68Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer

The recent development of quinoline-based PET tracers that act as fibroblast-activation-protein inhibitors (FAPIs) demonstrated promising preclinical and clinical results. FAP is overexpressed by cancer-associated fibroblasts of several tumor entities. Here, we quantify the tumor uptake on ⁶⁸Ga-FAPI PET/CT of various primary and metastatic tumors to identify the most promising indications for future application. Methods:⁶⁸Ga-FAPI PET/CT scans were requested by various referring physicians according to individual clinical indications that were considered insufficiently covered by ¹⁸F-FDG PET/CT or other imaging modalities. All PET/CT was performed 1 h after injection of 122–312 MBq of ⁶⁸Ga-FAPI-04. We retrospectively identified 80 patients with histopathologically proven primary tumors or metastases or radiologically unequivocal metastatic lesions of histologically proven primary tumors. Tumor uptake was quantified by SUV_max and SUV_mean (60% isocontour). Results: Eighty patients with 28 different tumor entities (54 primary tumors and 229 metastases) were evaluated. The highest average SUV_max (>12) was found in sarcoma, esophageal, breast, cholangiocarcinoma, and lung cancer. The lowest ⁶⁸Ga-FAPI uptake (average SUV_max < 6) was observed in pheochromocytoma, renal cell, differentiated thyroid, adenoid cystic, and gastric cancer. The average SUV_max of hepatocellular, colorectal, head–neck, ovarian, pancreatic, and prostate cancer was intermediate (SUV 6–12). SUV varied across and within all tumor entities. Because of low background in muscle and blood pool (SUV_max < 2), the tumor-to-background contrast ratios were more than 3-fold in the intermediate and more than 6-fold in the high-intensity uptake group. Conclusion: Several highly prevalent cancers presented with remarkably high uptake and image contrast on ⁶⁸Ga-FAPI PET/CT. The high and rather selective tumor uptake may open up new applications for noninvasive tumor characterization, staging examinations, or radioligand therapy.