<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2019-0052_s_007_w2aab3b8c70b1b7b1aab1c16b1Aa"><h3>Background</h3><p>Detectable uptake of <sup>68</sup>Ga-PSMA-ligands in sympathetic ganglia may potentially lead to mistaking them for malignant lesions. Our aim was to investigate the anatomy of cervico-thoracic-ganglia-complex (CTG-C) in the MR part of multimodal <sup>68</sup>Ga-PSMA-11 PET/MR imaging, in view of PET factors hindering its proper identification.</p></sec><sec id="j_raon-2019-0052_s_008_w2aab3b8c70b1b7b1aab1c16b2Aa"><h3>Patients and methods</h3><p>In 106 patients, 212 sites of the CTG-C were retrospectively reviewed to assess the radiotracer uptake (SUV<sub>max</sub>), size, shape, position, symmetry of location and visual uptake intensity. Asymmetry of PSMA-ligand uptake and increased uptake were regarded as risk factors of malignancy.</p></sec><sec id="j_raon-2019-0052_s_009_w2aab3b8c70b1b7b1aab1c16b3Aa"><h3>Results</h3><p>In 66.0% left (L) and 53.8% right (R) CTG-C we noticed configurations, resembling the shape of an exclamation-mark, a question-mark, or its part (called “typical”). Tumor-like CTG-C shapes (oval, binodular or longitudinal) were detected in 28.3% L-CTG-C and in 40.6% R-CTG-C. When visual assessment of PET suggested malignancy, the recognition of “typical” shape of underlying CTG-C on MR generated a rise in the accuracy of their proper identification (from 34.4% to 75%, χ2(1) = 70.4; p &lt; 0.001). Recognizing the shape of the CTG-C as “typical” in MR allowed us to classify as “not-suspicious” 61.9% of all CTG-C which were treated as “suspicious” after sole PET assessment.</p></sec><sec id="j_raon-2019-0052_s_010_w2aab3b8c70b1b7b1aab1c16b4Aa"><h3>Conclusions</h3><p>The characteristic shape of cervico-thoracic-ganglia-complex (resembling a question-mark, or its part) helps in proper recognition of CTG-C on multimodal whole-body <sup>68</sup>Ga-PSMA-ligand PET/MR imaging, when detectable uptake might lead to considering pathology.</p></sec></abstract>

BackgroundDetectable uptake of 68Ga-PSMA-ligands in sympathetic ganglia may potentially lead to mistaking them for malignant lesions. Our aim was to investigate the anatomy of cervico-thoracic-ganglia-complex (CTG-C) in the MR part of multimodal 68Ga-PSMA-11 PET/MR imaging, in view of PET factors hindering its proper identification.Patients and methodsIn 106 patients, 212 sites of the CTG-C were retrospectively reviewed to assess the radiotracer uptake (SUVmax), size, shape, position, symmetry of location and visual uptake intensity. Asymmetry of PSMA-ligand uptake and increased uptake were regarded as risk factors of malignancy.ResultsIn 66.0% left (L) and 53.8% right (R) CTG-C we noticed configurations, resembling the shape of an exclamation-mark, a question-mark, or its part (called “typical”). Tumor-like CTG-C shapes (oval, binodular or longitudinal) were detected in 28.3% L-CTG-C and in 40.6% R-CTG-C. When visual assessment of PET suggested malignancy, the recognition of “typical” shape of underlying CTG-C on MR generated a rise in the accuracy of their proper identification (from 34.4% to 75%, χ2(1) = 70.4; p < 0.001). Recognizing the shape of the CTG-C as “typical” in MR allowed us to classify as “not-suspicious” 61.9% of all CTG-C which were treated as “suspicious” after sole PET assessment.ConclusionsThe characteristic shape of cervico-thoracic-ganglia-complex (resembling a question-mark, or its part) helps in proper recognition of CTG-C on multimodal whole-body 68Ga-PSMA-ligand PET/MR imaging, when detectable uptake might lead to considering pathology.

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on <sup>68</sup>Ga-PSMA-11 PET/MR?

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on Ga-PSMA-11 PET/MR?

BackgroundDetectable uptake of 68Ga-PSMA-ligands in sympathetic ganglia may potentially lead to mistaking them for malignant lesions. Our aim was to...

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on ⁶⁸Ga-PSMA-11 PET/MR?

Article Category: Research Article

Published Online: Oct 25, 2019

Page range: 407 - 414

Received: Apr 02, 2019

Accepted: Sep 09, 2019

DOI: https://doi.org/10.2478/raon-2019-0052

© 2019 Ewa J. Bialek, Bogdan Malkowski, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on 68Ga-PSMA-11 PET/MR?

Article Category: Research Article

Published Online: Oct 25, 2019

Page range: 407 - 414

Received: Apr 02, 2019

Accepted: Sep 09, 2019

DOI: https://doi.org/10.2478/raon-2019-0052

© 2019 Ewa J. Bialek, Bogdan Malkowski, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on ⁶⁸Ga-PSMA-11 PET/MR?