{"title":"18F FDG PET/CT在噬血细胞淋巴组织细胞病中的应用。","authors":"Piyush Aggarwal, Lakshay Tyagi, Harmandeep Singh, Rajender Kumar, Harpreet Singh, Gaurav Prakash, Ankur Kumar Jindal, Manupdesh Singh Sachdeva, Deepti Suri, Bhagwant Rai Mittal","doi":"10.4103/ijnm.ijnm_5_25","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a fatal systemic inflammatory syndrome caused by a wide array of causes, which may be detected on <sup>18</sup>F fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F FDG PET/CT). This study explores the utility of <sup>18</sup>F FDG PET/CT in HLH.</p><p><strong>Materials and methods: </strong>Retrospective data of HLH patients referred for whole-body <sup>18</sup>F FDG PET/CT were analyzed for abnormal findings, and quantitative analysis using standardized uptake value (SUV), spleen-to-liver ratio (SLR), and bone-to-liver ratio (BLR) was done and correlated with laboratory parameters, bone marrow (BM) findings, and final diagnosis.</p><p><strong>Results: </strong>Twenty-four patients (median age 22 years [interquartile range 13-34]) were included in the study. The most common cause of HLH was infection (33%), malignancy (29%), and autoimmune disorders (13%), and five patients had primary HLH. <sup>18</sup>F FDG PET/CT was positive in 22/24 patients (92%). Hepatomegaly and splenomegaly were observed in 22 patients (92%) and 16 patients (67%), respectively, with six (25%) showing splenic lesions. Splenic uptake > liver was observed in 62.5% of patients and BM uptake > liver uptake in 50% of patients. There was no significant difference in median BM uptake (SUV<sub>max</sub> 4.0 vs. 3.5, <i>P</i> = 0.6) and BLR (1.475 vs. 1.514, <i>P</i> = 0.4) in patients with and without HLH on marrow sampling, but a significant difference was observed in hypercellular vs. normocellular/hypocellular marrow (SUV<sub>max</sub> 5.1 vs. 3.2, <i>P</i> = 0.019 and BLR 1.58 vs. 0.82, <i>P</i> = 0.043). A significant positive correlation was observed between splenic and BM uptake (<i>r</i> = 0.501, <i>P</i> = 0.013), BLR and SLR (<i>r</i> = 0.623, <i>P</i> = 0.001), C-reactive protein levels with BLR (<i>r</i> = 0.731, <i>P</i> = 0.001), and SLR (<i>r</i> = 0.594, <i>P</i> = 0.015), respectively. In 11 patients who underwent targeted sampling from most hypermetabolic sites, it helped reach the final diagnosis or eliminate malignant causes.</p><p><strong>Conclusion: </strong><sup>18</sup>F FDG PET/CT has a high diagnostic yield in HLH with the potential to detect its underlying causes and may be considered in the diagnostic algorithm of HLH.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"40 4","pages":"189-196"},"PeriodicalIF":0.5000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503177/pdf/","citationCount":"0","resultStr":"{\"title\":\"Utility of <sup>18</sup>F FDG PET/CT in Hemophagocytic Lymphohistiocytosis.\",\"authors\":\"Piyush Aggarwal, Lakshay Tyagi, Harmandeep Singh, Rajender Kumar, Harpreet Singh, Gaurav Prakash, Ankur Kumar Jindal, Manupdesh Singh Sachdeva, Deepti Suri, Bhagwant Rai Mittal\",\"doi\":\"10.4103/ijnm.ijnm_5_25\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a fatal systemic inflammatory syndrome caused by a wide array of causes, which may be detected on <sup>18</sup>F fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F FDG PET/CT). This study explores the utility of <sup>18</sup>F FDG PET/CT in HLH.</p><p><strong>Materials and methods: </strong>Retrospective data of HLH patients referred for whole-body <sup>18</sup>F FDG PET/CT were analyzed for abnormal findings, and quantitative analysis using standardized uptake value (SUV), spleen-to-liver ratio (SLR), and bone-to-liver ratio (BLR) was done and correlated with laboratory parameters, bone marrow (BM) findings, and final diagnosis.</p><p><strong>Results: </strong>Twenty-four patients (median age 22 years [interquartile range 13-34]) were included in the study. The most common cause of HLH was infection (33%), malignancy (29%), and autoimmune disorders (13%), and five patients had primary HLH. <sup>18</sup>F FDG PET/CT was positive in 22/24 patients (92%). Hepatomegaly and splenomegaly were observed in 22 patients (92%) and 16 patients (67%), respectively, with six (25%) showing splenic lesions. Splenic uptake > liver was observed in 62.5% of patients and BM uptake > liver uptake in 50% of patients. There was no significant difference in median BM uptake (SUV<sub>max</sub> 4.0 vs. 3.5, <i>P</i> = 0.6) and BLR (1.475 vs. 1.514, <i>P</i> = 0.4) in patients with and without HLH on marrow sampling, but a significant difference was observed in hypercellular vs. normocellular/hypocellular marrow (SUV<sub>max</sub> 5.1 vs. 3.2, <i>P</i> = 0.019 and BLR 1.58 vs. 0.82, <i>P</i> = 0.043). A significant positive correlation was observed between splenic and BM uptake (<i>r</i> = 0.501, <i>P</i> = 0.013), BLR and SLR (<i>r</i> = 0.623, <i>P</i> = 0.001), C-reactive protein levels with BLR (<i>r</i> = 0.731, <i>P</i> = 0.001), and SLR (<i>r</i> = 0.594, <i>P</i> = 0.015), respectively. In 11 patients who underwent targeted sampling from most hypermetabolic sites, it helped reach the final diagnosis or eliminate malignant causes.