Utility of 99mTc-FAPI-46 SPECT/CT in Restaging Hepatocellular Carcinoma: A Case Report

We present a 54-year-old man with hepatocellular carcinoma (HCC) presenting with diffuse bone pain 6 months postradiofrequency ablation. 99mTc-FAPI-46 SPECT/CT was performed to evaluate disease extent, confirming locally active primary HCC and revealing widespread FAPI-avid bone metastases. Considering the low performance of FDG PET/CT scan in hepatocellular carcinoma, this case highlights 99mTc- FAPI-46 Scintigraphy as a highly sensitive, accessible radiopharmaceutical for comprehensive HCC restaging, offering excellent visualization of stroma-rich extrahepatic lesions and critical insights into advanced tumor biology.