Physiological distribution of PSMA-ligand in salivary glands and seromucous glands of the head and neck on PET/CT

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Thomas J.W. Klein Nulent, Matthijs H. Valstar, Bart de Keizer, Stefan M. Willems, Laura A. Smit, Abrahim Al-Mamgani, Ludwig E. Smeele, Robert J.J. van Es, Remco de Bree, Wouter V. Vogel
ObjectivesProstate-specific membrane antigen (PSMA) PET/CT is used for detection and (re)staging of prostate cancer. However, healthy salivary, seromucous, and lacrimal glands also show high PSMA-ligand uptake. This study aimed to describe physiological PSMA-ligand uptake distribution characteristics in the head and neck, to aid in PSMA PET/CT interpretation and to identify possible new clinical applications for PSMA-ligand imaging.Study designThirty consecutive patients who underwent PSMA PET/CT for prostate cancer were evaluated. Tracer maximum standardized uptake values (SUVmax) in the salivary, seromucous, and lacrimal glands were determined visually and quantitatively. Overall and intra-individual variations were reported.ResultsAll gland locations showed increased tracer uptake. The mean SUVmax (±SD) varied: parotid 12.3±3.9; submandibular 11.7±3.5; sublingual 4.5±1.9; soft palate 2.4±0.5; pharyngeal wall 4.3±1.3; nasal mucosa 3.4±0.9; supraglottic larynx 2.7±0.7; and lacrimal 6.2±2.2. The parotid showed the largest overall variation in SUVmax (5.2-22.9), the sublingual glands the largest mean intra-individual difference (18.1%).ConclusionsMajor and minor salivary and seromucous glands consistently show high PSMA-ligand uptake. Minor gland locations can be selectively visualized by this technique for the first time. This provides potential new applications such as quantification of present salivary gland tissues and individualization of radiotherapy for head and neck cancer or ¹⁷⁷Lu-PSMA radionuclide treatment.



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