Superior Diagnostic Performance of ⁶⁸Ga-FAPI PET/CT Compared With ⁶⁸Ga-DOTATATE PET/CT in Medullary Thyroid Carcinoma.
Amin Saber Tanha, Haniye Elahifard, Mohsen Saberifar et al.
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Case in brief
A 60-year-old woman with synchronous papillary and medullary thyroid carcinomas had elevated serum calcitonin during the later course of her MTC. ⁶⁸Ga-DOTATATE PET/CT showed mildly avid locoregional and bone metastases, while nodal and liver metastases were non-avid. ⁶⁸Ga-FAPI PET/CT detected disease more effectively, particularly in the liver. She received ¹⁷⁷Lu-FAPI-2286 radioligand therapy, which was well tolerated but did not produce a biochemical response.
What made this case unusual
The liver metastases were non-avid on ⁶⁸Ga-DOTATATE imaging but were better detected with ⁶⁸Ga-FAPI PET/CT, illustrating a marked imaging difference within this patient.
Diagnostic / clinical pearl
In this case of advanced MTC, ⁶⁸Ga-FAPI PET/CT detected metastatic disease, particularly hepatic lesions, better than ⁶⁸Ga-DOTATATE PET/CT.
Why it matters
The lack of biochemical response despite tolerability of ¹⁷⁷Lu-FAPI-2286 highlights that improved lesion detection does not establish therapeutic efficacy; the report calls for standardized radioligand therapy protocols and exploration of combination strategies.