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Purpose <p>This study aims to investigate the prevalence, pattern, physiological basis, and influencing factors of sympathetic ganglia uptake on [<sup>18</sup>F]AlF-NOTA-LM3 PET/CT.</p> Methods <p>[<sup>18</sup>F]AlF-NOTA-LM3 PET/CT images from 101 patients were retrospectively reviewed to evaluate the presence of sympathetic ganglia uptake. Clinical data and normal-organ uptake were investigated to identify influencing factors. Uptake patterns were compared between sympathetic ganglia and metastatic lymph nodes. Immunohistochemical (IHC) staining for SSTR2 was performed on a stellate ganglion and other specimens.</p> Results <p>Positive sympathetic ganglia were observed in 76.2% (77/101) of patients on [<sup>18</sup>F]AlF-NOTA-LM3 PET/CT. 76.2% (77/101), 33.7% (34/101), 23.8% (24/101), 32.7% (33/101) of patients exhibited positive stellate, thoracic, celiac, and sacral ganglia, respectively. Sympathetic ganglia uptake was associated with higher pituitary, adrenal gland, small-intestinal uptake, and lower tumor burden. Sympathetic ganglia generally exhibited a bilateral symmetric distribution and significantly lower uptake than lymph node metastases (SUVmax: 2.29 ± 0.67 vs. 14.52 ± 14.29; <i>P</i> &lt; 0.001). An SUVmax cutoff of 3.45 differentiated sympathetic ganglia from metastatic lymph nodes with an accuracy of 95.9% and an AUC of 0.967. IHC revealed moderate SSTR2 expression in the membrane and cytoplasm of a subset of stellate ganglionic neurons and in neurons of both the myenteric and submucosal plexuses of duodenum.</p> Conclusion <p>Sympathetic ganglia uptake on SSTR PET/CT is a common physiological finding, featured by symmetric distribution and faint uptake. Histopathology confirming SSTR2-positive ganglionic neurons provides the biological basis for this uptake.</p>

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Beyond tumor tracing: physiological uptake of sympathetic ganglia on somatostatin receptor PET/CT — prevalence, patterns, and biological rationale

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Meixi Liu,
  • Ruping Hong,
  • Yuwei Zhang,
  • Xinchun Yan,
  • Jingnan Wang,
  • Haiqiong Zhang,
  • Chao Ren,
  • Zhenghai Huang,
  • Jing Shi,
  • Yuejuan Cheng,
  • Anli Tong,
  • Hongli Jing,
  • Wenjia Zhu,
  • Li Huo

摘要

Purpose

This study aims to investigate the prevalence, pattern, physiological basis, and influencing factors of sympathetic ganglia uptake on [18F]AlF-NOTA-LM3 PET/CT.

Methods

[18F]AlF-NOTA-LM3 PET/CT images from 101 patients were retrospectively reviewed to evaluate the presence of sympathetic ganglia uptake. Clinical data and normal-organ uptake were investigated to identify influencing factors. Uptake patterns were compared between sympathetic ganglia and metastatic lymph nodes. Immunohistochemical (IHC) staining for SSTR2 was performed on a stellate ganglion and other specimens.

Results

Positive sympathetic ganglia were observed in 76.2% (77/101) of patients on [18F]AlF-NOTA-LM3 PET/CT. 76.2% (77/101), 33.7% (34/101), 23.8% (24/101), 32.7% (33/101) of patients exhibited positive stellate, thoracic, celiac, and sacral ganglia, respectively. Sympathetic ganglia uptake was associated with higher pituitary, adrenal gland, small-intestinal uptake, and lower tumor burden. Sympathetic ganglia generally exhibited a bilateral symmetric distribution and significantly lower uptake than lymph node metastases (SUVmax: 2.29 ± 0.67 vs. 14.52 ± 14.29; P < 0.001). An SUVmax cutoff of 3.45 differentiated sympathetic ganglia from metastatic lymph nodes with an accuracy of 95.9% and an AUC of 0.967. IHC revealed moderate SSTR2 expression in the membrane and cytoplasm of a subset of stellate ganglionic neurons and in neurons of both the myenteric and submucosal plexuses of duodenum.

Conclusion

Sympathetic ganglia uptake on SSTR PET/CT is a common physiological finding, featured by symmetric distribution and faint uptake. Histopathology confirming SSTR2-positive ganglionic neurons provides the biological basis for this uptake.