[68Ga]Ga-FAPI-46 PET/CT in a patient with peritoneal carcinomatosis

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We present a case of a patient, previously treated for peritoneal metastases from colorectal cancer with HIPEC surgery, who underwent PET/CT with [⁶⁸Ga]Ga-FAPI-46 at our centre to determine whether peritoneal carcinomatosis had recurred. This was the first clinical application of this novel tracer that targets cancer associated fibroblast activity. Conventional contrast enhanced CT and MRI were acquired in conjunction. The [⁶⁸Ga]Ga-FAPI-46 PET/CT clearly demonstrated intense focal tracer uptake in a pelvic peritoneal deposition that was also apparent on CT. In addition, [⁶⁸Ga]Ga-FAPI-46 PET/CT demonstrated another peritoneal deposition on the serosal surface of a bowel wall that was missed in the clinical CT and MRI read, as well as more subtle diffuse peritoneal metastatic involvement in the abdomen, which was not at all visible on radiological imaging. This case illustrates the anticipated clinical value that FAPI-PET/CT may come to play in challenging oncological imaging tasks such as the detection of peritoneal carcinomatosis.