Interesting ImagesReverse Liver Spleen Uptake on [68Ga]Ga-PSMA-11 PET/CTAbubakar, Sofiullah FCNP(SA), MMED(UCT)∗; Al Riyami, Khulood MD, FRCR∗; Jain, Anjali DNB(Nuclear Medicine), MNAMS, FEBNM, FANMB∗; Jayakrishnan, Vipin MSc, DMRIT∗; Tag, Naima FCNP(SA), MMED(Stell)† Author Information From the ∗Department of Radiology and Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre †Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman. Received for publication March 14, 2022; revision accepted April 23, 2022. Conflicts of interest and sources of funding: none declared. Correspondence to: Sofiullah Abubakar, FCNP(SA), MMED(UCT), Department of Radiology and Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, SQU Street, Al Khoud, P.O. Box 566P.C 123, Muscat, Sultanate of Oman. E-mail: [email protected]. Clinical Nuclear Medicine: December 2022 - Volume 47 - Issue 12 - p 1063-1065 doi: 10.1097/RLU.0000000000004285 Buy Metrics Abstract An 80-year-old man underwent [68Ga]Ga-PSMA-11 PET/CT for staging of high-risk prostate cancer. Homogeneously increased liver uptake, more than 3-fold the splenic uptake, was seen. There was no hepatic lesion evident on CT. A higher liver to splenic uptake is more typical of some 18F-labeled PSMA PET/CT but unusual in 68Ga-labeled PSMA PET/CT scan. Further evaluation revealed a history of impaired renal function, bilateral renal atrophy, relatively decreased renal uptake of [68Ga]Ga-PSMA-11, and prominent bowel activity. We concluded that impaired renal function and subsequent poor excretion resulted in increased hepatic excretion, hence the unusual increased homogeneous hepatic uptake. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.