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[68Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice

  • Thomas Krohn
  • Frederik A. Verburg
  • Thomas Pufe
  • Winfried Neuhuber
  • Andreas Vogg
  • Alexander Heinzel
  • Felix M. MottaghyEmail author
  • Florian F. Behrendt
Original Article

Abstract

Purpose

To determine the frequency of seemingly pathological retroperitoneal uptake in the location of the coeliac ganglia in patients undergoing [68Ga]PSMA-HBED PET/CT.

Methods

The study included 85 men with prostate cancer referred for [68Ga]PSMA-HBED PET/CT. The PET/CT scans were evaluated for the local finding in the prostate and the presence of lymph node metastases, distant metastases and coeliac ganglia. The corresponding standardized uptake values (SUV) were determined. SUVmax to background uptake (gluteal muscle SUVmean) ratios were calculated for the ganglia and lymph node metastases. Immunohistochemistry was performed on the ganglia.

Results

In 76 of the 85 patients (89.4 %) at least one ganglion with tracer uptake was found. For the ganglia, SUVmax and SUVmax to background SUVmean ratios were 2.97 ± 0.88 and 7.98 ± 2.84 (range 1.57–6.38 and 2.83–30.6), respectively, and 82.8 % of all ganglia showed an uptake ratio of >5.0. For lymph node metastases, SUVmax and SUVmax to background SUVmean ratios were 8.5 ± 7.0 and 23.31 ± 22.23 (range 2.06–35.9 and 5.25–115.8), respectively. In 35 patients (41.2 %), no lymph node metastases were found but tracer uptake was seen in the ganglia. Immunohistochemistry confirmed strong PSMA expression in the ganglia.

Conclusion

Coeliac ganglia show a relevant [68Ga]PSMA-HBED uptake in most patients and may mimic lymph node metastases.

Keywords

68GaPSMA-HBED PET/CT Prostate cancer Coeliac ganglion Pitfall Immunohistochemistry 

Notes

Acknowledgments

We thank Nina Koch for technical support with the immunohistochemical examinations.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Thomas Krohn
    • 1
  • Frederik A. Verburg
    • 1
    • 3
  • Thomas Pufe
    • 2
  • Winfried Neuhuber
    • 4
  • Andreas Vogg
    • 1
  • Alexander Heinzel
    • 1
  • Felix M. Mottaghy
    • 1
    • 3
    Email author
  • Florian F. Behrendt
    • 1
  1. 1.Department of Nuclear MedicineRWTH University Hospital AachenAachenGermany
  2. 2.Department of Anatomy and Cell BiologyRWTH University AachenAachenGermany
  3. 3.Department of Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
  4. 4.Institute of Anatomy IUniversity of Erlangen-NurembergErlangenGermany

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