Increase 68 Ga-FAPI Uptake in Urogenital Tuberculosis

Area of Science:

• Urology
• Nuclear Medicine
• Infectious Diseases

Background:

• Urogenital tuberculosis is a common form of extrapulmonary tuberculosis.
• Prostate involvement can be challenging to diagnose, especially with elevated prostate-specific antigen (PSA) levels.
• Conventional imaging may not always detect subtle tuberculous lesions.

Observation:

• A 60-year-old male presented with elevated PSA, prompting multiparametric MRI.
• MRI showed abnormal prostate signals, but 68 Gallium-Prostate-Specific Membrane Antigen (Ga-PSMA) PET/CT was inconclusive.
• Subsequent 68 Gallium-Fibroblast Activation Protein (Ga-FAPI) PET/CT revealed intense prostate uptake and mild left kidney uptake.

Findings:

• 68 Ga-FAPI PET/CT demonstrated significant uptake in the prostate, consistent with inflammation or infection.
• Mild uptake in the left kidney was also noted.
• Histopathological examination confirmed tuberculosis as the cause of the observed uptake.

Implications:

• 68 Ga-FAPI PET/CT may serve as a valuable tool for diagnosing prostate tuberculosis, particularly when other methods fail.
• This imaging modality could improve the detection of uncommon presentations of urogenital tuberculosis.
• FAPI-based PET/CT offers potential for identifying inflammatory and infectious processes beyond its established role in oncology.