Vertebral Hemangioma Mimicking Bone Metastasis in 68Ga—PSMA Ligand PET/CT

Artigas, Carlos; Otte, F.; Lemort, Marc; Velthoven, Roland Van; Flamen, Patrick

doi:10.1097/rlu.0000000000001631

Cited by 49 publications

(25 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the increasing number of scanned patients and the growing distribution of 68 Ga-PSMA PET, nuclear medicine physicians and radiologists need to become familiar with pearls and pitfalls of this imaging modality (19). Several malignancies and also benign structures that exhibit an elevated 68 Ga-PSMA expression have already been described (1,(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…However, high 68 Ga-PSMA expression has also been described in malignant lesions not related to the prostate (e.g., renal cell carcinoma, bronchial carcinoma, glioblastoma), in benign tissues (e.g., renal tubules, duodenum, colon), and in benign lesions such as schwannomas, osteophytes, thyroid adenomas or vertebral and subcutaneous hemangiomas (1,(6)(7)(8)(9)(10)(11)(12)(13)(14). The ganglia of the sympathetic trunk are another tissue in which an increased 68 Ga-PSMA expression has been reported (15,16).…”

mentioning

confidence: 99%

See 1 more Smart Citation

⁶⁸Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging

et al. 2018

View full text Add to dashboard Cite

The study aims to investigate the presence of physiologic prostate-specific membrane antigen (Ga-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. Four hundred seven patients who underwent Glu-NH-CO-NH-Lys radiolabeled withGa-gallium -bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine--diacetic acid (Ga-PSMA-HBED-CC) PET (combined with a diagnostic CT) were retrospectively analyzed. The number of Ga-PSMA PET-positive cervical, celiac, and sacral ganglia was determined, and the configuration and SUV of each ganglion were measured. In addition, the configuration and SUV of adjacent lymph node metastases in the respective region (cervical, celiac, or sacral) were determined. Ga-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. TheGa-PSMA-ligand uptake was highest in celiac (mean SUV, 2.9 ± 0.8 vs. cervical mean SUV, 2.4 ± 0.6) and sacral (mean SUV 1.7 ± 0.5; both < 0.0001) ganglia. Intraindividually there was a statistically significant but weak to moderate correlation between the Ga-PSMA-ligand uptake in cervical versus celiac ganglia ( = 0.34, < 0.0001), cervical versus sacral ( = 0.52, < 0.0001), and celiac versus sacral ( = 0.16, < 0.05). The Ga-PSMA-ligand uptake was significantly more intense in adjacent lymph node metastases than the respective ganglia (cervical: 18.0 ± 16.2 vs. 2.4 ± 0.6, < 0.0001; celiac: 13.5 ± 12.3 vs. 2.9 ± 0.8, < 0.0001; sacral: 13.4 ± 11.6 vs. 1.7 ± 0.5, < 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%) ( < 0.00001). Ga-PSMA-ligand uptake in ganglia along the sympathetic trunk as assessed byGa-PSMA-HBED-CC PET represents an important pitfall in prostate cancer PET imaging. The Ga-PSMA-ligand uptake is higher in celiac ganglia than cervical or sacral ganglia, and the level ofGa-PSMA-ligand uptake seems to be patient-related. For the differentiation between lymph node metastases and sympathetic ganglia, both intensity of Ga-PSMA-ligand uptake and exact localization and configuration of the respective lesion should be examined carefully.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

⁶⁸Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The case highlights the potential morbidity of false positives. Other pathologies such as Paget's disease [16,17], paragangliomas [21], and haemangiomas [22,23] have been reported to cause PSMA uptake in bone. Primary bone malignancies can also masquerade as prostate cancer metastasis [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

et al. 2020

View full text Add to dashboard Cite

Objectives To determine the proportion of solitary rib lesions on pre‐treatment 68Gallium‐labelled prostate‐specific membrane antigen (PSMA)/computed tomography (CT) scans in men with prostate cancer that are malignant and examine any predictive factors. Patients and methods This retrospective single tertiary referral institution cohort study of men reviewed the results of 68Ga‐PSMA‐11 positron emission tomography (PET)/CT scans performed for primary staging prior to treatment of prostate cancer from July 2014 to September 2019. Men with PSMA uptake outside the prostate in only the rib lesion were included. A solitary rib lesion was considered to be malignant if it increased in size on follow‐up imaging. A lesion was considered benign if the prostate‐specific antigen (PSA) level remained <0.1 µg/L following a radical prostatectomy (RP), <2 µg/L above nadir following radiotherapy (RT) as per the Phoenix criteria, histology was benign on rib biopsy, or follow‐up imaging showed no growth of the rib lesion. If a lesion did not meet these criteria it was considered indeterminate. Results A total of 62 men had PSMA uptake in a solitary rib lesion; 54 went on to have RPs and eight underwent RT. In all, 61 of the men (98.4%) met the criteria for a benign rib lesion. Only one man had a false‐negative malignant lesion. This man had a rib lesion with a low maximum standardised uptake value (SUVmax) of 2.21 reported as benign, but the postoperative PSA level was 0.67 µg/L and the rib lesion progressed on follow‐up imaging, with development of widespread metastases. Of the benign rib lesions, there were four false positives reported as possible metastases. Three had percutaneous rib biopsies, two of which came back with benign histology and one was indeterminate. The indeterminate biopsy patient had a RP and his postoperative PSA level was <0.1 µg/L. A total of 43 (69.4%) men with benign rib lesions had a SUVmax greater than the SUVmax of the malignant lesion. Conclusion To our knowledge, this is the first cohort study of men with PSMA‐avid solitary rib lesions on pre‐treatment 68Ga‐PSMA PET/CT staging scans for prostate cancer. Our results indicate that the vast majority of these lesions have low‐intensity uptake and are benign. Intervention to confirm this is not usually required.

