A study compared the diagnostic performance of ¹⁸F-FAPI-04 PET/CT with ¹⁸F-FDG PET/CT in patients with pancreatic ductal adenocarcinoma (PDAC). Sixty-two PDAC patients underwent both imaging modalities. ¹⁸F-FAPI-04 PET/CT identified all patients, while ¹⁸F-FDG PET/CT missed one. ¹⁸F-FAPI-04 showed significantly higher tracer uptake in primary tumors, lymph node metastasis, and distant metastasis compared to ¹⁸F-FDG. The T staging was similar, but ¹⁸F-FAPI-04 showed higher N and M values, leading to 14 patients being upgraded and only one downgraded in TNM staging. ¹⁸F-FAPI-04 had higher sensitivity and accuracy in detecting primary tumors, lymph node metastases, and distant metastases. It also showed better detection of hepatic and peritoneal metastases compared to ¹⁸F-FDG. The study found that ¹⁸F-FAPI-04 PET/CT outperformed ¹⁸F-FDG PET/CT in identifying PDAC lesions and staging. However, SUVmax did not correlate with treatment response for either tracer. The study concluded that ¹⁸F-FAPI-04 PET/CT is more effective than ¹⁸F-FDG PET/CT in PDAC diagnosis and staging. The study had limitations, including the exclusion of non-pathologically diagnosed patients and the lack of pathologic evidence for LN metastasis advantages. The results suggest that ¹⁸F-FAPI-04 PET/CT may play a greater role in the clinical management of PDAC.A study compared the diagnostic performance of ¹⁸F-FAPI-04 PET/CT with ¹⁸F-FDG PET/CT in patients with pancreatic ductal adenocarcinoma (PDAC). Sixty-two PDAC patients underwent both imaging modalities. ¹⁸F-FAPI-04 PET/CT identified all patients, while ¹⁸F-FDG PET/CT missed one. ¹⁸F-FAPI-04 showed significantly higher tracer uptake in primary tumors, lymph node metastasis, and distant metastasis compared to ¹⁸F-FDG. The T staging was similar, but ¹⁸F-FAPI-04 showed higher N and M values, leading to 14 patients being upgraded and only one downgraded in TNM staging. ¹⁸F-FAPI-04 had higher sensitivity and accuracy in detecting primary tumors, lymph node metastases, and distant metastases. It also showed better detection of hepatic and peritoneal metastases compared to ¹⁸F-FDG. The study found that ¹⁸F-FAPI-04 PET/CT outperformed ¹⁸F-FDG PET/CT in identifying PDAC lesions and staging. However, SUVmax did not correlate with treatment response for either tracer. The study concluded that ¹⁸F-FAPI-04 PET/CT is more effective than ¹⁸F-FDG PET/CT in PDAC diagnosis and staging. The study had limitations, including the exclusion of non-pathologically diagnosed patients and the lack of pathologic evidence for LN metastasis advantages. The results suggest that ¹⁸F-FAPI-04 PET/CT may play a greater role in the clinical management of PDAC.