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AIM: This study aimed to compare the diagnostic capabilities of 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT imaging in staging gastric carcinoma, exploring the impact of 68 Ga-FAPI-04 PET/CT on treatment planning and its prognostic significance. METHODS: The research included 31 patients undergoing staging for gastric cancer, who received both 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT scans. We compared the SUV max and SUV mean of the primary tumor and lymph nodes, the count of organ metastases, tumor-to-background ratios, and overall staging accuracy. Additionally, the study evaluated radiological progression-free survival and overall survival rates. RESULTS: The 68 Ga-FAPI-04 PET/CT demonstrated superior efficacy in identifying the primary tumor compared with 18 F-FDG PET/CT, particularly in cases of poorly cohesive, signet-ring cell, and mucinous subtypes, with detection rates of 96.7% versus 77.4% ( P = 0.006 and P = 0.008, respectively). Analysis of lymph nodes showed a significantly higher detection of positive nodes with 68 Ga-FAPI-04 ( P = 0.026), although no significant differences were observed in SUV max and tumor-to-background ratio on a patient basis ( P > 0.05). SUV max and tumor-to-background ratios for peritoneal involvement were notably higher with 68 Ga-FAPI-04 PET/CT compared with 18 F-FDG PET/CT ( P = 0.04 for both). No significant differences were found in the detection of organ metastases and disease stage between the 2 imaging modalities ( P > 0.05). Primary tumor uptake did not significantly impact radiological progression-free survival or overall survival in either modality. CONCLUSIONS: 68 Ga-FAPI-04 PET/CT imaging surpasses 18 F-FDG PET/CT in detecting the primary tumor, especially in poorly cohesive and signet-ring cell gastric cancer types, and offers improved accuracy in disease staging. This indicates its potential to enhance treatment management and prognostic assessment in gastric cancer patients.

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ABSTRACT: A 76-year-old woman was diagnosed breast carcinoma and treated with breast-conserving surgery and chemoradiotherapy. A year after the treatment completion, restaging 18 F-FDG PET/CT scan detected no any pathological finding. However, due to a lesion detected during physical examination on the right thoracic wall adjacent to the primary tumor bed, 18 F-FDG PET/CT imaging was performed 9 months later for restaging. Highly intense FDG uptake was detected in an approximately 1-cm nodular lesion, and metastasis was reported as suspicious, and histopathological confirmation was recommended. Excision was performed and pathological examination diagnosed benign cellular fibrous histiocytoma.

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PURPOSE: In this prospective study, we aimed to make a quantitative assessment of the lacrimal glands before and after radioactive iodine (RAI) treatment in patients with hyperthyroidism and thyroid cancer. METHODS: The study included 80 eyes of 40 patients. There were 25 patients in group 1 (hyperthyroid group) and 15 patients in group 2 (thyroid cancer group). Group 1 has received low dose ( 131 I) and group 2 high dose ( 131 I). Before, and at the first and sixth month after RAI treatment, all patients underwent ophthalmological examinations, Schirmer tests, TBUT tests, tear osmolarity (TO), and ocular surface examinations. RESULTS: The age and sex characteristics of both groups were similar. Although no significant change was observed in tear film tests before and after treatment in group 1, a significant decrease in Schirmer and TBUT values and a significant increase in TO were observed in group 2 in the first month after treatment. These values returned to normal in the sixth month. Although no Schirmer test was observed lower than 10 mm in any patient before RAI treatment, the Schirmer test was measured 5 to 10 mm in 4 (10%) patients in group 2 in the first month after treatment. Again, in these patients, TBUT was below 10 seconds and TO was greater than 308 mOsm/L. CONCLUSIONS: In this study, although no change was observed in tear function tests in patients receiving low doses of RAI, a decrease in tear secretion and an increase in TO were detected in patients receiving high doses in the early period.

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ABSTRACT: We present an 87-year-old man diagnosed with prostate cancer and neuroendocrine differentiation, posttherapy results to consecutive 177 Lu-prostate-specific membrane antigen and 177 Lu-DOTATATE. Despite hormonal therapy and chemoradiotherapy, the patient progressed rapidly, and multiple liver and bone metastases showed regression after 177 Lu-prostate-specific membrane antigen and 177 Lu-DOTATATE treatment. Prostate cancer with neuroendocrine differentiation is resistant to treatments; however, treatment with the combination of 177 Lu-DOTATATE therapy may be promising.

