Abstract
Fibroblast activation protein (FAPI), a type II transmembrane glycoprotein is a promising target to image epithelial originated cancers. Pancreatic cancer is characterized with [68Ga]Ga-FAPI-04 and 18F-fluorodeoxyglucose(18F-FDG) uptake in varying degree. However physiologic uptake and uptake associated with acute/chronic pancreatitis makes interpretation challenging. We would like to present a case of pancreatic cancer whose tumor could not delineated from rest pancreatic tissue in [68Ga]Ga-FAPI-04 positron emission tomography/computed tomography (PET/CT) images due to intense FAPI uptake in whole pancreas but more remarkable in 18F-FDG PET/CT images.
Keywords:
FAPI, Gallium-68, pancreatic cancer, FDG, PET/CT
Ethics
Informed Consent: Informed consent was obtained from all subjects involved in the study.
Authorship Contributions
Surgical and Medical Practices: E.A., A.E.Ö., G.A., M.M.S., Es.A., Concept: E.A., Design: E.A., Es.A., Data Collection or Processing: E.A., M.M.S., Analysis or Interpretation: E.A., M.M.S., Literature Search: E.A., A.E.Ö., Writing: E.A.
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.
References
1
Giesel FL, Kratochwil C, Schlittenhardt J, Dendl K, Eiber M, Staudinger F, Kessler L, Fendler WP, Lindner T, Koerber SA, Cardinale J, Sennung D, Roehrich M, Debus J, Sathekge M, Haberkorn U, Calais J, Serfling S, Buck AL. Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients. Eur J Nucl Med Mol Imaging. 2021;48:4377-4385.
2
Pang Y, Zhao L, Shang Q, Meng T, Zhao L, Feng L, Wang S, Guo P, Wu X, Lin Q, Wu H, Huang W, Sun L, Chen H. Positron emission tomography and computed tomography with [68Ga]Ga-fibroblast activation protein inhibitors improves tumor detection and staging in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging. 2021;49:1322-1337.
3
Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, Sun L, Chen H. Comparison of 68Ga-FAPI and 18F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021;298:393-402.
4
Gündoğan C, Kömek H, Can C, Yildirim ÖA, Kaplan İ, Erdur E, Poyraz K, Güzel Y, Oruç Z, Çakabay B. Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma. Nucl Med Commun. 2022;43:64-72.
5
Veldhuijzen van Zanten SEM, Pieterman KJ, Wijnhoven BPL, Pruis IJ, Groot Koerkamp B, van Driel LMJW, Verburg FA, Thomeer MGJ. FAPI PET versus FDG PET, CT or MRI for staging pancreatic-, gastric- and cholangiocarcinoma: systematic review and head-to-head comparisons of diagnostic performances. Diagnostics (Basel). 2022;12:1958.
6
Shou Y, Xue Q, Yuan J, Zhao J. 68Ga-FAPI-04 PET/MR is helpful in differential diagnosis of pancreatitis from pancreatic malignancy compared to 18F-FDG PET/CT: a case report. Eur J Hybrid Imaging. 2021;5:12.
7
Luo Y, Pan Q, Zhang W, Li F. Intense FAPI uptake in ınflammation may mask the tumor activity of pancreatic cancer in 68Ga-FAPI PET/CT. Clin Nucl Med. 2020;45:310-311.
8
Li Y, Gao J, Li Y, Duan X, Shen C. Non-specific uptake of 18F-FAPI-04 in the pancreas and its related factors: a post-hoc analysis of an ongoing prospective clinical trial. Sci Rep. 2024;14:11141.
