Improved staging diagnosis using [68Ga]-DOTA-FAPI-04 PET/CT in a patient with nasopharyngeal carcinoma

Introduction  Early imaging of HNSCC and locoregional metastases is challenging due to increased glucose accumulation in surrounding tissues on [18F]-FDG PET/CT, which is the diagnostics of choice since decades.

[68Ga]-DOTA-FAPI-04 PET/CT allows more precise imaging by direct visualization of the tumor microenvironment in the form of cancer-associated fibroblasts and can therefore improve the early detection of HNSCC and locoregional metastases Case Report  A patient with nasopharyngeal carcinoma received repeated imaging with [18F]-FDG and [68Ga]-DOTA-FAPI-04 PET/CT under the same conditions and with little time gap. [68Ga]-DOTA-FAPI-04 PET/CT showed enhancement of a retropharyngeal lymph node and osseous lesions of the mandible on the right and the clavicle on the left side in addition to the primary tumor and cervical lymph nodes. In [18F]-FDG PET/CT performed at the same time, the retropharyngeal lymph node did not pathologically enrich while the osseous lesion of the mandible was retrospectively seen in conventional imaging. [68Ga]-DOTA-FAPI-04 PET/CT here is indicative of a palliative approach and adaptation of a palliative radiation field. Control [18F]-FDG PET/CT postintervention shows rapid progression with distant metastases and thoracoabdominal suspicious lymph nodes.

Conclusion  In our patient, simultaneous imaging with [68Ga]-DOTA-FAPI-04 PET/CT enabled a more precise imaging of the tumor microenvironment. This led to an adequate prognostic assessment with palliative therapy concept and adjustment of the radiation field.

Publication History

Article published online:
12 May 2023