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ABSTRACT: Medication-related osteonecrosis of the jaw (ONJ) is rare adverse effect of zoledronic acid. We present ONJ detected in a 65-year-old man with prostate cancer who underwent 18 F-FDG PET/CT for metabolic characterization and to exclude a second primary malignancy of the liver lesion observed in 68 Ga-PSMA PET/CT. ONJ has high metabolic activity on 18 F-FDG PET/CT and no PSMA receptor activation on the 68 Ga-PSMA PET/CT. In this case, we wanted to underline the importance of 18 F-FDG PET/CT imaging of medication-related ONJ in patients receiving zoledronic acid therapy and to emphasize that rapid and appropriate treatment can be provided.

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PURPOSE: Prostate-specific membrane antigen (PSMA)-targeted PET/CT is a well-established imaging method in prostate cancer (PC) for both staging and restaging, and also for theranostic applications. An alternative imaging method is crucial for 15% PSMA-negative cases. We aimed to investigate the contribution of 68 Ga-DOTA-FAPI-04 PET/CT to PC imaging. PATIENTS AND METHODS: Thirty-six patients diagnosed with PC were included. Patients underwent both 68 Ga-PSMA PET/CT and 68 Ga-DOTA-FAPI-04 PET/CT imaging within 1 week. In staging group, primary tumor uptake values were compared, and also correlations were done with histopathological findings, MRI findings, and total PSA levels. In biochemical recurrence group, the uptake values in prostatic region and metastases were evaluated to define the local recurrence or metastatic disease. RESULTS: In staging group, PSMA PET showed increased uptake in the primary lesion area in 14/27 (52%) patients, whereas 20/27 (74%) patients were positive in FAPI-04 PET. FAPI-04 positivity was found to be quite high, such as 54%, in PSMA-negative patients. A significant difference was observed between ISUP grade 1-3 patients and ISUP grade 4-5 patients in FAPI-04 PET ( P = 0.03). Local recurrence was detected in 3 patients, pelvic lymph node metastasis in 1 patient, and sacrum metastasis in 1 patient in biochemical recurrence group, and all of the lesions had more intense uptake in PSMA PET than FAPI-04 PET. CONCLUSIONS: FAPI PET imaging seems to have a potential to contribute PSMA PET imaging with FAPI positivity in more than half of PSMA-negative cases. Also, FAPI-targeted radionuclide therapy may be a promising method in patients resistant to PSMA-targeted therapy.

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A 70-year-old man with newly diagnosed rectum adenocarcinoma was referred to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging, and 68Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT for ongoing trial. Both 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT showed intense uptake in the primary rectal tumor, and also in nodular areas in the right lung. Due to intense 68Ga-FAPI-04 and 18F-FDG uptake, the lung lesions were considered as metastases. However the lesions were reduced in size on CT after 20 days antibiotherapy and diagnosed as pneumonia.

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ABSTRACT: We present a case of bilateral Phyllodes tumor located in both breasts in a 41-year-old woman who was detected with increased uptake on 68 Ga-FAPI-04 (fibroblast activation protein inhibitor) and 18 F-FDG PET/CT imaging. The tumor filling up the right breast was identified as borderline Phyllodes. The tumor with mild uptake in the left breast was reported as a benign Phyllodes tumor.

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AIM: Benign colonic lesions like tubular adenoma may show intense uptake on F-18-FDG PET/CT and can be mistaken for malignancy. In this study, we evaluated the role of 68Ga-FAPI-04 PET/CT for discriminating the benign and malignant colonic lesions. METHODS: Forty patients with diagnosis of colorectal cancer who had undergone 18F-FDG-PET/CT and 68Ga-FAPI-04 PET/CT for initial staging were retrospectively analyzed. The unexpected foci of uptake in colon on 18F-FDG PET/CT were compared with 68Ga-FAPI-04 PET/CT with lesion and background SUVmax. RESULTS: The primary colorectal lesion SUVmax on both PET/CTs was similar. A total of 9 incidental colon lesions in 7 patients were detected showing intense 18F-FDG uptake and no 68Ga-FAPI-04 uptake. All of the lesions were consistent with tubular adenoma histopathologically. CONCLUSION: 68Ga-FAPI PET/CT may have a crucial role for discrimination of benign and malignant colonic lesions and avoid the unnecessary interventions and extended surgeries in patients with colorectal cancer.

