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

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834911
OWN - NLM
STAT- In-Process
DA  - 20170823
LR  - 20170823
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - The clinical utility of splenic fluorodeoxyglucose uptake for diagnosis and
      prognosis in patients with macrophage activation syndrome.
PG  - e7901
LID - 10.1097/MD.0000000000007901 [doi]
AB  - 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.
FAU - Ahn, Sung Soo
AU  - Ahn SS
AD  - aDivision of Rheumatology, Department of Internal Medicine bDepartment of Nuclear
      Medicine, Severance Hospital cInstitute for Immunology and Immunological
      Diseases, Yonsei University College of Medicine, Seoul, South Korea.
FAU - Hwang, Sang Hyun
AU  - Hwang SH
FAU - Jung, Seung Min
AU  - Jung SM
FAU - Lee, Sang-Won
AU  - Lee SW
FAU - Park, Yong-Beom
AU  - Park YB
FAU - Yun, Mijin
AU  - Yun M
FAU - Song, Jason Jungsik
AU  - Song JJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007901 [doi]
AID - 00005792-201708250-00048 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7901. doi: 10.1097/MD.0000000000007901.