In the setting of ongoing COVID-19 vaccination, vaccine-related tracer uptake in locoregional lymph nodes has become a well-known issue in tumor staging by 18 F-FDG PET/CT. 68 Ga-FAPI PET/CT is a new oncologic imaging tool that may overcome this limitation.Methods: We assessed post-vaccine, head-to-head and same-day 18 F-FDG and 68 Ga-FAPI-46 PET/CT findings in a series of 11 patients from a large prospective imaging registry. All patients with documented tracer uptake in locoregional lymph nodes on PET/CT or PET/MRI, following vaccination within 6 weeks, were eligible for investigation.Result: Significant visual lymph node uptake adjacent to the injection site was noted in 11/11 (100%) patients with 18 F-FDG PET/CT versus 0/11 (0%) with 68 Ga-FAPI PET/CT. 18 F-FDG detected 73% and 68 Ga-FAPI PET/CT 94% of all tumor lesions. Conclusion:In this case-series study, 68 Ga-FAPI showed its potential to avoid 18 F-FDG-PET/CT post-vaccination pitfalls and presented superior tumor localization.Squibb, Celgene, Eisbach Bio, Roche/Genentech; he holds ownership and serves on the Board of Directors of Pharma15, all outside the submitted work.Benedikt M. Schaarschmidt received a research grant from PharmaCept for an undergoing investigator-initiated study not related to this paper.
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