RT Journal Article SR Electronic T1 Impact of 68Ga-FAPI-PET/CT imaging on the therapeutic management of primary and recurrent pancreatic ductal adenocarcinomas JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP jnumed.120.253062 DO 10.2967/jnumed.120.253062 A1 Manuel Röhrich A1 Patrick Naumann A1 Frederik Lars Giesel A1 Peter Choyke A1 Fabian Staudinger A1 Annika Wefers A1 Dawn P Liew A1 Clemens Kratochwil A1 Hendrik Rathke A1 Jakob Liermann A1 Klaus Herfarth A1 Dirk Jäger A1 Jürgen Debus A1 Uwe A. Haberkorn A1 Matthias Lang A1 Stefan A. Koerber YR 2020 UL http://jnm.snmjournals.org/content/early/2020/10/23/jnumed.120.253062.abstract AB Purpose: Pancreatic ductal carcinoma (PDAC) is a highly lethal cancer and early detection and accurate staging are critical to prolonging survival. PDAC typically has a prominent stroma including cancer-associated fibroblasts (CAFs) that express Fibroblast Activation Protein (FAP). FAP is a new target molecule for PET imaging of various tumors. In this retrospective study we describe the clinical impact of PET/CT imaging using 68Ga-labelled FAP-Inhibitors (68Ga-FAPI - PET/CT) in 19 patients with PDAC (7 primary, 12 progressive/recurrent). Patients and Methods: All patients have undergone contrast enhanced Computed Tomography (ceCT) for TNM staging before they were subjected to 68Ga-FAPI - PET/CT imaging. PET-scans were acquired 60 minutes after administration of 150-250 MBq of 68Ga-labelled FAP-specific tracers. In order to characterize 68Ga-FAPI-uptake over time, additional scans after 10 minutes and/or 180 minutes were performed in six patients. SUVmax and SUVmean values of PDAC manifestations and healthy organs were analyzed. The tumor burden according to 68Ga-FAPI - PET/CT was compared to TNM staging based on ceCT and changes in oncological management were recorded. Results: Compared to ceCT, 68Ga-FAPI - PET/CT results led to changes in TNM staging in 10/19 patients. 8/12 patients with recurrent/progressive disease, were up-staged, 1 down-staged and 3 had no change. In newly diagnosed PDAC, 1/7 patients was up-staged, the staging of 6 patients did not change. Changes in oncological management occurred in seven patients. Markedly elevated uptake of 68Ga-FAPI in PDAC manifestations after 1 hour was seen in most cases. Differentiation from pancreatitis based on static imaging 1 hour p.i. was challenging. With respect to imaging after multiple time points, PDAC and pancreatitis showed a trend for differential uptake kinetics. Conclusion: 68Ga-FAPI - PET/CT led to restaging in half of patients with PDAC and most patients with recurrent disease compared to standard of care imaging. The clinical value of 68Ga-FAPI - PET/CT should be further investigated.