Optimizing Intrahepatic Cholangiocarcinoma Staging: Comparison of [ 18 F]FDG, [ 68 Ga]Ga-FAPI, and [ 68 Ga]Ga-Trivehexin PET/CT Imaging.

Denizmen Zorba, Dilara; Arslan, Dilsat Firat; Sanli, Yasemin; Kuyumcu, Serkan · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Herein, we present a case of a patient with intrahepatic cholangiocarcinoma (ICC) who underwent [ 18 F]FDG, [ 68 Ga]Ga-Trivehexin, and [ 68 Ga]Ga-FAPI-04 PET/CT scans for initial staging. The primary liver lesion demonstrates progressively increased uptake across all 3 tracers, whereas metastatic cervical lymph nodes are visualized with [ 68 Ga]Ga-FAPI-04 PET/CT and [ 68 Ga]Ga-Trivehexin but not with [ 18 F]FDG; importantly, [ 68 Ga]Ga-FAPI-04 PET/CT, in addition, delineates metastatic abdominal lymph nodes. This case highlights that [ 68 Ga]Ga-Trivehexin PET/CT may serve as an alternative to [ 18 F]FDG PET/CT, warranting reevaluation of FDG limitations, while FAPI remains a strong competitor to both.

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