Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
J Nucl Med. 2018 Sep;59(9):1406-1411. doi: 10.2967/jnumed.117.204677. Epub 2018 Jan 25.
The study aims to investigate the presence of physiologic prostate-specific membrane antigen (Ga-PSMA)-ligand uptake on PET in cervical, celiac, and sacral ganglia of the sympathetic trunk as a pitfall for lymph node metastases in prostate cancer imaging. Four hundred seven patients who underwent Glu-NH-CO-NH-Lys radiolabeled with Ga-gallium -bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine--diacetic acid (Ga-PSMA-HBED-CC) PET (combined with a diagnostic CT) were retrospectively analyzed. The number of Ga-PSMA PET-positive cervical, celiac, and sacral ganglia was determined, and the configuration and SUV of each ganglion were measured. In addition, the configuration and SUV of adjacent lymph node metastases in the respective region (cervical, celiac, or sacral) were determined. Ga-PSMA-ligand uptake above background was detected in 401 (98.5%) patients in any peripheral ganglia, in 369 (92%) patients in cervical ganglia, in 363 (89%) patients in celiac ganglia, and in 183 (46%) patients in sacral ganglia. The Ga-PSMA-ligand uptake was highest in celiac (mean SUV, 2.9 ± 0.8 vs. cervical mean SUV, 2.4 ± 0.6) and sacral (mean SUV 1.7 ± 0.5; both < 0.0001) ganglia. Intraindividually there was a statistically significant but weak to moderate correlation between the Ga-PSMA-ligand uptake in cervical versus celiac ganglia ( = 0.34, < 0.0001), cervical versus sacral ( = 0.52, < 0.0001), and celiac versus sacral ( = 0.16, < 0.05). The Ga-PSMA-ligand uptake was significantly more intense in adjacent lymph node metastases than the respective ganglia (cervical: 18.0 ± 16.2 vs. 2.4 ± 0.6, < 0.0001; celiac: 13.5 ± 12.3 vs. 2.9 ± 0.8, < 0.0001; sacral: 13.4 ± 11.6 vs. 1.7 ± 0.5, < 0.0001). Furthermore, ganglia predominantly exhibit a band-shaped configuration (71.2%), followed by a teardrop (26.8%) and only rarely a nodular configuration (2.0%). Conversely, lymph node metastases are only rarely band-shaped (1.1%), but more often show teardrop (40.3%) or nodular appearance (58.6%) ( < 0.00001). Ga-PSMA-ligand uptake in ganglia along the sympathetic trunk as assessed by Ga-PSMA-HBED-CC PET represents an important pitfall in prostate cancer PET imaging. The Ga-PSMA-ligand uptake is higher in celiac ganglia than cervical or sacral ganglia, and the level of Ga-PSMA-ligand uptake seems to be patient-related. For the differentiation between lymph node metastases and sympathetic ganglia, both intensity of Ga-PSMA-ligand uptake and exact localization and configuration of the respective lesion should be examined carefully.
本研究旨在探讨前列腺特异性膜抗原（Ga-PSMA）配体在 PET 上的摄取是否存在于颈、腹腔和骶交感神经节中的生理现象，因为这可能是前列腺癌成像中淋巴结转移的一个陷阱。 回顾性分析了 407 例接受 Glu-NH-CO-NH-Lys 放射性标记 Ga- gallium -bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine--diacetic acid（Ga-PSMA-HBED-CC）PET（与诊断 CT 相结合）的患者。确定了 Ga-PSMA PET 阳性的颈、腹腔和骶神经节的数量，并测量了每个神经节的形态和 SUV。此外，还确定了各自区域（颈、腹腔或骶）中相邻淋巴结转移的形态和 SUV。 在 401 例（98.5%）患者的任何外周神经节中均检测到 Ga-PSMA 配体摄取高于背景，在 369 例（92%）患者的颈神经节中，在 363 例（89%）患者的腹腔神经节中，在 183 例（46%）患者的骶神经节中检测到 Ga-PSMA 配体摄取。在腹腔神经节（平均 SUV，2.9 ± 0.8 比颈神经节平均 SUV，2.4 ± 0.6；均 < 0.0001）和骶神经节（平均 SUV 1.7 ± 0.5；均 < 0.0001）中 Ga-PSMA 配体摄取最高。个体内，颈神经节与腹腔神经节（ = 0.34，< 0.0001）、颈神经节与骶神经节（ = 0.52，< 0.0001）和腹腔神经节与骶神经节（ = 0.16，< 0.05）之间的 Ga-PSMA 配体摄取存在统计学上显著但弱到中度相关性。Ga-PSMA 配体摄取在相邻淋巴结转移中明显高于相应的神经节（颈：18.0 ± 16.2 比 2.4 ± 0.6，< 0.0001；腹腔：13.5 ± 12.3 比 2.9 ± 0.8，< 0.0001；骶：13.4 ± 11.6 比 1.7 ± 0.5，< 0.0001）。此外，神经节主要表现为带状形态（71.2%），其次是泪滴状（26.8%），很少呈结节状（2.0%）。相反，淋巴结转移很少呈带状（1.1%），但更常见的是泪滴状（40.3%）或结节状外观（58.6%）（< 0.00001）。Ga-PSMA-HBED-CC PET 评估交感神经节中 Ga-PSMA 配体的摄取是前列腺癌 PET 成像中的一个重要陷阱。腹腔神经节中的 Ga-PSMA 配体摄取高于颈或骶神经节，Ga-PSMA 配体摄取水平似乎与患者相关。为了区分淋巴结转移和交感神经节，应仔细检查 Ga-PSMA 配体摄取的强度以及各自病变的准确位置和形态。
