继发性噬血细胞综合征的^(18)F-FDG PET/CT特征

^(18)F-FDG PET/CT Features of Secondary Hemophagocytic Syndrome

目的探讨继发性噬血细胞综合征(HPS)的^(18)F-FDG PET/CT特征及其应用价值。资料与方法回顾性分析2013年2月-2017年10月西南医科大学附属医院收治的继发性HPS并行PET/CT检查的35例患者,按病因分为恶性病变组(肿瘤相关)与非恶性病变组(感染、免疫相关),计算PET/CT对肿瘤相关HPS的诊断效能。分析两组患者的PET/CT相关参数差异及与实验室指标(中性粒细胞、白细胞、红细胞、血小板、乳酸脱氢酶、C-反应蛋白、谷丙转氨酶、三酰甘油、纤维蛋白原、铁蛋白)的相关性。结果 35例患者中,2例病因未明,恶性病变组19例,非恶性病变组14例,两组均以脾大、脾脏及骨髓弥漫性代谢增高、合并浆膜腔积液为主要表现,但恶性病变组常合并全身多处淋巴结增大伴糖代谢增高。恶性病变组与非恶性病变组的脾脏(5.76±4.11比3.23±1.49)、骨髓(5.02±2.96比3.03±1.06)及增大淋巴结(7.78±3.20比4.10±1.16)的最大标准化摄取值(SUVmax)比较,差异均有统计学意义(P<0.05)。PET/CT对肿瘤相关HPS的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为89.47%、85.71%、87.88%、89.47%、85.71%。中性粒细胞计数、血红蛋白与脾脏SUVmax(r=0.497、-0.490,P<0.05)及脾脏SUVmax/纵隔SUVmax比值(r=0.512、0.512,P<0.05)具有相关性。结论 PET/CT有助于鉴别继发HPS的原发病因,发现其他部位的合并症,指导活检及治疗,监测疗效。

Purpose To explore the features and application value of 18F-FDG PET/CT in secondary hemophagocytic syndrome （HPS）. Materials and Methods Thirty-five patients with secondary HPS who underwent PET/CT examinations from February 2013 to October 2017 in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed. The patients were classified as malignant lesions group （tumor related） and non-malignant lesions group （infection, immune-related） as per etiology, and the diagnostic efficacy of PET/CT for tumor-associated HPS was calculated. Differences concerning PET/CT related parameters between the two groups and its correlation with laboratory indicators （neutrophils, white blood cells, red blood cells, platelets, lactic dehydrogenase, C-reactive protein, glutamic-pyruvic transaminase, triacylglycerol, fibrinogen and ferritin） were analyzed. Results For 35 patients, 2 had unknown etiology, 19 were in the malignant lesions group, and 14 in the non-malignant lesions group. Both groups were dominantly manifested as splenauxe, increased diffusive metabolism of spleen and bone marrow combined with serous effusion. While the malignant lesions group was often associated with multiple lymph node enlargement and increased glycometabolism. The maximum standardized uptake values （SUVmax） of the spleen （5.76±4.11 vs. 3.23±1.49）, bone marrow （5.02±2.96 vs. 3.03±1.06）, and enlarged lymph nodes （7.78±3.20 vs. 4.10±1.16） in the malignant lesions group and the non-malignant lesions group were compared, the difference of which was all statistically significant （P〈0.05）. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT for tumor-associated HPS were 89.47%, 85.71%, 87.88%, 89.47% and 85.71%, respectively. Neutrophil count and hemoglobin were correlated with ratio of spleen SUVmax （r=0.497, -0.490, P〈0.05） and spleen SUVmax/mediastinal SUVmax （r=0.512, 0.512, P〈0.05）. Conclusion PET/CT is conducive to identify the primary cause of secondary HPS, spot complications of other sites, guide biopsy and treatment, and monitor the efficacy for treatment.