</p><p><strong>Conclusion: </strong><sup>18</sup>F FDG PET/CT has a high diagnostic yield in HLH with the potential to detect its underlying causes and may be considered in the diagnostic algorithm of HLH.</p>\",\"PeriodicalId\":45830,\"journal\":{\"name\":\"Indian Journal of Nuclear Medicine\",\"volume\":\"40 4\",\"pages\":\"189-196\"},\"PeriodicalIF\":0.5000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503177/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Nuclear Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/ijnm.ijnm_5_25\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/19 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Nuclear Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/ijnm.ijnm_5_25","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/19 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目的：噬血细胞淋巴组织细胞增多症（HLH）是一种由多种原因引起的致死性全身性炎症综合征，可在18F氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F FDG PET/CT）上检测到。本研究探讨18F FDG PET/CT在HLH中的应用。材料与方法：对转诊的HLH患者进行全身18F FDG PET/CT回顾性资料分析异常发现，采用标准化摄取值（SUV）、脾肝比（SLR）、骨肝比（BLR）进行定量分析，并与实验室参数、骨髓（BM）结果及最终诊断结果进行相关性分析。结果：24例患者（中位年龄22岁[四分位数范围13-34]）纳入研究。HLH最常见的病因是感染（33%）、恶性肿瘤（29%）和自身免疫性疾病（13%），5例患者为原发性HLH。18F FDG PET/CT阳性22/24（92%）。肝肿大22例（92%），脾肿大16例（67%），其中脾肿大6例（25%）。62.5%的患者脾脏摄取>，50%的患者肝脏摄取>。骨髓取样中，HLH患者和非HLH患者中位骨髓摄取（SUVmax 4.0 vs. 3.5, P = 0.6）和BLR （1.475 vs. 1.514, P = 0.4）无显著差异，但在高细胞与正常细胞/低细胞骨髓中观察到显著差异（SUVmax 5.1 vs. 3.2, P = 0.019, BLR 1.58 vs. 0.82, P = 0.043）。脾脏与BM摄取（r = 0.501, P = 0.013）、BLR和SLR （r = 0.623, P = 0.001）、c反应蛋白水平与BLR （r = 0.731, P = 0.001）、SLR （r = 0.594, P = 0.015）呈显著正相关。在11例患者中，从大多数高代谢部位进行靶向取样，有助于最终诊断或消除恶性原因。结论：18F FDG PET/CT对HLH的诊断率较高，有发现其病因的潜力，可纳入HLH的诊断算法。
Utility of 18F FDG PET/CT in Hemophagocytic Lymphohistiocytosis.
Purpose: Hemophagocytic lymphohistiocytosis (HLH) is a fatal systemic inflammatory syndrome caused by a wide array of causes, which may be detected on 18F fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG PET/CT). This study explores the utility of 18F FDG PET/CT in HLH.
Materials and methods: Retrospective data of HLH patients referred for whole-body 18F FDG PET/CT were analyzed for abnormal findings, and quantitative analysis using standardized uptake value (SUV), spleen-to-liver ratio (SLR), and bone-to-liver ratio (BLR) was done and correlated with laboratory parameters, bone marrow (BM) findings, and final diagnosis.
Results: Twenty-four patients (median age 22 years [interquartile range 13-34]) were included in the study. The most common cause of HLH was infection (33%), malignancy (29%), and autoimmune disorders (13%), and five patients had primary HLH. 18F FDG PET/CT was positive in 22/24 patients (92%). Hepatomegaly and splenomegaly were observed in 22 patients (92%) and 16 patients (67%), respectively, with six (25%) showing splenic lesions. Splenic uptake > liver was observed in 62.5% of patients and BM uptake > liver uptake in 50% of patients. There was no significant difference in median BM uptake (SUVmax 4.0 vs. 3.5, P = 0.6) and BLR (1.475 vs. 1.514, P = 0.4) in patients with and without HLH on marrow sampling, but a significant difference was observed in hypercellular vs. normocellular/hypocellular marrow (SUVmax 5.1 vs. 3.2, P = 0.019 and BLR 1.58 vs. 0.82, P = 0.043). A significant positive correlation was observed between splenic and BM uptake (r = 0.501, P = 0.013), BLR and SLR (r = 0.623, P = 0.001), C-reactive protein levels with BLR (r = 0.731, P = 0.001), and SLR (r = 0.594, P = 0.015), respectively. In 11 patients who underwent targeted sampling from most hypermetabolic sites, it helped reach the final diagnosis or eliminate malignant causes.
Conclusion: 18F FDG PET/CT has a high diagnostic yield in HLH with the potential to detect its underlying causes and may be considered in the diagnostic algorithm of HLH.
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