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@ARTICLE{AfsharOromieh:134799,
      author       = {A. Afshar-Oromieh and L. P. Sattler and K. Steiger and T.
                      Holland-Letz$^*$ and M. L. da Cunha and W. Mier and O.
                      Neels$^*$ and K. Kopka$^*$ and W. Weichert$^*$ and U.
                      Haberkorn},
      title        = {{T}racer uptake in mediastinal and paraaortal thoracic
                      lymph nodes as a potential pitfall in image interpretation
                      of {PSMA} ligand {PET}/{CT}.},
      journal      = {European journal of nuclear medicine and molecular imaging},
      volume       = {45},
      number       = {7},
      issn         = {1619-7089},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer-Verl.},
      reportid     = {DKFZ-2018-00592},
      pages        = {1179 - 1187},
      year         = {2018},
      abstract     = {Since the introduction of 68Ga-PSMA-11 PET/CT for imaging
                      prostate cancer (PC) we have frequently observed mediastinal
                      lymph nodes (LN) showing tracer uptake despite being
                      classified as benign. The aim of this evaluation was to
                      further analyze such LN.Two patient groups with biphasic
                      68Ga-PSMA-11 PET/CT at 1 h and 3 h p.i. were included in
                      this retrospective evaluation. Group A (n = 38) included
                      patients without LN metastases, and group B (n = 43)
                      patients with LN metastases of PC. SUV of
                      mediastinal/paraaortal LN of group A (n = 100) were
                      compared to SUV of LN metastases of group B (n = 91).
                      Additionally, 22 randomly selected mediastinal and
                      paraaortal LN of patients without PC were
                      immunohistochemically (IHC) analyzed for PSMA expression.In
                      group A, 7/38 patients $(18.4\%)$ presented with at least
                      one PSMA-positive mediastinal LN at 1 h p.i. and 3/38
                      $(7.9\%)$ positive LN at 3 h p.i. with a SUVmax of
                      2.3 ± 0.7 at 1 h p.i. (2.0 ± 0.7 at 3 h p.i.). A
                      total of 11 PSMA-positive mediastinal/paraaortal LN were
                      detected in nine patients considering both imaging timing
                      points. SUVmax of LN-metastases was 12.5 ± 13.2 at 1 h
                      p.i. (15.8 ± 17.0 at 3 h p.i.). SUVmax increased
                      clearly $(> 10\%)$ between 1 h and 3 h p.i. in $76.9\%$
                      of the LN metastases, and decreased significantly in
                      $72.7\%$ of the mediastinal/paraaortal LN. By IHC,
                      PSMA-expression was observed in intranodal vascular
                      endothelia of all investigated LN groups and to differing
                      degrees within germinal centers of 15/22 of them $(68.1\%).$
                      Expression was stronger in mediastinal nodes (p = 0.038)
                      and when follicular hyperplasia was present
                      (p = 0.050).PSMA-positive mediastinal/paraaortal benign
                      LN were visible in a notable proportion of patients.
                      PSMA-positivity on the histopathological level was
                      associated with the activation state of the LN. However, in
                      contrast to LN metastases of PC, they presented with
                      significantly lower uptake, which, in addition, usually
                      decreased over time.},
      cin          = {C060 / E030 / L101 / L701},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331 / I:(DE-He78)E030-20160331 /
                      I:(DE-He78)L101-20160331 / I:(DE-He78)L701-20160331},
      pnm          = {319H - Addenda (POF3-319H)},
      pid          = {G:(DE-HGF)POF3-319H},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29497802},
      doi          = {10.1007/s00259-018-3965-8},
      url          = {https://inrepo02.dkfz.de/record/134799},
}