Shi Yiping, Wu Jian Guo, Xu Lian, Zhu Yinjie, Wang Yining, Huang Gan, Liu Jianjun, Chen Ruohua
Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Nuclear Medicine, Second Affiliated Hospital, Nanchang University, Nanchang, China.
Front Oncol. 2021 Apr 23;11:666308. doi: 10.3389/fonc.2021.666308. eCollection 2021.
Studies have indicated that PSMA-positive ganglia represent a diagnostic pitfall for nuclear medicine physicians. No studies have described choline and FDG uptake in ganglia, which may be a source of misdiagnosis. Herein, we described the percentage and uptake pattern of Ga-PSMA, C-choline and F-FDG PET/CT in ganglia and evaluated the heterogeneous metabolic patterns of ganglia to differentiate from lymph node metastases (LNM).
Thirty-nine patients who underwent C-choline PET/CT and 120 patients who underwent Ga-PSMA PET/CT and F-FDG PET/CT were retrospectively analyzed. The prevalence of PSMA-positive, choline-positive and FDG-positive ganglia was determined, the SUVmax of ganglia in different locations were measured, and the configuration was described. The SUVmax cutoff of PSMA-PET, choline-PET and FDG-PET was determined by ROC curve analysis to differentiate ganglia from LNM.
329 PSMA-positive ganglia were identified in 120 patients, 95 choline-positive ganglia were identified in 39 patients, and 39 FDG-positive ganglia were identified in 34 patients. PSMA-positive uptake was observed in 98.3%, 95.8%, and 80.0% of cervical, coeliac, and sacral ganglia, respectively. Choline-positive uptake was observed in 84.6%, 97.4%, and 61.5% of cervical, coeliac, and sacral ganglia, respectively. FDG-positive uptake was observed in 16.7%, 13.3%, and 2.5% of cervical, coeliac, and sacral ganglia, respectively. Cervical and coeliac ganglia had a higher rate of PSMA-positive uptake than sacral ganglia. Choline uptake was highest in coeliac ganglia followed by cervical and sacral ganglia. PSMA, choline or FDG uptake in LNM was all significantly higher than ganglia. ROC curve analysis revealed that at a 4.1 SUVmax cutoff of PSMA-PET, the sensitivity, specificity and accuracy of LNM identification was 88.4%, 97.9% and 96.2%, respectively. ROC curve analysis revealed that at a 2.35 SUVmax cutoff for choline-PET, the sensitivity, specificity, and accuracy of LNM identification was 95.0%, 92.6% and 93.0%, respectively. ROC curve analysis revealed that at a 2.55 SUVmax cutoff for FDG-PET, the sensitivity, specificity, and accuracy of LNM identification was 77.3%, 87.2%, and 81.9%, respectively. PSMA-, Choline- and FDG-positive ganglia are mainly band-shaped; most LNMs exhibited nodular and teardrop-shaped configuration.
Ga-PSMA and C-choline uptake in ganglia was common, and FDG-positive ganglia were observed at lower frequency. Using Ga-PSMA, C-choline and F-FDG uptake and anatomic location and configuration, the differentiation of ganglia from adjacent LNM is feasible.
研究表明，PSMA阳性神经节是核医学医生诊断中的一个陷阱。尚无研究描述神经节中胆碱和FDG的摄取情况，这可能是误诊的一个来源。在此，我们描述了Ga-PSMA、C-胆碱和F-FDG PET/CT在神经节中的摄取百分比和模式，并评估了神经节的异质性代谢模式以与淋巴结转移（LNM）相鉴别。
回顾性分析39例行C-胆碱PET/CT的患者以及120例行Ga-PSMA PET/CT和F-FDG PET/CT的患者。确定PSMA阳性、胆碱阳性和FDG阳性神经节的患病率，测量不同部位神经节的SUVmax，并描述其形态。通过ROC曲线分析确定PSMA-PET、胆碱-PET和FDG-PET的SUVmax临界值，以区分神经节和LNM。
在120例患者中识别出329个PSMA阳性神经节，在39例患者中识别出95个胆碱阳性神经节，在34例患者中识别出39个FDG阳性神经节。PSMA阳性摄取分别在98.3%的颈神经节、95.8%的腹腔神经节和80.0%的骶神经节中观察到。胆碱阳性摄取分别在84.6%的颈神经节、97.4%的腹腔神经节和61.5%的骶神经节中观察到。FDG阳性摄取分别在16.7%的颈神经节、13.3%的腹腔神经节和2.5%的骶神经节中观察到。颈神经节和腹腔神经节的PSMA阳性摄取率高于骶神经节。胆碱摄取在腹腔神经节中最高，其次是颈神经节和骶神经节。LNM中PSMA、胆碱或FDG的摄取均显著高于神经节。ROC曲线分析显示，在PSMA-PET的SUVmax临界值为4.1时，LNM识别的敏感性、特异性和准确性分别为88.4%、97.9%和96.2%。ROC曲线分析显示，在胆碱-PET的SUVmax临界值为2.35时，LNM识别的敏感性、特异性和准确性分别为95.0%、92.6%和93.0%。ROC曲线分析显示，在FDG-PET的SUVmax临界值为2.55时，LNM识别的敏感性、特异性和准确性分别为77.3%、87.2%和81.9%。PSMA、胆碱和FDG阳性神经节主要呈带状；大多数LNM表现为结节状和泪滴状形态。
神经节中Ga-PSMA和C-胆碱摄取常见，FDG阳性神经节观察频率较低。利用Ga-PSMA、C-胆碱和F-FDG摄取以及解剖位置和形态，区分神经节与相邻LNM是可行的。
