PET-CT in AML-related hemophagocytic lymphohistiocytosis

Boddu, Prajwal; Oviedo, Sergio Pina; Rausch, Caitlin R.; Yam, Clinton; Daver, Naval; Kantarjian, Hagop M.; Kadia, Tapan M.

doi:10.1080/10428194.2017.1379079

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…In recent years, 18 F-FDG PET/CT has been suggested as a method for detecting potential triggers for secondary HLH [ 15 16 ]. Because of cytokine storm, reticuloendothelial system activation, and myeloproliferation, 18 F-FDG PET/CT images nonspecifically show diffusely increased FDG uptake in the liver, spleen, and axial skeleton [ 17 18 19 ]. Hence, it is necessary to improve the diagnostic specificity of 18 F-FDG PET/CT for prompt and precise detection of M-HLH.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Yang

Liu

et al. 2022

Korean J Radiol

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Objective 18 F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of 18 F-FDG PET/CT in identifying malignancy in patients with HLH by combining 18 F-FDG PET/CT and clinical parameters. Materials and Methods Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment 18 F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson’s chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). Results The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686–0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of 18 F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. Conclusion 18 F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using 18 F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of 18 F-FDG PET/CT images.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Yang

Liu

et al. 2022

Korean J Radiol

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“…A study has reported [ 34 ] that 18 FPET/CT is helpful in the localization of bone marrow biopsy, especially in patients whose etiology still cannot be found by multiple aspirations. Studies have found that the most common manifestations of HPS on 18 F-FDG PET/CT are hepatosplenic enlargement and increased FDG uptake, increased diffuse FDG uptake in the bone marrow, and higher FDG uptake in the spleen than in the liver [ 14 , 35 ]. In HPS, increased FDG uptake in the spleen can more directly reflect immune cell activation, so the metabolism of the spleen can more precisely reflect the activity of systemic inflammation in HPS relative to the bone marrow.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Hemophagocytic Syndrome by 18F-FDG PET/CT: A Meta-Analysis

Zhang¹,

He²,

Wang

et al. 2022

Journal of Healthcare Engineering

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Hemophagocytic syndrome (HPS) is a rare disease in clinical practice, and there are often cases of delayed diagnosis. At present, researchers have applied 18F-FDG PET/CT in the differential diagnosis of HPS, but no consensus has been formed. Therefore, this study aims to systematically evaluate the application value of 18F-FDG PET/CT in the diagnosis of HPS patients. PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wangfang database (Wangfang), and Chinese Biomedical Network (CBM) were searched to collect the relevant studies of 18F-FDG PET/CT in the diagnosis of HPS. Data from the articles were screened and extracted for meta-analysis using Stata16.0 software. A total of 10 retrospective studies, including 300 patients, were included in this meta-analysis. The meta-analysis results showed that the pooled sensitivity was 0.82 (95% CI: 0.67–0.95), specificity was 0.72 (95% CI: 0.51–0.86), positive likelihood ratio was 2.89 (95% CI: 1.46–5.75), positive likelihood ratio was 0.25 (95% CI: 0.12–0.54), diagnostic odds ratio was 2.89 (95% CI: 1.46–5.75), and AUC was 0.84 (95% CI: 0.81–0.87). The SUVmax in the liver, spleen, lymph nodes, and bone marrow of HPS patients was greater than 2.5, and the SUVmax in the spleen, lymph nodes, and bone marrow of malignant HPS patients was higher than that of benign HPS patients. The difference was statistically significant ( P < 0.05 ). According to the existing literature evidence, 18F-FDG PET/CT is an effective method for diagnosing HPS.

