Nuclear Medicine Imaging in Tumor Diagnostics Using FAPI-PET/CT: A Case-based Perspective on Malignant Peripheral Nerve Sheath Tumor.

Göller, Stephanie; Spektor, Anna-Maria; Stockinger, Marcus; Kaufmann, Justus; Röhrich, Manuel · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Unlike FDG, FAPI tracers target fibroblast activation protein inhibitor (FAPI), highly expressed in the tumor microenvironment. This allows better differentiation between viable tumor and post-therapeutic changes, that is, fibrosis or inflammation. Here, a 39-year-old man with a malignant peripheral nerve sheath tumor (MPNST) of the thoracic wall underwent surgery and adjuvant radiotherapy. FAPI-PET/CT 3 months after treatment showed paravertebral and diffuse pleural uptake. Biopsy verified tumor recurrence and pleural sarcomatosis. Among others, a FAPI-radioligand-therapy was initiated. This case demonstrates the efficacy of FAPI imaging in the staging and potential treatment of MPNST and pleural sarcomatosis.

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