^(18)F-FDG PET/CT在噬血细胞综合征诊断及预后判断中的应用

Utility of^(18)F-FDG PET/CT in the diagnosis and prognosis of hemophagocytic syndrome

目的探讨^(18)F-氟代脱氧葡萄糖正电子发射计算机断层成像(^(18)F-FDG PET/CT)在噬血细胞综合征(HLH)诊断和预后判断中的应用价值。方法回顾性选取2016年6月至2019年1月在首都医科大学附属北京友谊医院核医学科行^(18)F-FDG PET/CT检查的住院HLH患者。分析HLH患者化疗前的临床特点、实验室指标以及^(18)F-FDG PET/CT图像特点;用Kaplan-Meier法进行生存分析;检测^(18)F-FDG PET/CT诊断淋巴瘤相关性HLH的灵敏性、特异性、阳性预测值及阴性预测值;对^(18)F-FDG PET/CT代谢参数与实验室指标间的关系进行Spearman相关性分析;用受试者操作特征(ROC)曲线确定^(18)F-FDG PET/CT代谢参数预测HLH患者预后的最佳截断值;用对数秩检验以及Cox比例风险回归模型检测各指标与HLH患者预后间的关系。结果^(18)F-FDG PET/CT诊断淋巴瘤相关性HLH的敏感性为92.9%,特异性为80.8%,阳性预测值为72.2%,阴性预测值为95.5%。脾脏的标准化摄取值(SUV)与患者血清铁蛋白水平存在中度正相关(r=0.418,P=0.007)。骨髓SUV及其与纵隔的比值高提示患者生存时间较短,最佳截断值分别为4.98、3.60。多因素分析中,骨髓SUV是提示与HLH患者预后不良相关的唯一独立危险因素。结论^(18)F-FDG PET/CT在诊断淋巴瘤相关HLH上有良好的应用,可以帮助临床尽早明确HLH患者病因,从而及时、准确地进行治疗。脾脏SUV与HLH患者血清铁蛋白水平存在相关性,提示该值或许能够在一定程度上反映HLH患者的全身疾病状况。骨髓SUV值升高与预后不良相关。

Objective To evaluate the value of 18-fluorine fluorodeoxyglucose positron emission tomography and computed tomography(^(18)F-FDG PET/CT)in the diagnosis and prognosis of hemophagocytic syndrome.Methods Inpatient hemophagocytic lymphohistiocytosis(HLH)patients who underwent^(18)F-FDG PET/CT examination at the Department of Nuclear Medicine,Beijing Friendship Hospital,Capital Medical University from June 2016 to January 2019 were retrospectively selected.The clinical features,laboratory parameters and^(18)F-FDG PET/CT characters of patients with HLH before chemotherapy were summarized,retrospectively.Diagnostic performance of^(18)F-FDG PET for the detection of underlying lymphoma was evaluated,by calculating the sensitivity,specificity,positive predictive value and negative predictive value.Spearman correlation test was used to determine the correlations between^(18)F-FDG PET/CT and laboratory parameters.Survival analysis was performed by Kaplan-Meier method.The optimal cutoff value for predicting the prognosis of HLH patients using^(18)F-FDG PET/CT metabolic parameters was determined using the receiver operating characteristic(ROC)curve.The prognostic significance of^(18)F-FDG PET/CT and laboratory parameters was evaluated by log-rank test and Cox proportional hazards regression model.Results The sensitivity,specificity,positive predictive value and negative predictive value of^(18)F-FDG PET/CT for the diagnosis of lymphoma-associated HLH was 92.9%,80.8%,72.2%,95.5%,respectively.Standard uptake value(SUV)in the spleen was moderately positively associated with serum ferritin levels in HLH patients(r=0.418,P=0.007).A high level of bone marrow SUV and its ratio to the mediastinum suggested a shorter survival time for patients,and the optimal cutoff values were 4.98 and 3.60,respectively.Bone marrow SUV was the only independent risk factor for prognosis in patients with HLH.Conclusion^(18)F-FDG PET/CT is useful in the early diagnosis of lymphoma-associated HLH,which can contribute to the formation of early therapy.There is a correlation between spleen SUV and serum ferritin levels.Bone marrow SUV may be an important predictor of prognosis in patients with HLH.