Fibroblast imaging of hepatic carcinoma with 68Ga-FAPI-04 PET/CT: a pilot study in patients with suspected hepatic nodules



68Ga-FAPI-04 is a rapidly evolving PET tracer for whole-body imaging in a variety of cancers. We aimed to evaluate the diagnostic performance of 68Ga-FAPI-04 for detecting and characterizing hepatic nodules in patients with suspected carcinoma.


Twenty-five patients showing suspicious hepatic lesions for malignancy underwent 68Ga-FAPI-04 PET. The maximum and mean standardised uptake values (SUVmax, SUVmean) were measured for all detected lesions and normal hepatic tissues, respectively. The target-to-background ratio (TBR) was calculated by dividing the lesion SUVmax with the SUVmean of non-tumour liver tissue. Lesion uptake value was correlated with the in vitro hepatic FAP expression determined by immunohistochemistry (IHC).


In total, 17 patients who underwent surgery or biopsy were recruited for the final analysis. A total of 28 intrahepatic malignant lesions were detected in 16 patients; the mean SUVmax was 8.36 ± 4.21 (range 2.21 to 15.86), and mean TBR was 13.15 ± 9.48 (range 2.79 to 38.12) in all detected lesions (n = 28). One benign patient showed negligible hepatic uptake (SUVmax = 0.47), whereas 75% of the primary intrahepatic hepatocellular carcinoma (HCC) lesions (n = 6) showed prominent FAP expression, 12.5% of the lesions (n = 1) showed moderate expression in stromal cells, and one showed negligible expression.


68Ga-FAPI-04 showed high sensitivity in detecting hepatic malignancies, particularly in poorly differentiated forms with concordantly elevated FAP expression.

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This work was sponsored in part by the National Natural Science Foundation of China (Grant Nos. 81571713, No. 81671722, No. 81801741), Fundamental Research Funds for the Central Universities (3332020011) and the CAMS Innovation Fund for Medical Sciences (Grant Nos. 2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001).

Author information




Ximin Shi, Li Huo and Xiang Li designed the study, interpreted the data and led the writing and review of the manuscript. Ximin Shi, Haiqun Xing and Shaobo Yao synthesised the 68Ga-FAPI-4 and performed the examination. Xiaobo Yang and Haitao Zhao collected clinical data. Hui Zhang evaluated the FAP IHC images. Fang Li and Marcus Hacker participated in the review of the manuscript.

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Correspondence to Li Huo.

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This prospective study was approved by the Peking Union Medical College Hospital ethics committee (IRB protocol #ZS1810).

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All subjects provided written informed consent.

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This article is part of the Topical Collection on Oncology - General

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Shi, X., Xing, H., Yang, X. et al. Fibroblast imaging of hepatic carcinoma with 68Ga-FAPI-04 PET/CT: a pilot study in patients with suspected hepatic nodules. Eur J Nucl Med Mol Imaging 48, 196–203 (2021).

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  • 68Ga-FAPI-04
  • Fibroblast activating protein
  • Hepatic nodule
  • Hepatocellular carcinoma