Intense FAPI Uptake in Inflammation May Mask the Tumor Activity of Pancreatic Cancer in 68Ga-FAPI PET/CT

Abstract Contrast CT revealed diffuse enlargement of the pancreas with a suspicious lesion in the uncinate process in a 57-year-old man who presented with jaundice. 18 F-FDG PET/CT showed increased radioactivity in the enlarged pancreas with a nodular lesion with even higher uptake in the uncinate process. To differentiate autoimmune pancreatitis and pancreatic cancer, 68 Ga-FAPI PET/CT was performed. It revealed intense 68 Ga-FAPI uptake in the pancreas, but the FDG-avid lesion in the uncinate process was not shown. The patient was finally diagnosed with pancreatic cancer with tumor-induced pancreatitis with endoscopic ultrasonography–guided biopsy.