Seeing Beyond 68GA-DOTANOC and 18F-FDG PET/CT: 68GA-FAPI Only Uptake in a Rare Metastatic Well-differentiated Grade I Pancreatic Neuroendocrine Tumor

Somatostatin receptor (SSTR) imaging is the preferred modality for staging well-differentiated neuroendocrine tumors (NETs) and detecting unknown primary NETs. If SSTR imaging is negative, 18F-FDG PET/CT may be done to rule out tumor heterogeneity. We report a case of a 36-year-old woman with a well-differentiated grade I NET, who initially presented with severe right hypochondriac pain and vomiting. Standard diagnostic workup with 68Ga-DOTANOC followed by 18F-FDG PET/CT was negative; however, 68Ga-FAPI-04 PET/CT demonstrated intense tracer-avid lesions in pancreatic primary and liver metastases.