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The clinical utility of splenic fluorodeoxyglucose uptake for diagnosis and prognosis in patients with macrophage activation syndrome.

 Sung Soo Ahn  ;  Sang Hyun Hwang  ;  Seung Min Jung  ;  Sang-Won Lee  ;  Yong-Beom Park  ;  Mijin Yun  ;  Jason Jungsik Song 
 Medicine, Vol.96(34) : e7901, 2017 
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Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18/pharmacokinetics ; Humans ; Macrophage Activation Syndrome/diagnostic imaging ; Macrophage Activation Syndrome/metabolism ; Male ; Middle Aged ; Positron Emission Tomography Computed Tomography ; Sepsis/diagnostic imaging ; Sepsis/metabolism ; Spleen/metabolism
The aim of the study was to evaluate splenic glucose metabolism in macrophage activation syndrome (MAS), characterized by overwhelming systemic inflammation. Splenic F-fluorodeoxyglucose (FDG) uptake was compared in patients with MAS and sepsis using positron emission tomography/computed tomography (PET/CT).Clinical and FDG-PET/CT findings from patients with MAS and those with culture-proven sepsis were evaluated. The standardized uptake value (SUV) for the spleen and liver were measured. The maximum of the spleen to liver SUV ratio (SLRmax) was calculated as spleen SUVmax/liver SUVmean. The radiological splenic volume was also measured, and splenic metabolic volume (MV) was defined as the total splenic volume with an SLRmean > 1.14. The association between clinical features, laboratory variables, and SLRmax was analyzed.The median SLRmax and splenic MV were significantly higher in patients with MAS (n = 38) than they were in those with sepsis (n = 15) (SLRmax: 1.51 vs 1.09, P = .001; MV: 346.0 vs 154.0, P = .015). Multivariate analyses revealed that SLRmax > 1.31 was useful for discriminating between MAS and sepsis. SLRmax positively correlated with ferritin and lactate dehydrogenase level in MAS. Furthermore, MAS patients with high splenic FDG uptake (SLRmax > 1.72) had higher in-hospital mortality compared to those with moderate to low splenic FDG uptake (P = .013).This study was the first to demonstrate that splenic FDG uptake is significantly elevated in patients with MAS compared to those with sepsis. This may be useful to differentiate between MAS and sepsis, and to predict poor prognosis in patients with MAS.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
박용범(Park, Yong Beom)
송정식(Song, Jungsik Jason) ORCID logo https://orcid.org/0000-0003-0662-7704
안성수(Ahn, Sung Soo) ORCID logo https://orcid.org/0000-0002-9002-9880
윤미진(Yun, Mi Jin) ORCID logo https://orcid.org/0000-0002-1712-163X
이상원(Lee, Sang Won) ORCID logo https://orcid.org/0000-0002-8038-3341
정승민(Jung, Seung Min ) ORCID logo https://orcid.org/0000-0003-3465-2181
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