Complementary Findings of 18 F-FDG and 68 Ga-FAPI-46 PET/CT in a Chronic Left Ventricular Aneurysm.

A 72-year-old man with a history of apical myocardial infarction 12 years earlier, complicated by a chronic left ventricular aneurysm, underwent 18 F-FDG PET/CT and 68 Ga-FAPI-46 PET/CT imaging. 18 F-FDG PET/CT, performed without cardiac preparation, showed a well-defined photopenic defect corresponding to the aneurysm, consistent with a nonviable transmural scar. In contrast, 68 Ga-FAPI PET/CT demonstrated intense uptake along the aneurysmal wall with a ring-like pattern at the basal border zone. This discordant pattern suggests persistent fibroblast activation despite metabolic quiescence, indicating that chronic ventricular aneurysms may remain biologically active rather than inert fibrotic sequelae.