Xiao Zhang1,2, Wenyu Song1,2, Chunxia Qin1,2, Fang Liu1,2, Xiaoli Lan3,4. 1. Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. 2. Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China. 3. Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. xiaoli_lan@hust.edu.cn. 4. Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China. xiaoli_lan@hust.edu.cn.
Abstract
PURPOSE: 68Ga-Labelled Fibroblast Activation Protein Inhibitor (68Ga-FAPI) has shown promise in tumour positron emission tomography (PET) imaging, including malignant pancreatic lesions. Here, we showed several non-malignant findings of focal 68Ga-FAPI-04 uptake in the pancreas which were occasionally found by PET/MR. The study aimed to investigate the reasons for the focal uptake and remind caution for the diagnosis. METHODS: We retrospectively analysed imaging data of 103 patients who underwent 68Ga-FAPI-04 PET/MR at our institute from May 22 to July 8, 2020. Seven patients had focally elevated uptake of 68Ga-FAPI-04 in the pancreas; four of these underwent simultaneous 18F-FDG PET/CT scans. The clinical data, PET/MR imaging features, pathological, and follow-up results were further collected and analysed. RESULTS: The cases showed that 68Ga-FAPI-04 accumulation can occur in any part of the pancreas, with corresponding negative 18F-FDG uptake. Most lesions were small with no significant changes in CT or MR signals. The SUVmax value of 68Ga-FAPI-04 had a wide range of 3.1-9.1. All the pancreatic lesions were proven to be non-neoplastic by pathology confirmation or follow-up imaging. Lesions with uptake were identified including pancreatic pseudocysts, sites of prior pancreatitis, and foci of IgG 4-related disease. CONCLUSION: Though 68Ga-FAPI-04 demonstrates great potential for oncological diagnosis, focal 68Ga-FAPI-04 uptake could occur in benign pancreatic lesions and should be carefully evaluated. Fortunately, combined with MR, 68Ga-FAPI-04 PET/MR may potentially avoid the misdiagnosis of some pancreatic lesions. CLINICAL TRIAL REGISTRATION: NCT04554719 and NCT04605939. Registered September 13, 2020 and October 25, 2020, respectively.
PURPOSE: 68Ga-Labelled Fibroblast Activation Protein Inhibitor (68Ga-FAPI) has shown promise in tumour positron emission tomography (PET) imaging, including malignant pancreatic lesions. Here, we showed several non-malignant findings of focal 68Ga-FAPI-04 uptake in the pancreas which were occasionally found by PET/MR. The study aimed to investigate the reasons for the focal uptake and remind caution for the diagnosis. METHODS: We retrospectively analysed imaging data of 103 patients who underwent 68Ga-FAPI-04 PET/MR at our institute from May 22 to July 8, 2020. Seven patients had focally elevated uptake of 68Ga-FAPI-04 in the pancreas; four of these underwent simultaneous 18F-FDG PET/CT scans. The clinical data, PET/MR imaging features, pathological, and follow-up results were further collected and analysed. RESULTS: The cases showed that 68Ga-FAPI-04 accumulation can occur in any part of the pancreas, with corresponding negative 18F-FDG uptake. Most lesions were small with no significant changes in CT or MR signals. The SUVmax value of 68Ga-FAPI-04 had a wide range of 3.1-9.1. All the pancreatic lesions were proven to be non-neoplastic by pathology confirmation or follow-up imaging. Lesions with uptake were identified including pancreatic pseudocysts, sites of prior pancreatitis, and foci of IgG 4-related disease. CONCLUSION: Though 68Ga-FAPI-04 demonstrates great potential for oncological diagnosis, focal 68Ga-FAPI-04 uptake could occur in benign pancreatic lesions and should be carefully evaluated. Fortunately, combined with MR, 68Ga-FAPI-04 PET/MR may potentially avoid the misdiagnosis of some pancreatic lesions. CLINICAL TRIAL REGISTRATION: NCT04554719 and NCT04605939. Registered September 13, 2020 and October 25, 2020, respectively.
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