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Fibroblast Activation Protein: Molecular Imaging and Beyond.

Sophie C Siegmund¹, Rudolf A Werner², Frederik L Giesel³

¹Department of Nuclear Medicine, LMU University Hospital Munich, Marchioninistr. 15, 81377 Munich, Bavaria, Germany.

|April 30, 2026

Summary

Fibroblast activation protein (FAP) PET/CT offers high-contrast tumor imaging. Structured reporting aids interpretation, while FAP-targeted therapies show promise but need more clinical trials for translation.

Keywords:

FAP ligands FAP-RADS PET/CT Standardized reporting Theranostics

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Area of Science:

Oncology and Nuclear Medicine
Molecular Imaging and Theranostics

Background:

Fibroblast activation protein (FAP)-targeted PET/CT is increasingly utilized for visualizing stromal activation in desmoplastic tumors.
Challenges in interpreting benign fibroblastic processes necessitate structured reporting for FAP imaging.
Early FAP-targeted radionuclide therapy shows feasibility but faces limitations like rapid tracer washout and insufficient clinical trials.

Purpose of the Study:

To review current applications of FAP imaging in oncology.
To summarize FAP-targeted theranostic approaches.
To explore image-guided strategies using FAP PET for novel drug development.

Main Methods:

Review of current literature on FAP-targeted PET/CT imaging.
Analysis of early-stage FAP-targeted radionuclide therapy studies.
Exploration of theranostic concepts and image-guided therapeutic strategies.

Main Results:

FAP PET/CT provides high-contrast visualization of tumor stroma.
Structured reporting is crucial for accurate interpretation of FAP imaging.
FAP-targeted therapies demonstrate potential but require further clinical validation.

Conclusions:

FAP imaging is a valuable tool in oncology, aiding in tumor visualization and potentially guiding therapy.
Further research and clinical trials are essential to overcome limitations in FAP-targeted radionuclide therapy.
Image-guided strategies utilizing FAP PET may enhance the development and application of novel FAP-targeted drugs.