Abstract A 67-year-old man presented with generalized muscle pain for 2 months. A potential malignancy was suspected. The patient was subsequently enrolled in the clinical trial of 68 Ga-FAPI. Increased activity of FAPI and FDG was observed in muscle lesions. Moreover, 68 Ga-FAPI PET/CT showed intense FAPI uptake in the pancreas. Finally, pancreas and left iliopsoas muscle biopsies confirmed the diagnosis of pancreatic cancer with multiple muscle metastases.