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

Dilara Denizmen Zorba; Dilsat Firat Arslan; Yasemin Sanli; Serkan Kuyumcu

doi:10.1097/RLU.0000000000006310

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

Clin Nucl Med. 2026 Jan 20. doi: 10.1097/RLU.0000000000006310. Online ahead of print.

Authors

Dilara Denizmen Zorba¹, Dilsat Firat Arslan, Yasemin Sanli, Serkan Kuyumcu

Affiliation

¹ Department of Nuclear Medicine, Istanbul Medical Faculty, Nuclear Medicine, Istanbul University, Fatih, İstanbul, Turkey.

PMID: 41627164
DOI: 10.1097/RLU.0000000000006310

Abstract

Herein, we present a case of a patient with intrahepatic cholangiocarcinoma (ICC) who underwent [18F]FDG, [68Ga]Ga-Trivehexin, and [68Ga]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 [68Ga]Ga-FAPI-04 PET/CT and [68Ga]Ga-Trivehexin but not with [18F]FDG; importantly, [68Ga]Ga-FAPI-04 PET/CT, in addition, delineates metastatic abdominal lymph nodes. This case highlights that [68Ga]Ga-Trivehexin PET/CT may serve as an alternative to [18F]FDG PET/CT, warranting reevaluation of FDG limitations, while FAPI remains a strong competitor to both.

Keywords: FAPI; PET/CT; Trivehexin; cholangiocarcinoma; integrin.