Aortic Calcifications Mimicking Lymph Nodes on 18F-PSMA1007 PET

An 82-year-old patient with high-risk prostate adenocarcinoma, previously treated with radiotherapy and hormone therapy, presented with biochemical recurrence, as evidenced by a prostate-specific antigen level of 10 ng/mL. A positron emission tomography/computed tomography (PET/CT) scan using 18F-prostate-specific membrane antigen (PSMA ) 1007 revealed significant uptake at the prostate apex and multiple hypermetabolic osseous lesions in the sternum and L3, suggestive of local recurrence and metastasis. However, several hypermetabolic foci in the abdominopelvic region raised suspicion for potential involvement of the lumbar-aortic lymph nodes due to their moderate to intense uptake. After further investigation, these findings were attributed to active aortic calcifications. This case highlights a rare cause of false-positive results in 18F-PSMA 1007 PET/CT imaging and underscores the need for additional evaluations, such as abdominopelvic magnetic resonance imaging and renal and phosphocalcic assessments, when such results are suspected.