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. 2017 Nov;31(9):696-702.
doi: 10.1007/s12149-017-1201-4. Epub 2017 Aug 22.

Patterns of uptake of prostate-specific membrane antigen (PSMA)-targeted 18F-DCFPyL in peripheral ganglia

Rudolf A Werner  1   2 , Sara Sheikhbahaei  1 , Krystyna M Jones  1 , Mehrbod S Javadi  1 , Lilja B Solnes  1 , Ashley E Ross  3 , Mohamad E Allaf  4 , Kenneth J Pienta  4 , Constantin Lapa  2 , Andreas K Buck  2 , Takahiro Higuchi  2   5 , Martin G Pomper  1 , Michael A Gorin  1   4 , Steven P Rowe  6   7
Affiliations

Patterns of uptake of prostate-specific membrane antigen (PSMA)-targeted 18F-DCFPyL in peripheral ganglia

Rudolf A Werner et al. Ann Nucl Med. 2017 Nov.

Abstract

Objective: Radiotracers targeting prostate-specific membrane antigen (PSMA) have increasingly been recognized as showing uptake in a number of normal structures, anatomic variants, and non-prostate-cancer pathologies. We aimed to explore the frequency and degree of uptake in peripheral ganglia in patients undergoing PET with the PSMA-targeted agent 18F-DCFPyL.

Methods: A total of 98 patients who underwent 18F-DCFPyL PET/CT imaging were retrospectively analyzed. This included 76 men with prostate cancer (PCa) and 22 patients with renal cell carcinoma (RCC; 13 men, 9 women). Scans were evaluated for uptake in the cervical, stellate, celiac, lumbar and sacral ganglia. Maximum standardized uptake value corrected to body weight (SUVmax), and maximum standardized uptake value corrected to lean body mass (SULmax) were recorded for all ganglia with visible uptake above background. Ganglia-to-background ratios were calculated by dividing the SUVmax and SULmax values by the mean uptake in the ascending aorta (Aortamean) and the right gluteus muscle (Gluteusmean).

Results: Overall, 95 of 98 (96.9%) patients demonstrated uptake in at least one of the evaluated peripheral ganglia. With regard to the PCa cohort, the most frequent sites of radiotracer accumulation were lumbar ganglia (55/76, 72.4%), followed by the cervical ganglia (51/76, 67.1%). Bilateral uptake was found in the majority of cases [lumbar 44/55 (80%) and cervical 30/51 (58.8%)]. Additionally, discernible radiotracer uptake was recorded in 50/76 (65.8%) of the analyzed stellate ganglia and in 45/76 (59.2%) of the celiac ganglia, whereas only 5/76 (6.6%) of the sacral ganglia demonstrated 18F-DCFPyL accumulation. Similar findings were observed for patients with RCC, with the most frequent locations of radiotracer uptake in both the lumbar (20/22, 90.9%) and cervical ganglia (19/22, 86.4%). No laterality preference was found in mean PSMA-ligand uptake for either the PCa or RCC cohorts.

Conclusion: As PSMA-targeted agents become more widely disseminated, the patterns of uptake in structures that are not directly relevant to patients' cancers must be understood. This is the first systematic evaluation of the uptake of 18F-DCFPyL in ganglia demonstrating a general trend with a descending frequency of radiotracer accumulation in lumbar, cervical, stellate, celiac, and sacral ganglia. The underlying biology that leads to variability of PSMA-targeted radiotracers in peripheral ganglia is not currently understood, but may provide opportunities for future research.

Keywords: 18F-DCFPyL; Ganglia; Imaging pitfalls; PSMA; Prostate cancer.

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Conflict of interest statement

Conflict of interest

MGP is a coinventor on a US Patent covering 18F-DCFPyL, and as such is entitled to a portion of any licensing fees and royalties generated by this technology. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. MAG has served as a consultant to Progenics Pharmaceuticals, the licensee of 18F-DCFPyL. MAG, KJP, MGP, and SPR have received research support from Progenics Pharmaceuticals.

Sources of funding

The Prostate Cancer Foundation Young Investigator Award, philanthropy raised by the James Buchanan Brady Urological Institute, and National Institutes of Health Grants CA134675 and CA183031. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant agreement.

Figures

Fig. 1
Fig. 1
a Anterior view of 18F-DCFPyL maximum intensity projection (MIP) image from a 56-year-old PCa patient undergoing preoperative staging. Mild radiotracer uptake is seen in multiple cervical DRG bilaterally (red arrows). b Axial 18F-DCFPyL PET and c axial 18F-DCFPyL PET/CT fusion images from the C5–6 level also show mild radiotracer uptake in the C6 DRG bilaterally (red arrows). Note normal physiologic biodistribution of this radiotracer including uptake in the major salivary glands and structures of the larynx
Fig. 2
Fig. 2
a Sagittal view of 18F-DCFPyL MIP image from a 58-year-old female patient with history of metastatic RCC and undergoing a staging examination. Multiple lumbar and sacral DRG show mild uptake (red arrows). b Axial 18F-DCFPyL PET and c axial 18F-DCFPyL PET/CT through the S1–2 level both demonstrate mild uptake of the S1 DRG (red arrows). Again, a portion of the normal physiologic biodistribution of the radiotracer is apparent including uptake in the patient’s remaining kidney, liver, and bowel
Fig. 3
Fig. 3
a Axial 18F-DCFPyL PET and b axial 18F-DCFPyL PET/CT images from a 66-year-old male patient undergoing staging evaluation for recurrent PCa. Focal mild-moderate radiotracer uptake is noted in the left celiac ganglion (red arrow). A similar degree of uptake was seen in the right celiac ganglion (not shown). c Axial 18F-DCFPyL PET and d axial 18F-DCFPyL PET/CT images from a 67-year-old male with recurrent PCa. Mild uptake is present in the stellate ganglia bilaterally (red arrows)
See this image and copyright information in PMC

References

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