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

Authors

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

Published in

European journal of nuclear medicine and molecular imaging. Jun 24, 2026. Epub Jun 24, 2026.

Abstract

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

PMID:
42340391
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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