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PURPOSE: In this prospective study, PET findings of 18 F-FDG PET/CT in breast cancer staging were compared with 68 Ga-FAP inhibitor (FAPI) 04 PET/CT findings in selected cases with relatively low 18 F-FDG uptake in the primary tumor or with suspected nodal or distant metastases. PATIENTS AND METHODS: Twenty-four women with a median age of 45 years (range, 36-67 years) who underwent initial staging 18 F-FDG PET/CT for breast cancer underwent 68 Ga-FAPI-04 PET/CT imaging within the same week. SUV max and quantities of primary tumors and locoregional and distant metastatic lesions were recorded from both images, and these data were compared statistically. RESULTS: The histological subtypes of primary tumors were 11 invasive lobular, 8 invasive ductal, and 5 mucinous subtypes. More intense 68 Ga-FAPI-04 uptake (mean, 17.1 ± 7.9; 7.4-38.5) was detected in all primary tumoral lesions compared with 18 F-FDG (mean, 6.3 ± 3.9; 1.5-20.5) ( P = <0.001, Z = 4.107). Additional lesions showing 68 Ga-FAPI-04 uptake in the breast were detected in 29.2% (n = 7) of patients. In 8.3% (n = 2) of the patients, the primary lesion showed only 68 Ga-FAPI-04 uptake. In 68 Ga-FAPI-04 PET/CT, 25% (n = 6) of the patients showed more lymph node involvement and more intense uptake in the ipsilateral axilla. In addition, infraclavicular (level 3) lymph nodes in 4 patients (16.7%), supraclavicular lymph nodes in 1 patient, and internal mammary lymph nodes in 1 patient were detected only on 68 Ga-FAPI-04 PET/CT. In a patient with lung and bone metastases, 68 Ga-FAPI-04 uptake was higher, and the lung nodule showed only 68 Ga-FAPI-04 uptake. CONCLUSIONS: In selected low-FDG-affinity breast cancer patients, 68 Ga-FAPI-04 PET/CT showed the primary tumor with higher sensitivity and higher SUV max values compared with 18 F-FDG PET/CT. In addition, it is believed that this method may contribute to the management of patients' treatment by increasing the nodal stage.

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Fibroblast activation protein (FAP) is expressed as a pro-inflammatory agent from fibrous tissue in liver cirrhosis and in the tumor microenvironment. Cirrhosis is the last stage of any chronic liver disease, and the natural course of cirrhosis is the progression from the asymptomatic phase to the symptomatic decompensated phase with the development of ascites. Although various clinical features suggest cirrhosis in patients with chronic liver disease, non-invasive methods should follow the clinical approach before a definitive diagnosis. Herein, we present three cases of liver cirrhosis with fibroblast activation protein inhibitor (FAPI) uptake to demonstrate the usefulness of 68Ga-FAPI-04 positron emission tomography/computed tomography (PET/CT) scan in cirrhosis.

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Rectal neuroendocrine carcinomas constitute <1% of all neuroendocrine carcinomas and <1% of all gastrointestinal tract malignancies. Cutaneous metastases of rectal neuroendocrine carcinoma are rarer than visceral metastases. We represent a 71-year-old man who was diagnosed with neuroendocrine tumor grade 3 originating from the rectum 1 year ago. He was referred for 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography for restaging after 6 cycles of chemotherapy and radiotherapy. Intensely increased 18F-FDG uptake in the right cutaneous inguinal region was consistent with neuroendocrine carcinoma metastasis with biopsy from the same region.

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Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract; however, they can also be rarely seen in other organs. Testicular neuroendocrine tumors account for less than 1% of all testicular neoplasms. They may present as primary testicular or secondary tumors from extratesticular sources. Jejunal neuroendocrine tumor metastasis to the testis is extremely rare. We present the case of a 61-year-old man with a jejunal neuroendocrine tumor and metastases to bilateral testicles revealed on Gallium-68-DOTATATE positron emission tomography/computed tomography.

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AIM: Aim of study is to compare the results of Gallium-68-prostate-specific membrane antigen ( 68 Ga-PSMA) and 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography(PET)/computed tomography (CT), to evaluate the correlation between PET findings and the level of PSMA, Claudin (Clau) 1, 4, and 7 receptors obtained by immunohistochemical (IHC) analysis, and to determine potential predictive and prognostic values in TNBC. METHODS: Forty-seven lesions of 42 subjects diagnosed TNBC both underwent PET/CT scan for preoperative staging/restaging were prospectively included study. PSMA, Clau 1, 4, and 7 expressions were IHC evaluated from the biopsy samples of the primary tumor (PT). Maximum standardized uptake value(SUV max) of the PT, lymph node, and distant organ metastases (DOMs) on 18 F-FDG and 68 Ga-PSMA PET/CT were compared with PSMA, Clau 1, 4, and 7 receptor expressions. RESULTS: IHC analyses on 29 BC lesions to demonstrate Clau expression showed 86% (25/29) Clau 1, 86% (25/29) Clau 4, 45% (13/29) Clau 7, and 48% (14/29) PSMA-positive. The mean DOM (SUVmax) was 15.5 ± 11.6 for 18 F-FDG and 6.0 ± 2.9 for 68 Ga-PSMA. Axial diameter of BC PT had a significant positive correlation with 18 F-FDG SUVmax, 68 Ga-PSMA SUVmax, and PSMA scores. BC lesions 68 Ga-PSMA SUVmax had a significant negative correlation with the Ki-67 index. Axial diameter of the primary tumor had significant negative correlation with Clau 7 scores ( r = -0.409, P = 0.034). Absence of Clau 1 expression found to significantly increase the rate of DOM (100% vs. 28%) ( P = 0.014). All patients with axillary lymph node (ALN) metastases ( n = 17, 100%) exhibited Clau 4 positivity ( P = 0.021). The presence of PSMA expression observed to significantly increase the rate of ALN metastases (64.7% vs. 25%) ( P = 0.035). CONCLUSION: Confirming PSMA expression with PET imaging would be significant as PSMA, a theranostic agent, may be a considerable potential agent for radionuclide treatment strategies, in addition to its additional diagnostic contribution to FDG, especially in patients with metastatic TNBC, which is an aggressive, heterogeneous disease.

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ABSTRACT: We presented a 69-year-old man with liver cirrhosis who underwent 68 Ga-fibroblast activation protein (FAPI)-04 PET/CT imaging for an ongoing study. In addition to the significant activity in liver cirrhosis on FAPI PET, a primary prostate tumor was incidentally detected with bone metastases. Further, FAPI-negative metastases were not observed on CT evaluation. In this context, we think that FAPI may be helpful with the potential theranostic aspect, especially in selected patients when current treatment options are not applicable or unresponsive. However, we should await the results of prospective studies investigating both prognostic and theranostic use of FAPI and demonstrating its effectiveness in cancer therapy.

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ABSTRACT: A 47-year-old woman had complaint of palpable swelling in the left breast for the last 3 weeks. 18F-FDG PET/CT for staging of concomitant invasive carcinoma in the right breast and 68Ga-labeled fibroblast activation protein inhibitor 04 PET/CT imaging in an ongoing study were performed. Increased radiopharmaceutical uptake was observed in both PET/CT imaging in complex fibroadenoma located in the left breast.

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ABSTRACT: A 79-year-old man with prostate cancer was evaluated with 68Ga-prostate-specific membrane antigen (PSMA), 68Ga-FAPI-04, and 18F-FDG PET/CT scans since a rise in prostate-specific antigen was seen at last control while receiving chemotherapy. Abnormal FDG uptakes were observed in the tumoral areas of the left half of the prostate and walls of the bladder, although PSMA and FAPI activity were absent or lower in the relevant tumoral areas. Restaging 68Ga-PSMA and 18F-FDG PET/CT scans were obtained on the patient whose progression continued after transurethral tumor resection. Herein, we present a case proving intraindividual tumor heterogeneity in prostate cancer underwent PET/CT imaging with 3 different radiopharmaceuticals.

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ABSTRACT: A 58-year-old man who underwent surgery for a well-differentiated neuroendocrine tumor of pancreatic origin was evaluated with 68Ga-DOTATATE PET/CT imaging in the follow-up period. After PET/CT findings consistent with disease remission, the patient was started on leflunomide treatment with the diagnosis of rheumatoid arthritis. The patient received leflunomide for 6 months. Then, 68Ga-DOTATATE PET/CT scan was repeated to evaluate the primary disease outcome. Besides the disease remission, we also observed alterations in DOTATATE uptakes of some tissues and organs. In this case, we present the changes in 68Ga-DOTATATE PET/CT scan findings after leflunomide use.

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ABSTRACT: A 57-year-old man with familial adenomatous polyposis (FAP) and newly diagnosed colonic adenocarcinoma was referred to 18 F-FDG PET/CT for staging and 68 Ga-FAPI-04 PET/CT for ongoing trial. 18 F-FDG PET/CT showed equal intense 18 F-FDG uptake in the tumor and multiple hypermetabolic polypoid lesions in the entire colorectum. 68 Ga-FAPI-04 PET/CT showed intense 68 Ga-FAPI-04 uptake only at the colonic tumor, without uptake at polypoid lesions.

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ABSTRACT: We present 2 patients mimicking malignancy with intense gastric 68 Ga-FAPI-04 uptake on PET/CT. Both patients showed low to moderate 18 F-FDG uptake. Histopathology revealed chronic active gastritis. Chronic gastritis may resemble gastric malignancies by showing false-positive 68 Ga-FAPI-04 uptake.

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