68Ga FAPI PET/CT Imaging in Peritoneal Carcinomatosis

HomeRadiologyVol. 297, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in Radiology68Ga FAPI PET/CT Imaging in Peritoneal CarcinomatosisWei Guo, Haojun Chen Wei Guo, Haojun Chen Author AffiliationsFrom the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, 55 Zhenhai Road, Xiamen 361003, China.Address correspondence to H.C. (e-mail: [email protected]).Wei GuoHaojun Chen Published Online:Oct 13 2020https://doi.org/10.1148/radiol.2020202469MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPointA 63-year-old man presented with rising carcinoembryonic antigen levels. Endoscopic examination of the stomach and colon had normal findings. Fluorine 18 fluorodeoxyglucose (FDG) PET/CT was performed and showed multiple mesenteric nodules with moderate radiopharmaceutical uptake (Figure, part A). These abnormal foci were suspected to be metastases from gastrointestinal cancer, although no abnormal activity was observed within the gastrointestinal tract at endoscopy. Follow-up with gallium 68 (68Ga) fibroblast-activated protein inhibitor (FAPI) PET/CT was performed to help detect the primary lesion. This examination showed a focus of increased 68Ga FAPI uptake in the gastric wall (Figure, part B) and a greater number of abnormal foci in the mesentery and omentum than that shown with FDG PET/CT (Figure, parts C, D). The patient subsequently underwent CT-guided biopsy of the gastric wall where there was increased 68Ga FAPI uptake (Figure, part E). A histopathologic examination confirmed the diagnosis of gastric adenocarcinoma (Figure, part F).A, Coronal fluorine 18 (18F) fluorodeoxyglucose (FDG) PET maximum intensity projection image shows multiple mesenteric nodules with moderate activity (standardized uptake value [SUV], 2.5–4.7) (arrows). B, Coronal gallium 68 (68Ga) fibroblast-activated protein inhibitor (FAPI) PET maximum intensity projection image shows innumerable mesenteric nodules. C, Axial FDG PET image shows no significant activity in stomach (arrow). D, Axial 68Ga FAPI PET image shows extensive uptake in thickened gastric wall (SUV, 14.5) (arrow). E, Unenhanced CT image shows CT-guided biopsy with needle positioned within thickened gastric wall (arrow). F, Photomicrograph (hematoxylin-eosin stain; original magnification, ×25) of biopsy specimen shows moderately differentiated tubular gastric adenocarcinoma (arrow indicates tubule).Download as PowerPointOpen in Image Viewer Studies have shown that 68Ga FAPI is a promising PET tracer that could be more sensitive than FDG for some malignancies (1,2). Gastric adenocarcinoma sometimes demonstrates a low FDG uptake. As the tumor invades the peritoneal tissues, a fibrotic response may occur, resulting in severe fibrosis. Therefore, the sensitivity of PET imaging of fibroblast activation with 68Ga FAPI in the detection of peritoneal carcinomatosis from gastric cancer may be superior to that with FDG. This case demonstrates an example where 68Ga FAPI outperformed FDG in helping identify the primary lesion and peritoneal carcinomatosis from gastric adenocarcinoma.Disclosures of Conflicts of Interest: W.G. disclosed no relevant relationships. H.C. disclosed no relevant relationships.Supported by the National Natural Science Foundation of China (grant nos. 81801735 and 81701736).References1. Chen H, Pang Y, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging 2020;47(8):1820–1832. Crossref, Medline, Google Scholar2. Kratochwil C, Flechsig P, Lindner T, et al. 68Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. J Nucl Med 2019;60(6):801–805. Crossref, Medline, Google ScholarArticle HistoryReceived: June 2 2020Revision requested: June 22 2020Revision received: June 26 2020Accepted: July 29 2020Published online: Oct 13 2020Published in print: Dec 2020 FiguresReferencesRelatedDetailsCited By68Ga-FAPI-46 PET/CT Tracer Uptake in CT-diagnosed Intra-Abdominal Fat NecrosisPeter George Maliha, Martin Allen-Auerbach, Masatoshi Hotta, Jeremie Calais, 30 June 2023 | Radiology: Imaging Cancer, Vol. 5, No. 4Head-to-head comparison of [18F]-FDG and [68 Ga]-DOTA-FAPI-04 PET/CT for radiological evaluation of platinum-sensitive recurrent ovarian cancerShuaiLiu, ZhengFeng, XiaopingXu, HuijuanGe, XingzhuJu, XiaohuaWu, ShaoliSong2023 | European Journal of Nuclear Medicine and Molecular Imaging, Vol. 50, No. 5Incidental Focal68Ga-FAPI-46 Uptake in a Urachal Remnant: A Potential Pitfall Mimicking a Malignant Peritoneal LesionPeter GeorgeMaliha, MahbodJafarvard, JohannesCzernin, JeremieCalais, MasatoshiHotta2023 | Journal of Nuclear Medicine, Vol. 64, No. 6Feasibility of a deep learning algorithm to achieve the low-dose 68Ga-FAPI/the fast-scan PET images: a multicenter studyLinLiu, XingyuChen, LiwenWan, NaZhang, RuibaoHu, WenboLi, ShengpingLiu, YanZhu, HuaPang, DongLiang, YueChen, ZhanliHu2023 | The British Journal of RadiologyClinical summary of fibroblast activation protein inhibitor-based radiopharmaceuticals: cancer and beyondMengtingLi, Muhsin H.Younis, YongxueZhang, WeiboCai, XiaoliLan2022 | European Journal of Nuclear Medicine and Molecular Imaging, Vol. 49, No. 8Gallium-68-labeled fibroblast activation protein inhibitor PET in gastrointestinal cancer: insights into diagnosis and managementChunxiaQin, YangmeihuiSong, YongkangGai, WeiweiRuan, QingyaoLiu, FangLiu, DanzhaZheng, PengZhang, HongliLiu, TaoZhang, KaixiongTao, XiaoliLan2022 | European Journal of Nuclear Medicine and Molecular Imaging, Vol. 49, No. 12FAPI PET/CT research progress in digestive system tumoursDengsaiPeng, JingHe, HanxiangLiu, JianpengCao, YingweiWang, YueChen2022 | Digestive and Liver Disease, Vol. 54, No. 2Postoperative follow-up for gastric cancer needs to be individualized according to age, tumour recurrence pattern, and recurrence timeWen-WuQiu, Qi-YueChen, Wen-ZeZheng, Qi-ChenHe, Ze-NingHuang, Jian-WeiXie, Jia-BinWang, Jian-XianLin, JunLu, Long-LongCao, MiLin, Ru-HongTu, Ju-LiLin, Hua-LongZheng, Guang-TanLin, Guo-ShengLin, Chao-HuiZheng, Chang-MingHuang, PingLi2022 | European Journal of Surgical Oncology, Vol. 48, No. 868Ga-FAPI PET/CT Detected Non–FDG-Avid Gastric Stromal TumorLinQiu, LianjunLan, HanxiangLiu, JiaDeng, YueChen2022 | Clinical Nuclear Medicine, Vol. 47, No. 3FAPI PET/CT in the Diagnosis of Abdominal and Pelvic TumorsTianshuoYang, LongMa, HaodongHou, FengGao, WeijingTao2022 | Frontiers in Oncology, Vol. 11Case Report: 68Ga-FAPI PET/CT, a more advantageous detection mean of gastric, peritoneal, and ovarian metastases from breast cancerTianyueLi, XiaojingJiang, ZhaoqiZhang, XiaolinChen, JianfangWang, XinmingZhao, JingmianZhang2022 | Frontiers in Oncology, Vol. 12Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric CancerShumaoZhang, WeiWang, TingtingXu, HaoyuanDing, YiLi, HuipanLiu, YinxueHuang, LinLiu, TaoDu, YanZhao, YueChen, LinQiu2022 | Frontiers in Oncology, Vol. 12Imaging Cancer-Associated Fibroblasts (CAFs) with FAPi PETLauraGilardi, Lighea SimonaAirò Farulla, EmreDemirci, IlariaClerici, EmanuelaOmodeo Salè, FrancescoCeci2022 | Biomedicines, Vol. 10, No. 3Noninvasive Monitoring of Reparative Fibrosis after Myocardial Infarction in Rats Using 68Ga-FAPI-04 PET/CTPengxinQiao, YutongWang, KeZhu, DanzhaZheng, YangmeihuiSong, DaweiJiang, ChunxiaQin, XiaoliLan2022 | Molecular Pharmaceutics, Vol. 19, No. 11FAPI Uptake in a Vertebral Body Fracture in a Patient With Lung CancerJunhaoWu, HuipanLiu, LeiOu, GuohaoJiang, ChunyinZhang2021 | Clinical Nuclear Medicine, Vol. 46, No. 6Al18F-NOTA-FAPI-04 Outperforms 18F-FDG PET/CT in Identifying the Primary Lesion and Rare Metastases From Gastric CancerYingKou, ZhiweiYao, ZhuzhongCheng2021 | Clinical Nuclear Medicine, Vol. 46, No. 12Recommended Articles 68Ga-FAPI PET/CT Depicted Non-FDG-Avid Metastatic Appendiceal Mucinous AdenocarcinomaRadiology2021Volume: 301Issue: 1pp. 45Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal CancersRadiology2020Volume: 298Issue: 2pp. 393-402FAPI PET: Fibroblast Activation Protein Inhibitor Use in Oncologic and Nononcologic DiseaseRadiology2023Volume: 306Issue: 2Prospective Comparison of 68Ga-FAPI versus 18F-FDG PET/CT for Tumor Staging in Biliary Tract CancersRadiology2022Volume: 304Issue: 3pp. 648-657Comparison of 68Ga-FAPI and 18F-FDG PET/CT in the Evaluation of Advanced Lung CancerRadiology2022Volume: 303Issue: 1pp. 191-199See More RSNA Education Exhibits Gastric Cancer: Pearls, Pitfalls and Lessons Learned from The Multidisciplinary Tumor BoardDigital Posters2022Don’t Be So thick! 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