Effects of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 (HBED-CC) PET/MRI

  • Ali Afshar-Oromieh
  • Maya Wolf
  • Uwe Haberkorn
  • Marc Kachelrieß
  • Regula Gnirs
  • Klaus Kopka
  • Heinz-Peter Schlemmer
  • Martin T. Freitag
Original Article



PSMA ligand imaging with hybrid PET/MRI scanners could be an integral part of the clinical routine in the future. However, the first study about this novel method revealed a severe photopenic artifact (“halo artifact”) around the urinary bladder causing significantly reduced tumor visibility. The aim of this evaluation was to analyze the role of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 PET/MRI hypothesizing that this influences the appearance.


Twenty-seven consecutive patients were subjected to 68Ga-PSMA-11 PET/CT (1 h p.i.) followed by PET/MRI (3 h p.i.). PET/MRI was first started with scans of the abdomen to pelvis with arms positioned up above the head. Immediately thereafter, additional scans from the pelvis to abdomen were conducted with arms positioned down beside the trunk. All investigations were first analyzed separately and then compared with respect to tumor detection and tumor uptake (SUV) as well as the presence and intensity of the halo artifact. The Wilcoxon signed rank test was used to determine statistical differences including Bonferroni correction.


The halo was significantly reduced if the arms were elevated. Lesions inside the halo artifact (n = 16) demonstrated significantly increased SUVmean (p = 0.0007) and SUVmax (p = 0.0024) with arms positioned up. The halo appearance and intensity was not dependent on the total activity and activity concentration of the urinary bladder.


Positioning the arms down was shown to be significantly associated with the appearance of the halo artifact in PET/MRI. Positioning the arms up above the head can significantly reduce the halo artifact, thereby detecting more tumor lesions.


Prostate cancer PSMA Pet/MRI Halo artifact Prostate-specific membrane antigen 


Compliance with ethical standards

Conflicts of interest

Ali Afshar-Oromieh has received honoraria from Siemens Healthcare for one educational talk. All other authors declare that they have no conflicts of interest.

Ethical approval

This retrospective study was approved by the local ethics committee (S-485/2012, S-638/2013) and was conducted in agreement with the Declaration of Helsinki. All patients gave written informed consent.

Supplementary material

259_2017_3718_Fig9_ESM.gif (78 kb)
Supplementary Figure 1

The volume of the urinary bladder was measured by drawing a 90% isocontour VOI around the urinary bladder. The software automatically calculated the activity concentration as well. (GIF 77 kb)

259_2017_3718_MOESM1_ESM.tif (622 kb)
High-resolution image (TIFF 621 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Nuclear MedicineHeidelberg University HospitalHeidelbergGermany
  2. 2.Clinical Cooperation Unit Nuclear MedicineGerman Cancer Research CenterHeidelbergGermany
  3. 3.Department of RadiologyGerman Cancer Research CenterHeidelbergGermany
  4. 4.Department of Medical Physics in RadiologyGerman Cancer Research CenterHeidelbergGermany
  5. 5.Division of Radiopharmaceutical ChemistryGerman Cancer Research CenterHeidelbergGermany

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