Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, Wien, Vienna, 1090, Austria.
Cancer Imaging. 2024 Aug 18;24(1):108. doi: 10.1186/s40644-024-00757-w.
The hyperinflammatory condition and lymphoproliferation due to Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (HLH) affect the detection of lymphomas by F-FDG PET/CT. We aimed to improve the diagnostic capabilities of F-FDG PET/CT by combining laboratory parameters.
This retrospective study involved 46 patients diagnosed with EBV-positive HLH, who underwent F-FDG PET/CT before beginning chemotherapy within a 4-year timeframe. These patients were categorized into two groups: EBV-associated HLH (EBV-HLH) (n = 31) and EBV-positive lymphoma-associated HLH (EBV + LA-HLH) (n = 15). We employed multivariable logistic regression and regression tree analysis to develop diagnostic models and assessed their efficacy in diagnosis and prognosis.
A nomogram combining the SUVmax ratio, copies of plasma EBV-DNA, and IFN-γ reached 100% sensitivity and 81.8% specificity, with an AUC of 0.926 (95%CI, 0.779-0.988). Importantly, this nomogram also demonstrated predictive power for mortality in EBV-HLH patients, with a hazard ratio of 4.2 (95%CI, 1.1-16.5). The high-risk EBV-HLH patients identified by the nomogram had a similarly unfavorable prognosis as patients with lymphoma.
The study found that while F-FDG PET/CT alone has limitations in differentiating between lymphoma and EBV-HLH in patients with active EBV infection, the integration of a nomogram significantly improves the diagnostic accuracy and also exhibits a strong association with prognostic outcomes.
由于 EBV 相关噬血细胞性淋巴组织细胞增生症（HLH）引起的超炎症状态和淋巴增生会影响 F-FDG PET/CT 对淋巴瘤的检测。我们旨在通过结合实验室参数来提高 F-FDG PET/CT 的诊断能力。
这项回顾性研究涉及 46 名在 4 年内接受化疗前接受 F-FDG PET/CT 的 EBV 阳性 HLH 患者。这些患者分为两组：EBV 相关 HLH（EBV-HLH）（n=31）和 EBV 阳性淋巴瘤相关 HLH（EBV+LA-HLH）（n=15）。我们采用多变量逻辑回归和回归树分析来建立诊断模型，并评估它们在诊断和预后方面的效果。
一个结合了 SUVmax 比值、血浆 EBV-DNA 拷贝数和 IFN-γ的列线图达到了 100%的灵敏度和 81.8%的特异性，AUC 为 0.926（95%CI，0.779-0.988）。重要的是，该列线图还显示了 EBV-HLH 患者死亡率的预测能力，风险比为 4.2（95%CI，1.1-16.5）。列线图确定的高危 EBV-HLH 患者的预后与淋巴瘤患者相似不佳。
本研究发现，虽然 F-FDG PET/CT 单独用于区分活动性 EBV 感染患者中的淋巴瘤和 EBV-HLH 具有局限性，但列线图的整合大大提高了诊断准确性，并且与预后结果密切相关。
