Atypical Presentation of Liver Metastasis in Medullary Thyroid Carcinoma: Variable Pattern and Interlesional Heterogeneity Observed on 18 F-FDG, 68 Ga-DOTATATE, and 68 Ga-DOTA-FAPI-04 PET/CT.

Ravada, Shyam Kumar; Parghane, Rahul Vithalrao; Malhotra, Gaurav; Basu, Sandip · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Metastatic medullary thyroid carcinoma (MTC) can exhibit variable progression, with liver metastases occurring in up to 62% of cases. We report an unusual case of 50-year-old man with progressive MTC and atypical hypodense metastasis in the left lobe of liver that showed no tracer avidity on conventional 18 F-FDG and 68 Ga-DOTATATE PET/CT but was intensely avid on 68 Ga-DOTA-FAPI-04 PET/CT, implying a possible role of FAPI PET/CT imaging in diagnosing unusual metastatic lesions that may be missed on conventional PET imaging and also its theranostic potential for future management.

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