show abstract

“…It also acts as a folate hydrolase that can be expressed in normal tissues and in both benign and malignant processes (13,14). For example, PSMA-ligand uptake can appear in conditions including but not limited to Paget's disease, myelomas, fibrous dysplasia, hemangiomas, and bone fractures (15)(16)(17)(18)(19)(20), which can represent false-positive findings for metastatic disease on 68 Ga-PSMA PET. Given the management implications of the presence of osseous metastatic disease and the potential for false positives, guidelines have been suggested for interpreting 68 Ga-PSMA PET osseous lesions, including PSMA-RADS (21) and Prostate Cancer Molecular Imaging Standardized Evaluation (22).…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

et al. 2020

View full text Add to dashboard Cite

Bone is the most common site of distant metastatic spread in prostate adenocarcinoma. Prostatespecific membrane antigen uptake has been described in both benign and malignant bone lesions, which can lead to false-positive findings on 68 Ga-prostate-specific membrane antigen-11 positron emission tomography (68 Ga-PSMA-11 PET). The purpose of this study was to evaluate the diagnostic accuracy of 68 Ga-PSMA-11 PET for osseous prostate cancer metastases and improve bone uptake interpretation using semi-quantitative metrics. METHODS. 56 prostate cancer patients (18 pre-prostatectomy, 38 biochemical recurrence) who underwent 68 Ga-PSMA-11 PET/MRI or PET/CT examinations with osseous PSMA-ligand uptake were included in the study. Medical records were reviewed retrospectively by boardcertified nuclear radiologists to determine true or false positivity based on a composite endpoint. For each avid osseous lesion, biological volume, size, PSMA-RADS rating, maximum standardized uptake value (SUVmax), and ratio of lesion SUVmax to liver, blood pool, and background bone SUVmax were measured. Differences between benign and malignant lesions were evaluated for statistical significance, and cutoff values for these parameters were determined to maximize diagnostic accuracy. RESULTS. Among 56 participants, 13 patients (22.8%) had false-positive osseous 68 Ga-PSMA-11 findings and 43 patients (76.8%) had true-positive osseous 68 Ga-PSMA-11 findings. Twentytwo patients (39%) had 1 osseous lesion, 18 (32%) had 2-4 lesions, and 16 (29%) had 5 or more lesions. Cutoff values resulting in statistically significant (p<0.005) differences between benign and malignant lesions were: PSMA-RADS ≥4, SUVmax ≥4.1, SUVmax ratio of lesion to blood by on November 1, 2020. For personal use only. jnm.snmjournals.org Downloaded from pool ≥2.11, to liver ≥0.55, and to bone ≥4.4. These measurements corresponded to lesion-based 68 Ga-PSMA-11 PET lesion detection rate for malignancy of 80%, 93%, 89%, 21%, 89%, and a specificity of 73%, 73%, 73%, 93%, 60%, respectively. CONCLUSION. PSMA-RADS rating, SUVmax, and SUVmax ratio of lesion to blood pool can help differentiate benign from malignant lesions on 68 Ga-PSMA-11 PET. SUVmax ratio to blood pool above 2.2 is a reasonable parameter to support image interpretation and presented superior lesion detection rate and specificity when compared to visual interpretation by PSMA RADS. These parameters hold clinical value by improving diagnostic accuracy for metastatic prostate cancer on 68 Ga-PSMA-11 PET/MRI and PET/CT.

show abstract

Vertebral Hemangioma Mimicking Bone Metastasis in 68Ga—PSMA Ligand PET/CT

Cited by 49 publications

References 8 publications

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

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

Contact Info

Product

Resources

About

Vertebral Hemangioma Mimicking Bone Metastasis in 68Ga—PSMA Ligand PET/CT

Cited by 49 publications

References 8 publications

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

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging 68Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

Factors Predicting Metastatic Disease in 68Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

Contact Info

Product

Resources

About

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

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer