Introduction

Ovarian cancer is known for its high recurrence rate and complex metastatic patterns, often involving lymph nodes, peritoneum, omentum, and distant sites. Accurate assessment of disease progression after surgery and chemotherapy is critical for guiding further oncologic management.

68Ga-FAPI PET-CT, a novel molecular imaging modality targeting cancer-associated fibroblasts, has shown superior sensitivity in detecting recurrent and metastatic ovarian cancer, especially in the peritoneum and lymph nodes.

This case highlights the clinical value of 68Ga-FAPI PET-CT in identifying disease progression in a treated ovarian cancer patient

Case Presentation

Patient: 56-year-old female

Diagnosis: Carcinoma ovary

Treatment History:

Underwent hysterectomy with bilateral salpingo-oophorectomy in 2021

Completed chemotherapy in November 2025

Follow-up Indication: Suspicion of recurrence on CT abdomen and pelvis (03-06-2025)

Referring Oncologist: Dr. Basavaraj H (Radiation Oncology)

A previous FDG PET-CT performed outside (July 2022) was available for comparison.

Imaging Technique

A whole-body 68Ga-FAPI-04 PET-CT scan (vertex to mid-thigh) was performed using a digital time-of-flight PET-CT scanner with IV contrast. The study allowed high-resolution evaluation of metabolically active disease with excellent lesion-to-background contrast.

PET-CT Findings

The scan revealed extensive metabolically active disease, including:

Multiple tracer-avid supraclavicular lymph nodes, largest on the right (SUVmax 6.8)

Extensive mediastinal and hilar lymphadenopathy, including internal mammary and paratracheal nodes

Bulky abdominal and retroperitoneal nodal masses, involving gastrohepatic, peripancreatic, aortocaval, mesenteric, and para-aortic regions (SUVmax up to 11.0)

Pelvic and iliac lymph node metastases, including external and internal iliac chains

Multiple tracer-avid peritoneal, omental, mesenteric, and falciform ligament deposits, consistent with peritoneal carcinomatosis

Mild ascites and pleural effusion, suggesting advanced disease

No skeletal metastases

These findings were consistent with significant disease progression 

 

Clinical Impact

The scan confirmed systemic disease progression after prior surgery and chemotherapy

Helped oncologists decide on further lines of systemic or targeted therapy

Enabled comprehensive mapping of disease burden in a single whole-body study

Prevented under-staging and unnecessary invasive procedures

Why 68Ga-FAPI PET-CT Is Valuable in Ovarian Cancer

Compared to FDG PET-CT, FAPI PET-CT offers:

Better detection of peritoneal and omental metastases

Minimal physiological bowel uptake

Superior contrast in fibrotic and desmoplastic tumors

High accuracy in recurrence and progression assessment

This makes FAPI PET-CT especially useful in advanced and recurrent ovarian cancer.

Expertise at NeuMoD Digital PET-CT, Hubli

At NeuMoD Digital PET-CT & Molecular Theranostics, Hubli, we provide:

Advanced FAPI PET-CT imaging

Prompt appointments without delay

Accurate staging, restaging, and therapy-response assessment

Compassionate, patient-centric cancer care