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.
Divband et al. (Sun,) studied this question.