Advances in Positron Emission Tomography Combined With Computed Tomography (PET/CT) Imaging in Cervical Cancer: From Metabolic Assessment to Fibroblast Activation Protein-Targeted Imaging

Positron emission tomography combined with computed tomography (PET/CT) has transformed the staging and management of cervical cancer, extending far beyond conventional anatomical imaging. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT currently serves as the standard-of-care functional imaging modality for initial staging, nodal mapping, treatment response assessment, and surveillance; however, its utility is constrained by limited spatial resolution for small nodal metastases, suboptimal specificity in inflammatory lesions, physiological urinary tracer excretion obscuring pelvic disease, and inability to characterize tumor microenvironmental composition. These limitations have driven the development of fibroblast activation protein inhibitor (FAPI) PET/CT, which capitalizes on the overexpression of fibroblast activation protein within the cancer-associated stroma of cervical tumors. FAPI-based imaging offers superior tumor-to-background contrast, improved delineation of primary lesions and metastatic deposits, and promising theranostic potential. This review traces the evolution from ¹⁸F-FDG metabolic imaging to FAPI-targeted PET/CT, reflecting a broader paradigm shift toward molecularly informed imaging in cervical cancer. Future directions include prospective clinical validation, radiomics integration, and the role of FAPI-PET in guiding adaptive radiotherapy and systemic treatment decisions.