The superiority of [ 68 Ga]-FAPI-04 over [ 18 F]-FDG PET/CT in imaging metastatic esophageal squamous cell carcinoma
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IMAGE OF THE MONTH
The superiority of [68Ga]-FAPI-04 over [18F]-FDG PET/CT in imaging metastatic esophageal squamous cell carcinoma Qiufang Liu 1,2 & Si Shi 2,3 & Xiaoping Xu 1,2 & Xianjun Yu 2,3 & Shaoli Song 1,2 Received: 28 June 2020 / Accepted: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Gallium-68-labeled fibroblast-activation-protein inhibitor (FAPI) presents high uptake and satisfying image contrast in several types of cancers. PET/CT imaging with radiolabeled FAPI is promising to facilitate better tumor diagnosis and staging [1, 2]. Here, we report a 62-year-old man presented with loss of appetite, emaciation for 2 months, and elevated tumor markers (CA125 377.00 U/mL, CA15–3 69.70 U/mL, and CEA 5.90 ng/mL). He was subjected to endoscopy and abdominal MRI for initial examination. The endoscopy detected an esophageal mass, and the pathology of biopsied tissue was esophageal squamous cell carcinoma (SCC). And MRI detected a soft-tissue mass in the pancreatic body. With an interval of 2 days, the patient then received [18F]-FDG and [68Ga]-
This article is part of the Topical Collection on Image of the month * Shaoli Song [email protected] 1
Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
2
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
3
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
FAPI-04 PET/CT scans for adequate staging and evaluation. [18F]-FDG PET/CT revealed a lesion in the lower esophagus with high uptake (SUVmax = 6.4) and a soft-tissue mass in the pancreatic body (SUVmax = 12.9). [18F]-FDG PET/CT also visualized enlarged lymph nodes in mediastinum, abdominal cavity, and retroperitoneal space with moderate-to-high uptake (SUVmax = 5.3–11.3). Additionally, [18F]-FDG PET/CT revealed small lymph nodes (with diameter < 10 mm) in the right upper neck, left supraclavicular area, and bilateral hilar regions with low uptake (SUVmax = 2.3–3.8), and the vague lymph nodes were highlighted by blue arrows in the Fig. a. In comparison, [68Ga]-FAPI-04 PET/CT detected tumors in the lower esophagus and pancreatic body with higher contrast and clarity. The uptake value in terms of SUVmax in these two lesions is 12.8 and 20.8, respectively (Fig. a–b). More importantly, [68Ga]-FAPI-04 PET/CT demonstrated more lymph nodes with higher uptake in the bilateral tracheoesophageal grooves, left axillary, abdominal cavity, and retroperitoneal areas than [18F]-FDG PET/CT (Fig. b, yellow arrows). Remarkably, [68Ga]-FAPI-04 PET/CT clearly delineated additional lymph nodes with intense uptake in the right retrocrural space. The small lymph nodes with low-to-mild uptake on 18F-FDG PET/CT images had no [68Ga]-FAPI-04 uptake. As a result, we considered these lymph nodes as inflammatory after multidisciplinary discussions. Finally, the patient underwent endoscopic ultrasound-guided biopsy of the pancreatic mass, and immunochemical-stai
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