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68Ga-FAPI-04 PET/CT Versus 18F-FDG PET/CT in Malignant Peritoneal Mesothelioma
Cihan Gündoğan1, Yunus Güzel1, Halil Kömek1
1From the Departments of Nuclear Medicine.
Abstract:
An 83-year-old man presented with abdominal pain, vomiting, and bloating. His abdominal CT revealed heterogeneous peritoneal thickening in the lower quadrants, which was more prominent in the pelvic region. 18F-FDG PET/CT performed to locate the primary tumor showed irregular peritoneal and omental thickening with low to moderate FDG uptake. 68Ga-FAPI (fibroblast activation protein-specific inhibitor)-04 PET/CT of the patient, whose primary tumor could not be detected using FDG, showed high radiopharmaceutical uptake in the areas of heterogeneous thickening on peritoneal and serosal surfaces. Peritoneal Tru-Cut biopsy revealed malignant tumoral infiltration indicating mesothelioma. This case showed that 68Ga-FAPI-04 PET/CT could be a promising radiopharmaceutical in the evaluation of peritoneal mesothelioma.
Insights
This study highlights 68Ga-FAPI-04 PET/CT as a promising tool for diagnosing peritoneal mesothelioma. This imaging technique effectively identified tumor infiltration where 18F-FDG PET/CT was less conclusive, aiding in patient diagnosis.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceuticals
Background:
- Peritoneal mesothelioma diagnosis can be challenging, often requiring invasive procedures.
- 18F-FDG PET/CT is a standard imaging modality but may show limited uptake in some peritoneal malignancies.
Observation:
- An 83-year-old male presented with symptoms suggestive of peritoneal disease.
- Abdominal CT showed heterogeneous peritoneal thickening. 18F-FDG PET/CT revealed low to moderate uptake in thickened areas.
- 68Ga-FAPI-04 PET/CT demonstrated high uptake in peritoneal and serosal thickening, identifying the malignancy.
Findings:
- Peritoneal Tru-Cut biopsy confirmed malignant tumoral infiltration consistent with mesothelioma.
- 68Ga-FAPI-04 PET/CT successfully visualized areas of peritoneal mesothelioma with high radiopharmaceutical uptake.
- FDG PET/CT showed limited utility in detecting the primary tumor in this case.
Implications:
- 68Ga-FAPI-04 PET/CT shows potential as a superior imaging agent for evaluating peritoneal mesothelioma.
- This advanced imaging may improve diagnostic accuracy and guide treatment strategies for peritoneal malignancies.
- Further research is warranted to establish the role of 68Ga-FAPI-04 PET/CT in clinical practice for mesothelioma.
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