Enhanced Detection of Recurrent Diffuse Malignant Peritoneal Mesothelioma Using 68 Ga-FAPI PET/CT Compared to 18 F-FDG PET/CT: A Case Report

Our plain-English summary of Enhanced Detection of Recurrent Diffuse Malignant Peritoneal Mesothelioma Using 68 Ga-FAPI PET/CT Compared to 18 F-FDG PET/CT: A Case Report, by M. Abdulrahman, U. Al-Rasheed, A. Dabous, et al (World Journal of Nuclear Medicine, 2025).

The study

• Authors: M. Abdulrahman, U. Al-Rasheed, A. Dabous, A. Al-Ibraheem
• Journal: World Journal of Nuclear Medicine
• Published: 2025;24(2):185-188
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and aggressive subtype of epithelioid mesothelioma that arises from the lining of the abdominal cavity. While the applications of traditional fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in diagnosis and staging of DMPM are well-established, the utility of gallium-68 fibroblast activating protein inhibitor ( 68 Ga-FAPI) PET/CT in detecting disease recurrence remains an area that requires further research and validation, with limited literature. Implementing FAPI PET/CT for these cases may provide superior lesion detectability and higher reporter confidence, prompting the need for further studies to investigate the potential future role of FAPI theranostics in guiding treatment decisions for DMPM. This case report describes a 49-year-old male patient diagnosed with DMPM, who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but developed recurrent disease that was better visualized on 68 Ga-FAPI PET/CT compared with 18 F-FDG PET/CT.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).

In plain English

This case report described one 49-year-old man with diffuse malignant peritoneal mesothelioma, a cancer of the abdominal lining, treated at the authors' hospital. The article stated that he worked in an office with no exposure to any "isolation materials". It did not otherwise describe asbestos exposure for him. A biopsy pointed to epithelioid mesothelioma. He then had extensive surgery plus heated chemotherapy (mitomycin) given inside the abdomen. Follow-up scans with FDG PET/CT, a standard scan that tracks sugar uptake, showed suspected deposits in the abdominal wall. A later scan showed a right groin mass. Its removal, with the right testicle and spermatic cord, confirmed testicular mesothelioma. A later FDG scan showed a small new nodule and a few suspicious deposits with little or no uptake. A different scan, 68Ga-FAPI PET/CT, showed high uptake in the same lesions (SUVmax up to 14.5, against 1 on FDG), and the authors reported that it confirmed recurrence. Six cycles of carboplatin and pemetrexed were decided on. The authors concluded that FAPI PET imaging was a promising development. Because this report describes one patient, it gives no rates of its own for how often either scan detects disease or for how patients fare.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 49-year-old single male patient with diffuse malignant peritoneal mesothelioma, admitted to the authors' hospital (authors affiliated with King Hussein Cancer Center, Amman, Jordan); dates not given
• Exposure: the patient reported office work with no exposure to any isolation materials; the article does not otherwise describe asbestos exposure for this patient. The study compared two imaging methods, 68Ga-FAPI PET/CT and 18F-FDG PET/CT.
• Main results:
  • A diagnostic laparoscopic peritoneal biopsy showed atypical mesothelial proliferation favoring diffuse peritoneal epithelioid mesothelioma. The patient underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin.
  • The first post-surgical 18F-FDG PET/CT showed a few soft tissue thickenings or nodules in the anterior abdominal wall. The most prominent measured 0.75 cm with SUVmax 4.97 and was reported as an omental deposit.
  • A later FDG PET/CT showed a right inguinal soft tissue mass, measuring 4.7 by 3.5 by 7.0 cm with SUVmax 5.1. A right inguinal orchidectomy with spermatic cord excision confirmed testicular mesothelioma.
  • At the latest follow-up, FDG PET/CT showed a new small right lower abdominal subcutaneous nodule with minimal to no FDG uptake, plus a few suspicious peritoneal-based deposits without significant metabolic activity.
  • 68Ga-FAPI PET/CT showed high uptake in the same lesions, with SUVmax up to 14.5 compared with a prior SUVmax of 1 on FDG PET. The authors reported that this confirmed disease recurrence. The lesion measured a stable 0.7 cm.
  • A multidisciplinary committee decided on six cycles of carboplatin and pemetrexed, followed by 68Ga-FAPI PET/CT-guided follow-up.
• The authors' conclusion: The authors concluded that the use of FAPI in PET imaging is a promising development in molecular imaging for detecting, staging and monitoring these tumors.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Epithelioid, Mesothelioma, Staging, Fibroblast, Cytoreductive Surgery, HIPEC.

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