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Bicornuate Uterus With FAPI Uptake Mimicking Ovarian Metastasis
1Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Clinical Nuclear Medicine
|May 18, 2026
Summary
Gallium-68 FAPI PET/MR imaging showed uptake in the adnexa, but 18F-FDG PET/MR ruled out malignancy. This case highlights multi-tracer imaging for differentiating benign findings from ovarian metastasis in cancer patients.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiology
Background:
- A 48-year-old woman with a history of colon cancer presented with abdominal pain and elevated tumor markers, raising concern for recurrent disease or metastasis.
- Distinguishing between benign physiological uptake and malignant lesions is crucial for accurate diagnosis and treatment planning.
Purpose of the Study:
- To evaluate the utility of combined 68Ga-FAPI and 18F-FDG PET/MR imaging in a patient with a history of colon cancer presenting with suspicious adnexal findings.
- To differentiate potential ovarian metastasis from other causes of adnexal uptake.
Main Methods:
- The patient underwent integrated 68Ga-FAPI and 18F-FDG PET/MR examinations.
- FAPI imaging assessed fibroblast activation, while FDG imaging evaluated glucose metabolism.
Main Results:
- FAPI imaging demonstrated focal uptake in both adnexal regions.
- No abnormal 18F-FDG metabolism was detected in the adnexa.
- The adnexal uptake was ultimately attributed to physiological FAPI avidity in the myometrium of a known bicornuate uterus, not ovarian metastasis.
Conclusions:
- Combined 68Ga-FAPI and 18F-FDG PET/MR imaging can effectively differentiate benign physiological uptake from malignancy in the adnexa.
- 18F-FDG PET/MR plays a vital role in excluding malignancy, while FAPI PET/MR can identify specific tissue characteristics.
- Multi-tracer PET/MR imaging enhances diagnostic accuracy in complex oncological cases, particularly in differentiating benign findings from metastasis.
