68Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging
68Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging
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DOI：
10.2967/jnumed.117.204677
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发表时间：
2018-09-01
影响因子：
9.3
通讯作者：
Eiber, Matthias
中科院分区：
文献类型：
--
作者：
Rischpler, Christoph;Beck, Teresa I.;Eiber, Matthias
本研究旨在探讨在前列腺癌显像中，交感神经节的颈、腹和骶神经节中是否存在生理性前列腺特异性膜抗原(GA-68-PSMA)配体摄取，作为前列腺癌淋巴转移的隐患。方法：回顾分析407例患者行Ga-68-GaN，N-双[2-羟基-5-(羧乙基)苄基]乙二胺-N，N-二乙酸(Ga-68-PSMA-HBED-CC)PET(结合诊断CT)的临床资料。测定颈、腹、骶神经节中Ga-68-PSMA PET阳性神经节的数目，并测量各神经节的形态和最大血流速度(SUVmax)。此外，还确定了相应区域(颈部、腹腔区或骶部)的邻近淋巴结转移的形态和SUVmax。结果：401例(98.5%)外周神经节、369例(92%)颈神经节、363例(%)腹腔神经节、183例(46%)骶神经节有上述背景摄取。Ga-68-PSMA配基摄取在腹神经节(平均SUVmax为2.9+/-0.8vs.颈部平均SUVmax为2.4+/-0.6)和骶神经节(平均SUVmax为1.7+/-0.5；P均为0.0001)中最高。在个体内，颈神经节与腹神经节(R=0.34，P<；0.0001)、颈神经节与骶神经节(R=0.52，P<；0.0001)以及腹神经节与骶神经节(R=0.16，P<；0.0001)的Ga-68-PSMA配体摄取之间存在着统计学上的显著至弱至中度的相关性。在邻近淋巴结转移灶中，Ga-68配体的摄取显著高于相应神经节(颈部：18.0±/-16.2vs.2.4+/-0.6，P<；0.0001；腹腔：13.5±/-12.3vs.2.9+/-0.8，P<；0.0001；骶骨：13.4+/-11.6vs.1.7+/-0.5P<；0.0001)。此外，神经节以带状结构为主(71.2%)，其次为泪滴状(26.8%)，极少数为结节状(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(58.6%)(P<；0.00001)。结论：用Ga-68-PSMA-HBED-CC PET评价交感神经干神经节对Ga-68-PSMA配体的摄取是前列腺癌PET成像的一个重要缺陷。腹腔神经节对Ga-68-PSMA配体的摄取高于颈神经节和骶神经节，且Ga-68-PSMA配体摄取水平似乎与患者有关。对于淋巴结转移和交感神经节的鉴别，应仔细检查Ga-68-PSMA配体摄取的强度和各自病变的准确定位和形态。
The study aims to investigate the presence of physiologic prostate-specific membrane antigen (Ga-68-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. Methods: Four hundred seven patients who underwent Glu-NH-CO-NH-Lys radiolabeled with Ga-68-gallium N, N-bis[2-hydroxy-5-(carboxyethyl) benzyl] ethylenediamine-N, N-diacetic acid (Ga-68-PSMA-HBED-CC) PET (combined with a diagnostic CT) were retrospectively analyzed. The number of Ga-68-PSMA PET-positive cervical, celiac, and sacral ganglia was determined, and the configuration and SUVmax of each ganglion were measured. In addition, the configuration and SUVmax of adjacent lymph node metastases in the respective region (cervical, celiac, or sacral) were determined. Results: Ga-68-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-68-PSMA-ligand uptake was highest in celiac (mean SUVmax, 2.9 +/- 0.8 vs. cervical mean SUVmax, 2.4 +/- 0.6) and sacral (mean SUVmax 1.7 +/- 0.5; both P < 0.0001) ganglia. Intraindividually there was a statistically significant but weak to moderate correlation between the Ga-68-PSMA-ligand uptake in cervical versus celiac ganglia (R = 0.34, P < 0.0001), cervical versus sacral (R = 0.52, P < 0.0001), and celiac versus sacral (R = 0.16, P < 0.05). The Ga-68-PSMA-ligand uptake was significantlymore intense in adjacent lymph node metastases than the respective ganglia (cervical: 18.0 +/- 16.2 vs. 2.4 +/- 0.6, P < 0.0001; celiac: 13.5 +/- 12.3 vs. 2.9 +/- 0.8, P < 0.0001; sacral: 13.4 +/- 11.6 vs. 1.7 +/- 0.5, P < 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%) (P < 0.00001). Conclusion: Ga-68-PSMA-ligand uptake in ganglia along the sympathetic trunk as assessed by Ga-68-PSMA-HBED-CC PET represents an important pitfall in prostate cancer PET imaging. The Ga-68-PSMA-ligand uptake is higher in celiac ganglia than cervical or sacral ganglia, and the level of Ga-68-PSMA-ligand uptake seems to be patient-related. For the differentiation between lymph node metastases and sympathetic ganglia, both intensity of Ga-68-PSMA-ligand uptake and exact localization and configuration of the respective lesion should be examined carefully.