Optimizing Intrahepatic Cholangiocarcinoma Staging: Comparison of [ 18 F]FDG, [ 68 Ga]Ga-FAPI, and [ 68...

Area of Science:

• Nuclear Medicine
• Oncology
• Radiochemistry

Background:

• Intrahepatic cholangiocarcinoma (ICC) is a challenging liver cancer.
• Accurate initial staging is crucial for effective treatment planning.
• Positron emission tomography/computed tomography (PET/CT) tracers play a key role in staging.

Purpose of the Study:

• To compare the efficacy of three PET/CT tracers ([18F]FDG, [68Ga]Ga-Trivehexin, and [68Ga]Ga-FAPI-04) for initial staging of ICC.
• To evaluate the diagnostic performance of these tracers in identifying primary and metastatic lesions.

Main Methods:

• A single patient with biopsy-proven ICC underwent staging with [18F]FDG, [68Ga]Ga-Trivehexin, and [68Ga]Ga-FAPI-04 PET/CT.
• Comparative analysis of tracer uptake in the primary liver lesion and metastatic lymph nodes (cervical and abdominal).

Main Results:

• The primary ICC lesion showed increased uptake across all three tracers.
• [68Ga]Ga-FAPI-04 and [68Ga]Ga-Trivehexin visualized metastatic cervical lymph nodes, while [18F]FDG did not.
• [68Ga]Ga-FAPI-04 PET/CT additionally identified metastatic abdominal lymph nodes.

Conclusions:

• [68Ga]Ga-FAPI-04 PET/CT demonstrates high potential for ICC staging, effectively identifying metastatic sites missed by [18F]FDG.
• [68Ga]Ga-Trivehexin PET/CT may serve as a viable alternative to [18F]FDG PET/CT.
• FAPI-based tracers show promise and warrant further investigation in ICC management.