Complementary Findings of 18F-FDG and 68Ga-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.