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“…Preceding studies on PET/CT scan of acute-myelocytic-leukemia-related HLH patients revealed elevated FDG uptakes in spleen and bone marrow ( 14 ). In IIM patients who developed sHLH, only spleen SUVmean was prominently elevated and significantly associated with development of sHLH.…”

Section: Discussionmentioning

confidence: 99%

“…Recent years have seen cytokines and PET/CT scan as effective tools in prediction and evaluation of sHLH (14,15). Since 18 F-fluorodeoxyglucose (FDG) uptake in PET/CT scan can, to some extent, reflect focal inflammation and immune activation, the clinical value of PET/CT scan has been evaluated in familial and secondary HLH patients (16).…”

Section: Introductionmentioning

confidence: 99%

Clinical Value of 18F-FDG PET/CT Scan and Cytokine Profiles in Secondary Hemophagocytic Lymphohistiocytosis in Idiopathic Inflammatory Myopathy Patients: A Pilot Study

Liang

Liu

et al. 2021

Front. Immunol.

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BackgroundSecondary hemophagocytic lymphohistiocytosis (sHLH) is a rare but fatal complication in idiopathic inflammatory myopathy (IIM) patients. The clinical value of radiological manifestations and serum cytokines remain unknown in this systemic crisis. This study aims to investigate the clinical value of PET/CT scan and cytokine profiles in predicting and understanding sHLH in IIM patients.MethodsAdult IIM patients who were admitted to the four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU) from January 1, 2017 to December 31, 2020 were reviewed. PET/CT scan, cytokine profiles, and other factors of patients who met the inclusion and exclusion criteria were collected and analyzed.ResultsSixty-nine out of 352 IIM patients were finally enrolled into the study. Ten patients developed sHLH and 70.0% of them died within 6 months. After false discovery rate (FDR) correction and multivariate logistic regression analysis, increased serum interferon (IFN)-γ level (p = 0.017), higher spleen mean standard uptake value (SUVmean, p = 0.035), and positivity of anti-MDA5 antibody (p = 0.049) were found to be significantly correlated with development of sHLH in IIM patients. The combination of serum IFN-γ, spleen SUVmean, and anti-MDA5 antibody found a balanced and satisfying predictor with a cutoff value of 0.047 and AUC of 0.946. A moderate correlation was identified between ferritin and spleen SUVmean (p = 0.001, r = 0.380) as well as serum IFN-γ(p = 0.001, r = 0.398). Before FDR correction, higher bilateral lung SUVmean (p = 0.034) and higher colon/rectum SUVmean (p = 0.013) were also observed in IIM patients who developed sHLH. By narrowing down to IIM patients with sHLH, anti-MDA5-antibody-positive DM patients tended to suffer from unfavorable outcome (p = 0.004) in Kaplan–Meier survival analysis.ConclusionIncreased serum level of IFN-γ, elevated splenic FDG uptake, and positivity of anti-MDA5 antibody were significantly correlated with development of sHLH in IIM patients. Lung and lower digestive tract might also be affected due to systemic immune activation in IIM patients with sHLH. In addition, splenic FDG uptake, in combination with serum IFN-γand anti-MDA5 antibody, was found valuable in predicting development of sHLH in IIM patients. Among IIM patients with sHLH, anti-MDA5-antibody-positive DM patients showed higher tendency for unfavorable outcome.

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PET-CT in AML-related hemophagocytic lymphohistiocytosis

Cited by 7 publications

References 15 publications

Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Differential Diagnosis of Hemophagocytic Syndrome by 18F-FDG PET/CT: A Meta-Analysis

Clinical Value of 18F-FDG PET/CT Scan and Cytokine Profiles in Secondary Hemophagocytic Lymphohistiocytosis in Idiopathic Inflammatory Myopathy Patients: A Pilot Study

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PET-CT in AML-related hemophagocytic lymphohistiocytosis

Cited by 7 publications

References 15 publications

Development and Validation of 18F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Development and Validation of 18F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Differential Diagnosis of Hemophagocytic Syndrome by 18F-FDG PET/CT: A Meta-Analysis

Clinical Value of 18F-FDG PET/CT Scan and Cytokine Profiles in Secondary Hemophagocytic Lymphohistiocytosis in Idiopathic Inflammatory Myopathy Patients: A Pilot Study

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Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Development and Validation of ¹⁸F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis