99m Tc-FAPI-46 Uptake in Medication-Related Jaw Osteonecrosis

We present a case of a 58-year-old woman with a history of breast cancer who developed medication-related osteonecrosis of the jaw following a dental extraction. Notably, a 99m Tc-FAPI-46 scintigraphy revealed increased FAPI uptake at the site of osteonecrosis. This scan also identified skeletal metastases that had been previously undetected by a 99m Tc-MDP scan. This case demonstrates the potential of FAPI imaging in enhancing the detection of skeletal metastatic lesions. Our experience highlights the novelty of 99m Tc-FAPI uptake in jaw osteonecrosis and suggests its potential advantages for diagnosing metastatic breast cancer, especially in resource-limited countries where 68 Ga-FAPI PET/CT might not be available.