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

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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.

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Acknowledgments

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

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Thomas Krohn, Frederik A. Verburg, Andreas Vogg, Alexander Heinzel, Felix M. Mottaghy & Florian F. Behrendt

  2. Department of Anatomy and Cell Biology, RWTH University Aachen, 52074, Aachen, Germany

    Thomas Pufe

  3. Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Frederik A. Verburg & Felix M. Mottaghy

  4. Institute of Anatomy I, University of Erlangen-Nuremberg, 91054, Erlangen, Germany

    Winfried Neuhuber

Authors
  1. Thomas Krohn
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  2. Frederik A. Verburg
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  3. Thomas Pufe
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  4. Winfried Neuhuber
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  5. Andreas Vogg
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  6. Alexander Heinzel
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  7. Felix M. Mottaghy
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  8. Florian F. Behrendt
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Corresponding author

Correspondence to Felix M. Mottaghy.

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Krohn, T., Verburg, F.A., Pufe, T. et al. [68Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice. Eur J Nucl Med Mol Imaging 42, 210–214 (2015). https://doi.org/10.1007/s00259-014-2915-3

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  • DOI: https://doi.org/10.1007/s00259-014-2915-3

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