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

Alberts, Ian; Sachpekidis, Christos; Dijkstra, Lotte; Prenosil, George; Gourni, Eleni; Boxler, Silvan; Gross, Tobias; Thalmann, George; Rahbar, Kambiz; Rominger, Axel; Afshar-Oromieh, Ali (2020). The role of additional late PSMA-ligand PET/CT in the differentiation between lymph node metastases and ganglia. European journal of nuclear medicine and molecular imaging, 47(3), pp. 642-651. Springer-Verlag 10.1007/s00259-019-04552-9

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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.


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.


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.


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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Alberts, Ian Leigh, Sachpekidis, Christos, Prenosil, George, Gourni, Eleni, Boxler, Silvan, Gross, Tobias, Thalmann, George, Rominger, Axel Oliver, Afshar Oromieh, Ali


600 Technology > 610 Medicine & health








Sabine Lanz

Date Deposited:

30 Jan 2020 15:36

Last Modified:

05 Dec 2022 15:35

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Ganglion PET/CT PSMA Positron emission tomography Prostate cancer Prostate-specific membrane antigen




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