High 68Ga-FAPI-04 and Low 18F-FDG Uptake in a Patient With Hepatic Epithelioid Hemangioendothelioma

We report a rare case of multifocal hepatic epithelioid hemangioendothelioma (HEHE) evaluated using [⁶⁸Ga]Ga-FAPI-04 and [¹⁸F]FDG PET/CT. Abdominal CT revealed multiple hepatic masses with mild peripheral enhancement and central necrosis. On [¹⁸F]FDG PET/CT, the lesions demonstrated uptake similar to or faint compared with normal liver parenchyma, whereas [⁶⁸Ga]Ga-FAPI-04 PET/CT showed intense tracer accumulation with a high tumor-to-background ratio in all hepatic lesions, without evidence of extrahepatic involvement. This case illustrates the potential diagnostic advantage of FAPI imaging in detecting and characterizing hepatic vascular tumors with low FDG avidity.