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Molecular Imaging and Radionuclide Therapy
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Comparison of 68Ga-FAPI-04 and 68Ga-PSMA in a Case of Interstitial Lung Disease
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Comparison of 68Ga-FAPI-04 and 68Ga-PSMA in a Case of Interstitial Lung Disease

Mol Imaging Radionucl Ther 2025;34(2):129-131 DOI: 10.4274/mirt.galenos.2024.93270
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Abstract

We present the 68Ga-prostate-specific membrane antigen (PSMA) and 68Ga-fibroblast activation protein inhibitor (FAPI)-04 positron emission tomography/computed tomography (PET/CT) findings comparatively of a 76-year-old man with a history of progressive dyspnea and evidence of interstitial lung disease (ILD) abnormalities on high-resolution CT. Moderate PSMA uptake was observed in areas with ILD abnormalities on 68Ga-PSMA PET/CT. 68Ga-FAPI-04 PET/CT showed relatively higher FAPI-04 uptake in these regions. These findings offer the potential to assess disease activity at the cellular and molecular levels. This approach may provide valuable insight into the pathophysiology of ILD beyond the structural changes captured by traditional imaging methods.

Keywords: Fibroblast activation protein inhibitor, interstitial lung disease, PSMA, PET

Figure 1
Figure 1. A 76-year-old man diagnosed with interstitial lung disease (ILD) presented with newly diagnosed prostate carcinoma with a Gleason score of 4+3. 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was performed for staging. Dependent atelectasis, subpleural reticular density increase, and traction bronchiectasis were observed in the lower lobes of both lungs, showing moderate PSMA uptake in both lungs (E, PSMA PET MIP; F, axial CT image; G, axial PET image, and H axial PET/CT fusion image). There was no evidence of prostate cancer residue or metastasis. Subsequently, the patient underwent a 68Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT scan as part of the prospective research conducted at our clinic. The patient provided written informed consent. In ILD findings where PSMA uptake (SUVmax: 4.8) was observed, FAPI-04 uptake (SUVmax: 6.4) was at a relatively higher uptake to PSMA on 68Ga-FAPI-04 PET/CT (A, FAPI-04 PET MIP; B, axial CT image; C, axial PET image, and D axial PET/CT fusion image). ILD is a heterogeneous group of parenchymal lung disorders characterized by inflammation and fibrosis (). High-resolution computed tomography has been the cornerstone of imaging in ILD, providing detailed anatomical information and aiding disease classification (). However, the quest for more precise and comprehensive imaging techniques has led to exploring molecular imaging modalities such as PET using novel radiotracers. PSMA has garnered interest in non-prostatic diseases due to its increased expression in neoangiogenesis associated with inflammation and fibrosis (). Similarly, FAPI, targeting fibroblast activation, has shown promise in visualizing and monitoring fibrotic lung diseases (,,,,,). These emerging PET tracers have the potential to assess disease activity at the cellular and molecular level, providing valuable insights into the pathophysiology of ILD beyond structural changes captured by conventional imaging modalities. This report underscores the potential of PET imaging with novel radiotracers as useful adjuncts to traditional diagnostic modalities, which may offer a deeper understanding of disease pathogenesis and pave the way for targeted therapies in patients with ILD.
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Footnotes

Ethics

Informed Consent: The patient provided written informed consent.

Authorship Contributions

Surgical and Medical Practices: H.Ö., A.K., Concept: H.Ö., A.K., Design: H.Ö., A.K., Data Collection or Processing: H.Ö., A.K., Analysis or Interpretation: H.Ö., A.K., Literature Search: H.Ö., A.K., Writing: H.Ö., A.K.

Conflict of Interest: No conflicts of interest were declared by the authors.

Financial Disclosure: The authors declare that this study has received no financial support.

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