Imaging of cardiac fibroblast activation in a patient after acute myocardial infarction using 68Ga-FAPI-04
Susan Notohamiprodjo, Stephan G. Nekolla, Stephanie Robu, Alberto Villagrán Asiares, Christian Kupatt, Tareq Ibrahim, Karl‐Ludwig Laugwitz, Marcus R. Makowski, Markus Schwaiger, Wolfgang Weber, Zohreh Varasteh
Abstract
Our previous study has demonstrated the feasibility of noninvasive imaging of fibroblast activation protein (FAP)-expression after myocardial infarction (MI) in MI-territory in a rat model with 68 Ga-FAPI-04-PET. In the current extended clinical case, we sought to delineate cardiac uptake of 68 Ga-FAPI-04 in a patient after MI with clinical indication for the evidence of fibroblast activation. Carcinoma patients without cardiac disease underwent 68 Ga-FAPI-04-PET/CT as control. The patient with one-vessel disease underwent dynamic 68 Ga-FAPI-04-cardiac-PET/CMR for 60 minutes. Correlation of cardiac 68 Ga-FAPI-04 uptake with clinical findings, ECG, echocardiography, coronary-arteriography and enhanced cardiac-MRI with T1 MOLLI and ECV mapping were performed. No uptake was found in normal myocardium and in mature scar. A focal intense 68 Ga-FAPI-04 uptake with continuous wash-out in the infarct territory of coronary occlusion correlating with T1 and ECV mapping was observed. The uptake of 68 Ga-FAPI-04 extends beyond the actual infarcted area and overestimates the infarct size as confirmed by follow-up CMR.