[^68Ga]Ga-FAPI versus 2-[^18F]FDG PET/CT in patients with autoimmune thyroiditis: a case control study

Purpose Radiolabelled fibroblast activation protein inhibitors (FAPIs) are becoming increasingly important for imaging various tumour diseases.

However, it is essential to be aware of potential pitfalls.

Here, we investigate FAP expression in the thyroid gland in autoimmune thyroiditis (AIT).

Methods AIT patients with pathological thyroid uptake on [^68Ga]Ga-FAPI PET were compared with glucose metabolism on 2-[^18F]FDG PET in terms of SUV_max/SUV_peak/SUV_mean/tissue-to-background ratio (TBR), and with a healthy control group.

Results Between September 2019 and July 2021, 6 patients presented with a visually increased thyroid uptake and TBR on [^68Ga]Ga-FAPI PET.

In the retrospective clinical work-up, all patients had known or newly diagnosed AIT.

Compared to a matched healthy control group, FAP expression and glucose metabolism were significantly increased ([^68Ga]Ga-FAPI (SUV_peak): 7.0 vs. 1.7; p  = 0.004/(TBR_bloodpool): 6.8 vs. 1.7; p  = 0.002; 2-[^18F]FDG (SUV_peak): 3.9 vs. 1.4; p  = 0.004/(TBR_bloodpool): 4.0 vs. 1.2; p  = 0.041).

However, there was no significant difference in median uptake between [^68Ga]Ga-FAPI and 2-[18F]FDG PET (SUV_peak: 7.3 vs. 5.6; p  = 0.104).

Conclusion Patients with AIT show higher thyroid uptake on [^68Ga]Ga-FAPI and 2-[^18F]FDG PET.

Incidental thyroid uptake is another pitfall in the interpretation of [^68Ga]Ga-FAPI PET and should prompt a clinical work-up.