Value of 18F-FDG PET/CT imaging in hemophagocytic lymphohistiocytosis
Objective To explore the diagnostic value of 18F-FDG PET/CT imaging in etiology of patients with hemophagocytic lymphohistiocytosis(HLH).Methods Retrospective analysis was performed on 49 patients newly diagnosed as HLH(32 males,17 females;age 19-61 years)who received 18F-FDG PET/CT imaging in Affiliated Hospital of Jining Medical University from January 2017 to January 2023.PET/CT images and clinical parameters were observed and recorded.Based on the pathological examination and clinical follow-up results,diagnostic efficacies for HLH etiology of PET/CT,PET and CT imaging were calculated.x2 test,independent-sample t test and Mann-Whitney U test were used to compare the differ-ences between hematologic tumors associated HLH and non-hematologic tumor associated HLH.Multivariate logistic regression was used to analyze the predictors of secondary HLH in hematologic tumors.ROC curve analy-sis was used to calculate AUCs and optimal threshold of lymph node SUVmax and soluble CD25(sCD25)to predict secondary HLH in patients with hematologic tumors.Results The sensitivity,specificity,accura-cy,positive predictive value and negative predictive value of PET/CT,PET and CT in the etiological diag-nosis of HLH were 85.7％(30/35),8/10,84.4％(38/45),93.8％(30/32),8/13;77.1％(27/35),6/10,73.3％(33/45),87.1％(27/31),6/14;62.9％(22/35),5/10,60.0％(27/45),81.5％(22/27),5/18,respectively.There were differences in lymph node distribution and boundary,liver and spleen and bone lesions,SUVmax of lymph node and liver and spleen and bone,gender,age,WBC,neutrophil(ANC),PLT,lactate dehydrogenase(LDH),total bilirubin(TBIL),C-reactive protein(CRP)and sCD25 between different etiology groups(x2 values:3.91-9.66,t values:3.75-7.90,z values:3.82-4.01,all P＜0.05).SUVmax of lymph nodes and sCD25 were predictive factors for secondary HLH of hematological tumors(odds ratio(OR):1.28(95％CI:1.09-1.72),1.56(95％CI:1.17-2.49),P values:0.004,0.013).The optimal thresholds were 12.6 and 40 028 ng/L,with the AUC of 0.87 and 0.76,with the sen-sitivity and specificity of 88.6％(31/35)and 8/10,65.7％(23/35)and 7/10,respectively.The combined AUC was 0.83 and the sensitivity and specificity were 74.3％(26/35)and 9/10.Conclusions 18F-FDG PET/CT imaging is of high value for the diagnosis of the cause of HLH.SUVmax of lymph node and sCD25 are predictive factors for secondary HLH of hematologic tumors.
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