A 65-year-old man with suspected pancreatic cancer underwent 18F-FDG PET/CT for initial staging. Mild FDG uptake was observed in the pancreatic mass and bone destruction in the 10th rib on the right. No significant FDG uptake was seen with the multiple hypodense or isodense nodules in the liver. However, 68Ga-FAPI PET/CT revealed intense FAPI uptake in the pancreas and the 10th rib and multiple lesions in the liver. Finally, a biopsy confirmed carcinoma in the head of the pancreas with liver metastasis. This case highlighted that 68Ga-FAPI may outperform 18F-FDG PET/CT in identifying micrometastases of bones and hidden liver metastases.
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