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@antjehellwich.bsky.social Sep 29, 2026, 7:52 AM

FAPI PET/MRI in #Endometriosis: A Practical Approach to Mapping Complex Disease Beyond Standard Pelvic #MRI by Philipp Schindler, MD; et al. (University Hospital Münster, Germany).

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#PETMRI #MolecularImaging #RadSky #WomensHealth

Although endometriosis is often described as a pelvic disease, daily practice shows that the questions relevant to patients and surgeons are broader:
- Where is the active disease?
- Which organs or compartments are involved?
- Which lesions could change the operative strategy?

The authors share their experience with fibroblast activation protein (FAP)-targeted PET/MRI, showing how molecular information can provide a practical guide for MRI interpretation, particularly in anatomically challenging areas.

Clinical benefit:
Better visualization of complex, multifocal, peritoneal, tubo-ovarian, and extrapelvic diseases, which may improve preoperative planning and patient counseling.

Operational benefit:
An MRI-first, PET-guided second read can translate molecular hot spots into a structured, #Enzian-based map for the multidisciplinary team.

Financial and societal perspective:
Earlier and more targeted diagnoses could reduce the need for repeated consultations, duplicate tests, unnecessary procedures, and lost productivity in a disease that is often not diagnosed until years after the onset of symptoms.

Images: Patient presenting with menstrual cycle-dependent right shoulder pain.
(2A) MIP PET images demonstrate abnormal tracer uptake in the right diaphragm, bilateral round ligaments, the peritoneum surrounding both ovaries, and the left fallopian tube (indicated by arrows).
On fused PET/MRI, a T2-hyperintense lesion with focal tracer uptake is identified inferior to the right hemidiaphragm, consistent with diaphragmatic endometriosis (arrows, 2B).
Subsequent laparoscopy confirmed extensive pelvic endometriosis and diaphragmatic implants (2C).

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