68Ga-FAPI PET/CT safely detects multifocal endometriosis: a case report

Endometriosis can be tough to diagnose accurately, especially when standard imaging misses hidden lesions. We explored whether 68Ga-FAPI-46 PET/CT, a new molecular imaging technique, could spot multifocal endometriosis that conventional methods overlook. A 28-year-old woman with severe menstrual pain underwent transvaginal ultrasound (TVS), pelvic MRI, and 68Ga-FAPI-46 PET/CT. The PET/CT scan was performed 60 minutes after injecting 3 mCi (111 MBq) of 68Ga-FAPI-46, targeting fibroblast activation protein (FAP) in fibrotic tissue. We used Monte Carlo simulations (GATE v9.0) to estimate radiation doses to organs, ensuring safety. TVS and MRI detected a right ovarian endometrioma, but 68Ga-FAPI-46 PET/CT went further, confirming this lesion (SUVmax 9.5) and revealing two additional nodules in the left adnexa (SUVmax 9.6) that MRI missed. Surgical pathology confirmed multifocal endometriosis. Dosimetry showed a low ovarian radiation dose (0.73 × 10− 2 Gy/GBq), proving the procedure’s safety for young women. 68Ga-FAPI-46 PET/CT is a safe and powerful tool for uncovering hidden endometriotic lesions, potentially guiding better surgical planning. While promising, larger studies are needed to confirm its role in routine practice.