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An Automated Radiosynthesis of [68Ga]Ga-FAPI-46 for Routine Clinical Use
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FAPI: a solution to all, what about NENs?

Ozgul Ekmekcioglu1, Filiz Celik2, Simon Hughes3

  • 1Nuclear Medicine Department, Yeditepe University Medical Faculty, Kosuyolu, Istanbul, Türkiye. ozgulek@gmail.com.

EJNMMI Reports
|July 8, 2026
PubMed
Summary

Fibroblast activation protein (FAP) PET imaging visualizes tumor stroma by targeting cancer-associated fibroblasts. This technique enhances lesion detection in neuroendocrine neoplasms (NENs), offering valuable complementary information.

Keywords:
FAPIFibroblast activation proteinNeuroendocrine tumorsPET/CT

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiochemistry

Background:

  • Fibroblast activation protein (FAP)-targeted positron emission tomography (PET) imaging visualizes tumor stroma by targeting cancer-associated fibroblasts (CAFs).
  • This approach offers high tumor-to-background contrast and improved lesion detection, particularly in tumors with low [¹⁸F]FDG avidity.
  • CAFs play a crucial role in tumor progression and response to therapy.

Purpose of the Study:

  • To review the biological rationale, current evidence, and potential clinical applications of FAP-targeted PET imaging in neuroendocrine neoplasms (NENs).
  • To explore how FAPI PET can provide complementary information to conventional imaging modalities for NENs.

Main Methods:

  • Literature review of studies investigating FAPI PET in NENs.
  • Evaluation of the biological basis for targeting CAFs in NENs.
  • Analysis of current clinical evidence and potential future roles of FAPI PET in NEN management.

Main Results:

  • FAPI PET demonstrates potential for high tumor-to-background contrast in NENs.
  • It may improve lesion detection in NENs with low [¹⁸F]FDG uptake.
  • Stromal imaging with FAPI PET offers complementary information to conventional diagnostic methods.

Conclusions:

  • FAPI PET imaging is a promising technique for visualizing the tumor stroma in NENs.
  • Its ability to target CAFs may enhance diagnostic accuracy and inform therapeutic strategies.
  • Further clinical evaluation is warranted to establish the full role of FAPI PET in NEN management.