Incidental Detection of Severe LAD Stenosis by FAPI PET/CT in a Patient Under Evaluation for Solitary Pulmonary Nodule – Correlation with Coronary Flow Velocity and Coronary Angiogram

68 Ga Fibroblast Activation Protein Inhibitor 04 (FAPI-04) is a radiolabelled molecular agent targeting the fibroblast activation protein (FAP). It is highly expressed on cancer-associated fibroblasts in the tumor stroma and at very low levels expressed throughout the body. Its role in inflammatory conditions is based on fibroblast proliferation. Its use has been well established in many oncological settings, while its role in non-oncological indications, especially in myocardial ischemia and fibrosis, is still evolving. We present an incidental finding of myocardial fibrosis (chronic infarct) in an unsuspected left anterior descending artery (LAD) stenosis on 68 Ga FAPI-04 imaging in a patient under evaluation for a solitary pulmonary nodule. This finding was later correlated with 99mTc SestaMIBI SPECT, doppler sampling of coronary artery velocities and finally coronary angiogram.