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European Journal of Nuclear Medicine and Molecular Imaging

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01-03-2020 | Prostate Cancer | Original Article

The role of additional late PSMA-ligand PET/CT in the differentiation between lymph node metastases and ganglia

Authors: Ian Alberts, Christos Sachpekidis, Lotte Dijkstra, George Prenosil, Eleni Gourni, Silvan Boxler, Tobias Gross, George Thalmann, Kambiz Rahbar, Axel Rominger, Ali Afshar-Oromieh

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2020

Abstract

Purpose

Differentiating between prostate cancer (PC) lesions and benign structures which exhibit radiotracer uptake in PSMA-ligand PET/CT can be challenging. Additional late imaging has been shown to be a powerful method for the discrimination between PC and non-PC lesions, owing to the increasing tracer uptake of the former. Nevertheless, there are no pre-existing studies which describe the dynamic tracer uptake for ganglia, which this present study aims to address.

Methods

Fifty consecutive patients with PC who received standard and late ⁶⁸Ga-PSMA-11-PET/CT (by local protocol at 1.5 h “standard” and 2.5 h p.i. “late”) underwent retrospective evaluation. All lesions with a tracer uptake above local background indicative for ganglia as well as PC lesions were analysed with regard to their maximum standardised uptake values (SUVmax) and localisation.

Results

Overall, 86 PSMA-positive ganglia were identified in 70% (n = 35) of the patients. Five ganglia exhibited PSMA avidity at late imaging only, and three at standard imaging only. A total of 66 lesions suggestive for PC were detected in 44 patients (88%), of which 45% (n = 30) were morphologically identified as lymph nodes (LN), the remainder being locally recurrent lesions or bone metastases. No solid organ metastases were present in our cohort. At late scanning, 73% of the LN exhibited an increase in SUVmax, whereas 65% of the ganglia exhibited a decreasing or stable SUVmax.

Conclusion

Whereas the presence of increasing tracer uptake in potential PC lesions can provide additional data about the likelihood of malignancy, increasing SUVmax alone does not reliably differentiate between ganglia and PC lesions and is a potential diagnostic pitfall. We therefore recommend high-resolution CT to enable morphological characterisation of ganglia.

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Title: The role of additional late PSMA-ligand PET/CT in the differentiation between lymph node metastases and ganglia
Authors: Ian Alberts
Christos Sachpekidis
Lotte Dijkstra
George Prenosil
Eleni Gourni
Silvan Boxler
Tobias Gross
George Thalmann
Kambiz Rahbar
Axel Rominger
Ali Afshar-Oromieh
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Metastasis
Prostate Cancer
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04552-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The role of additional late PSMA-ligand PET/CT in the differentiation between lymph node metastases and ganglia

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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