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.
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.
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.
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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This work was supported by National Natural Science Foundation of China (No. 82030052, and 81901783).
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Zhang, X., Song, W., Qin, C. et al. Non-malignant findings of focal 68Ga-FAPI-04 uptake in pancreas. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05194-6