Optimizing Intrahepatic Cholangiocarcinoma Staging

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.