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

Purpose To determine the frequency of seemingly pathological retroperitoneal uptake in the location of the coeliac ganglia in patients undergoing [Ga-68]PSMA-HBED PET/CT. Methods The study included 85 men with prostate cancer referred for [Ga-68]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 [Ga-68]PSMA-HBED uptake in most patients and may mimic lymph node metastases.