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, YongBeom Park, Mijin Yun, Jason Jungsik Song

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Abstract

The aim of the study was to evaluate splenic glucose metabolism in macrophage activation syndrome (MAS), characterized by overwhelming systemic inflammation. Splenic 18 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 (SLR max) was calculated as spleen SUV max /liver SUV mean. The radiological splenic volume was also measured, and splenic metabolic volume (MV) was defined as the total splenic volume with an SLR mean > 1.14. The association between clinical features, laboratory variables, and SLR max was analyzed. The median SLR max and splenic MV were significantly higher in patients with MAS (n = 38) than they were in those with sepsis (n=15) (SLR max: 1.51 vs 1.09, P=.001; MV: 346.0 vs 154.0, P=.015). Multivariate analyses revealed that SLR max > 1.31 was useful for discriminating between MAS and sepsis. SLR max positively correlated with ferritin and lactate dehydrogenase level in MAS. Furthermore, MAS patients with high splenic FDG uptake (SLR max >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.

Original languageEnglish
Article numbere7901
JournalMedicine (United States)
Volume96
Issue number34
DOIs
Publication statusPublished - 2017 Aug 1

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Macrophage Activation Syndrome
Sepsis
Spleen
Liver
Fluorodeoxyglucose F18
Ferritins
Hospital Mortality
L-Lactate Dehydrogenase

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Ahn, Sung Soo ; Hwang, Sang Hyun ; Jung, Seung Min ; Lee, Sang Won ; Park, YongBeom ; Yun, Mijin ; Song, Jason Jungsik. / The clinical utility of splenic fluorodeoxyglucose uptake for diagnosis and prognosis in patients with macrophage activation syndrome. In: Medicine (United States). 2017 ; Vol. 96, No. 34.
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abstract = "The aim of the study was to evaluate splenic glucose metabolism in macrophage activation syndrome (MAS), characterized by overwhelming systemic inflammation. Splenic 18 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 (SLR max) was calculated as spleen SUV max /liver SUV mean. The radiological splenic volume was also measured, and splenic metabolic volume (MV) was defined as the total splenic volume with an SLR mean > 1.14. The association between clinical features, laboratory variables, and SLR max was analyzed. The median SLR max and splenic MV were significantly higher in patients with MAS (n = 38) than they were in those with sepsis (n=15) (SLR max: 1.51 vs 1.09, P=.001; MV: 346.0 vs 154.0, P=.015). Multivariate analyses revealed that SLR max > 1.31 was useful for discriminating between MAS and sepsis. SLR max positively correlated with ferritin and lactate dehydrogenase level in MAS. Furthermore, MAS patients with high splenic FDG uptake (SLR max >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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The clinical utility of splenic fluorodeoxyglucose uptake for diagnosis and prognosis in patients with macrophage activation syndrome. / Ahn, Sung Soo; Hwang, Sang Hyun; Jung, Seung Min; Lee, Sang Won; Park, YongBeom; Yun, Mijin; Song, Jason Jungsik.

In: Medicine (United States), Vol. 96, No. 34, e7901, 01.08.2017.

Research output: Contribution to journalArticle

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