Incremental Diagnostic Value of 68Ga-FAPI PET/CT in Evaluating Pediatric Neuroblastoma

Neuroblastoma staging typically involves 18F-FDG PET/CT or 123I-MIBG scintigraphy, although their sensitivity may be limited. We present a 16-year-old girl with previously operated neuroblastoma who was reevaluated for recurrence. 18F-FDG PET/CT showed minimal uptake in the abdominal lesion, slightly lower than liver activity, a hypodense hepatic lesion without FDG uptake initially considered benign, and no osseous involvement. In contrast, 68Ga-FAPI PET/CT demonstrated heterogeneous moderate-to-intense uptake in the abdominal tumor, revealing additional hepatic and osseous metastases, which enabled accurate restaging and influenced management. This case highlights the incremental diagnostic value of FAPI PET/CT when FDG PET/CT underestimates disease extent.