[18F]FDG PET/CT的敏感性为0.77（95% CI：0.66-0.85）。然而，由于缺乏有关相关真阴性的足够信息，无法评估两种成像模式的特异性。在诊断转移性肺癌病灶方面，FAPI PET/CT与[18F]FDG PET/CT相比具有更高的敏感性。因此，FAPI PET/CT可能被考虑为评估原发肺癌肿瘤、淋巴结转移和远处转移的一种替代成像方式。FAPI可能成为评估原发肺癌肿瘤、淋巴结转移和远处转移的[18F]FDG的替代物，在治疗中发挥着非常重要的作用。© 2023. 作者（们），在欧洲放射学学会独家许可。

This article aims to compare the diagnostic performance of 18-fluorodeoxyglucose ([18F]FDG) PET/CT and fibroblast activating protein inhibitor (FAPI) PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer patients.A systematic search was conducted on the Cochrane Library, Embase, and PubMed/MEDLINE databases from inception until November 1, 2022. Included studies assessed the use of FAPI PET/CT and [18F]FDG PET/CT in patients with lung cancer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the risk of bias. A random variable model was used to analyze the diagnostic tests of the two imaging modalities.The sensitivity of FAPI PET/CT in detecting primary lung cancer lesions was 0.98 (95% CI: 0.88-1.00), while the sensitivity of [18F]FDG PET/CT was 0.99 (95% CI: 0.74-1.00). For the detection of metastatic lesions (lymph node metastases and distant metastases), FAPI PET/CT had a sensitivity of 0.99 (95% CI: 0.90-1.00), while the sensitivity of [18F]FDG PET/CT was 0.77 (95% CI: 0.66-0.85). However, the specificity of the two imaging modalities could not be assessed due to the lack of sufficient information on pertinent true negatives.In the diagnosis of metastatic lung cancer lesions, FAPI PET/CT demonstrated a higher sensitivity compared to [18F]FDG PET/CT. Therefore, FAPI PET/CT may be considered an alternative imaging modality for the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases.FAPI may be an alternative to [18F]FDG in the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases, which plays a very important role in treatment.• This article is to compare the performance of [18F]FDG PET/CT with FAPI PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer. • However, FAPI PET/CT has a higher sensitivity for the diagnostic assessment of metastatic lung cancer lesions.© 2023. The Author(s), under exclusive licence to European Society of Radiology.