68Ga-FAPI-46 PET/CT Tracer Uptake in CT-Diagnosed Intra-Abdominal Fat Necrosis: Letter to Maliha et al.

Editor

I read with great interest the Images in Cancer article by Dr Maliha et al. in the June 2023 issue of Radiology: Imaging Cancer, which provides valuable insights regarding FAPI uptake in fat necrosis [1]. While I acknowledge the insights provided by the authors, there are a few points that merit further evaluation and discussion.

First, in the initial description of the case the authors describe the finding of a “lung mass” which was not illustrated. This could be an important finding since among the all the differential considerations, the authors have not considered the possibility of a case of omental tuberculosis. Being a great imitator, tuberculosis has proven to be challenging to diagnose with oncological PET/CT, as the findings mimic those of primary tumors and metastases [2]. Next, the authors mentioned that a CT examination was conducted [1]. However, it was not specified whether intravenous contrast was administered. Indeed, smooth peritoneal thickening with enhancement upon contrast enhanced CT is suggestive of omental tuberculosis [2]. Differently from the authors, in order to further confirm/exclude omental TB or simply a fat necrosis, I would have considered an US-guided biopsy [3].

In conclusion, while thanking the authors for their excellent contribution to the Images in Cancer Collection, we would very much appreciate a response from the authors giving their stance/opinion with regard to the above to clarify the doubts we have raised.

Author Statements

Conflicts of Interest

The author has no conflicts of Interest to declare.

References

1. Maliha PG, Allen-Auerbach M, Hotta M, Calais J. 68ga-FAPI-46 PET/CT tracer uptake in CT-diagnosed intra-abdominal fat necrosis. Radiol Imaging Cancer. 2023; 5: e230026.
2. Pragalathan B, Omar Mohamed Ozaal AM, Lavanya S, Raviraj S. Omental tuberculosis (TB) is a rare disease which can mimic gastrointestinal malignancies: A case report. Int J Surg Case Rep. 2020; 77: 318-20.
3. Perera Molligoda Arachchige AS. What must be done in case of a dense collection? Radiol Med. 2021; 126: 1657-8.