Seeing Beyond 68GA-DOTANOC and 18F-FDG PET/CT: 68GA-FAPI Only Uptake in a Rare Metastatic Well-differentiated Grade I Pancreatic Neuroendocrine Tumor.

Singareddy, Chandra T R; Baa, Annie K; Kankara, Shreyas R; Bukelo, Maria F · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Somatostatin receptor (SSTR) imaging is the preferred modality for staging well-differentiated neuroendocrine tumors (NETs) and detecting unknown primary NETs. If SSTR imaging is negative, 18F-FDG PET/CT may be done to rule out tumor heterogeneity. We report a case of a 36-year-old woman with a well-differentiated grade I NET, who initially presented with severe right hypochondriac pain and vomiting. Standard diagnostic workup with 68Ga-DOTANOC followed by 18F-FDG PET/CT was negative; however, 68Ga-FAPI-04 PET/CT demonstrated intense tracer-avid lesions in pancreatic primary and liver metastases.

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