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This month's editor's favorite is Kessler and colleagues' “Visualization of Fibroblast Activation After Myocardial Infarction Using 68Ga-FAPI PET"​ This study analyzed the pattern of myocardial 68Ga-fibroblast-activation protein-α inhibitor (FAPI) uptake in patients after acute myocardial infarction (AMI) comparing FAPI PET to coronary angiography.  Authors correlated FAPI uptake with left ventricular function. A cohort of 10 patients with no prior history of coronary artery disease underwent FAPI PET 18 ± 20.6 days after AMI (ST-segment elevation myocardial infarction [n = 5] and non–ST-segment elevation infarction [n = 5]), respectively. SUVmax, SUVmean, and SUVpeak of localized myocardial tracer uptake were measured Tracer uptake volume was reported as fibroblast activation volume (FAV), with imaging data correlated to clinical parameters. Focal FAPI uptake was observed in all patients. Average uptake at 10 minutes post injection was 8.9 ± 4.4 (SUVmax), 7.6 ± 4.0 (SUVpeak), and 5.3 ± 2.8 (SUVmean), respectively. Affected myocardium showed a partial to complete match between tracer uptake and confirmed culprit lesion by coronary angiography in 44.4% and 55.6% of patients, respectively.

A strong correlation between FAV and peak creatine kinase level (r = 0.90, P < 0.01) and inverse correlation of FAV with left ventricular function (r = −0.69, P < 0.05) was observed.

Authors concluded that we should expect to see in vivo visualization of fibroblast activation after AMI. The uptake area showed a very good agreement with the affected coronary territory. A strong correlation of the de novo established parameter FAV with left ventricular function and peak creatine kinase was observed. FAPI PET/CT may provide important insights into mechanisms of structural remodeling after AMI. It will be interesting to see if FAPI PET will become useful for the determination of myocardial viability and if fibrous lesions such as prior myocardial infarction create confounds to potential cancer treatments with radiolabeled FAPI.

Current Issue

Performance of Multiparametric Functional Imaging to Assess Peritoneal Tumor Burden in Ovarian Cancer

Mallet, Estelle; Angeles, Martina Aida; Cabarrou, Bastien; More

Clinical Nuclear Medicine. 46(10):797-806, October 2021.

Visualization of Fibroblast Activation After Myocardial Infarction Using 68Ga-FAPI PET

Kessler, Lukas; Kupusovic, Jana; Ferdinandus, Justin; More

Clinical Nuclear Medicine. 46(10):807-813, October 2021.