68Ga-FAPI PET/CT Depicted Non-FDG-Avid Metastatic Appendiceal Mucinous Adenocarcinoma

HomeRadiologyVol. 301, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in Radiology68Ga-FAPI PET/CT Depicted Non-FDG-Avid Metastatic Appendiceal Mucinous AdenocarcinomaLin Qiu, Yue Chen Lin Qiu, Yue Chen Author AffiliationsFrom the Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, No. 25 TaiPing St, Jiangyang District, Luzhou 646000, People's Republic of China; and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China.Address correspondence to Y.C. (e-mail: [email protected])Lin QiuYue Chen Published Online:Aug 3 2021https://doi.org/10.1148/radiol.2021210723MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 59-year-old man presented with newly diagnosed peritoneal metastatic adenocarcinoma according to peritoneal tissue sample biopsy and underwent fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT for detecting the primary tumor. However, at 18F-FDG PET/CT, no abnormal activity in the abdominal and pelvic cavity was observed on the maximum intensity projection image (Figure, A) and axial images (Figure, B–D). A gallium 68 (68Ga)–conjugated fibroblast-activation protein inhibitor (FAPI) PET/CT maximum intensity projection image (Figure, E) and axial fused images (Figure, F–H) showed innumerable abnormal increased tracer accumulation in the peritoneum, mesentery, and omentum. Additionally, a focus of increased 68Ga-FAPI uptake in the ileocecal intestinal wall (Figure, H) and in an enlarged mesenteric lymph node nearby (Figure, G) were shown. The 68Ga-FAPI PET/CT features suggested appendiceal carcinoma with lymph node metastasis and widespread peritoneal carcinomatosis. Several authors have reported that 68Ga-FAPI is a more sensitive PET tracer than 18F-FDG for some malignancies (1–3). This case demonstrated that 68Ga-FAPI PET/CT outperforms 18F-FDG PET/CT in helping to identify both primary and metastatic lesions in appendiceal mucinous adenocarcinoma. A low level of glucose transporter protein type 1 and a high level of fibroblast-activated protein may be expressed in this subtype of adenocarcinoma.Images in a 59-year-old man who presented with newly diagnosed peritoneal metastatic adenocarcinoma. (A) Fluorine 18 (18F) fluorodeoxyglucose (FDG) PET maximum intensity projection image shows no abnormal uptake in abdominal and pelvic cavity. (B–D) Axial 18F-FDG PET/CT images demonstrate (B) minimal physiologic accumulation in intestinal tract and (C, D) no abnormal activity in abdominal and pelvic cavity. (E) Gallium 68 (68Ga)–conjugated fibroblast-activation protein inhibitor (FAPI) PET maximum intensity projection image shows innumerable abnormal increased accumulation in abdominal and pelvic cavity. (F–H) Axial 68Ga-FAPI PET images show increased uptake in ileocecal intestinal wall (arrowhead in H) in enlarged mesenteric lymph node nearby (long arrow in G) and many abnormal foci in peritoneum, mesentery, and omentum (short arrows in F–H).Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: L.Q. disclosed no relevant relationships. Y.C. disclosed no relevant relationships.References1. Chen H, Pang Y, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging 2020;47(8):1820–1832. Crossref, Medline, Google Scholar2. Fan C, Guo W, Su G, Chen B, Chen H. Widespread Metastatic Gastric Signet-Ring Cell Carcinoma Shown by 68Ga-FAPI PET/CT. Clin Nucl Med 2021;46(2):e78–e79. Crossref, Medline, Google Scholar3. Liu Q, Shi S, Xu X, Yu X, Song S. The superiority of [68Ga]-FAPI-04 over [18F]-FDG PET/CT in imaging metastatic esophageal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2021;48(4):1248–1249. Crossref, Medline, Google ScholarArticle HistoryReceived: Mar 20 2021Revision requested: Apr 15 2021Revision received: Apr 16 2021Accepted: Apr 20 2020Published online: Aug 03 2021Published in print: Oct 2021 FiguresReferencesRelatedDetailsCited ByFAPI PET/CT in the Diagnosis of Abdominal and Pelvic TumorsTianshuoYang, LongMa, HaodongHou, FengGao, WeijingTao2022 | Frontiers in Oncology, Vol. 11Recommended Articles Prospective Comparison of 68Ga-FAPI versus 18F-FDG PET/CT for Tumor Staging in Biliary Tract CancersRadiology2022Volume: 304Issue: 3pp. 648-65768Ga FAPI PET/CT Imaging in Peritoneal CarcinomatosisRadiology2020Volume: 297Issue: 3pp. 521Neoplasms of the Appendix: Pictorial Review with Clinical and Pathologic CorrelationRadioGraphics2017Volume: 37Issue: 4pp. 1059-1083Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal CancersRadiology2020Volume: 298Issue: 2pp. 393-402Spectrum of MRI Features of Mucin-producing Neoplasms in the Abdomen and PelvisRadioGraphics2022Volume: 42Issue: 2pp. 469-486See More RSNA Education Exhibits Embryology And Anatomy Of The Omentum, Mesentery And Peritoneum, Oh My!Digital Posters2021The Forgotten System: Lymphatics of Abdomen and PelvisDigital Posters2022Don't Step In The Puddle: Challenges And Mimics Of Mucin-containing Lesions In Abdomen And PelvisDigital Posters2021 RSNA Case Collection Carcinoid of the Ileal NeobladderRSNA Case Collection2022Krukenberg TumorsRSNA Case Collection2021Mucinous Adenocarcinoma in Perianal FistulaRSNA Case Collection2021 Vol. 301, No. 1 Metrics Altmetric Score PDF download