The Clinical Utility of Splenic Fluorodeoxyglucose Uptake for Diagnosis and Prognosis in Patients with Macrophage Activation Syndrome

Sung Soo Ahn¹, Sang Hyun Hwang², Seung Min Jung¹, Sang-Won Lee¹, Yong-Beom Park³, Mijin Yun² and Jason Jungsik Song¹, ¹Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), ²Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), ³Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Autoimmune diseases and macrophage activation syndrome

Session Information

Date: Sunday, November 5, 2017

Title: Imaging of Rheumatic Diseases Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Abstract

Background/Purpose: To evaluate splenic glucose metabolism in macrophage activation syndrome (MAS), characterised by overwhelming systemic inflammation. Splenic ¹⁸F-fluorodeoxyglucose (FDG) uptake was compared in patients with MAS and sepsis using positron emission tomography/computed tomography (PET/CT).

Methods: Clinical and FDG-PET/CT findings from patients with MAS and those with culture-proven sepsis were evaluated. Standardised uptake value (SUV) for the spleen and liver were measured. The maximum of the spleen to liver SUV ratio (SLR_max) was calculated as spleen SUV_max/liver SUV_mean. Radiological splenic volume was also measured, and splenic metabolic volume (MV) was defined as total splenic volume with an SLR_mean > 1.14. The association between clinical features, laboratory variables, and SLR_max was analysed.

Results: The median SLR_max and splenic MV were significantly higher in patients with MAS (n = 38) than they were in those with sepsis (n = 15) (SLR_max: 1.51 vs. 1.09, p = 0.001; MV: 346.0 vs. 154.0, p = 0.015) (Figure 1). Multivariate analyses revealed that SLR_max > 1.31 was useful for discriminating between MAS and sepsis (Table 1). SLR_max positively correlated with ferritin and lactate dehydrogenase level in MAS. Furthermore, MAS patients with high splenic FDG uptake (SLR_max>1.72) had higher in-hospital mortality compared to those with moderate to low splenic FDG uptake (p = 0.013).

Conclusion: 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.

References

1. Rosado FG, Kim AS. Hemophagocytic lymphohistiocytosis: an update on diagnosis and pathogenesis. American journal of clinical pathology. 2013;139(6):713-727.

Figure. 1 Comparison of the standardised ¹⁸F-fluorodeoxyglucose uptake values (SUV) in patients with macrophage activation syndrome (MAS; n = 38), patients with sepsis (n = 15), and healthy controls (n = 40) (A) The SUV_max of spleen to liver ratio. (B) The SUV_max of bone marrow to liver ratio. (C) Spleen radiologic volume. (D) Spleen metabolic volume. (E) Representative 18F-FDG PET/CT images in patient with MAS (left), patient with sepsis (middle), and healthy control subject (right). ns, not significant. Data are expressed as the median; error bars indicate the interquartile range.

Disclosure: S. S. Ahn, None; S. H. Hwang, None; S. M. Jung, None; S. W. Lee, None; Y. B. Park, None; M. Yun, None; J. J. Song, None.

To cite this abstract in AMA style:

Ahn SS, Hwang SH, Jung SM, Lee SW, Park YB, Yun M, Song JJ. The Clinical Utility of Splenic Fluorodeoxyglucose Uptake for Diagnosis and Prognosis in Patients with Macrophage Activation Syndrome [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-clinical-utility-of-splenic-fluorodeoxyglucose-uptake-for-diagnosis-and-prognosis-in-patients-with-macrophage-activation-syndrome/. Accessed .

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