{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:04:39Z","timestamp":1794013479700,"version":"4.8.0"},"reference-count":37,"publisher":"Scientific Scholar","issue":"4","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"\n Purpose:<\/jats:title>\n \n Hemophagocytic lymphohistiocytosis (HLH) is a fatal systemic inflammatory syndrome caused by a wide array of causes, which may be detected on\n 18<\/jats:sup>\n F fluorodeoxyglucose positron emission tomography\/computed tomography (\n 18<\/jats:sup>\n F FDG PET\/CT). This study explores the utility of\n 18<\/jats:sup>\n F FDG PET\/CT in HLH.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n Retrospective data of HLH patients referred for whole-body\n 18<\/jats:sup>\n F FDG PET\/CT were analyzed for abnormal findings, and quantitative analysis using standardized uptake value (SUV), spleen-to-liver ratio (SLR), and bone-to-liver ratio (BLR) was done and correlated with laboratory parameters, bone marrow (BM) findings, and final diagnosis.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Twenty-four patients (median age 22 years [interquartile range 13\u201334]) were included in the study. The most common cause of HLH was infection (33%), malignancy (29%), and autoimmune disorders (13%), and five patients had primary HLH.\n 18<\/jats:sup>\n F FDG PET\/CT was positive in 22\/24 patients (92%). Hepatomegaly and splenomegaly were observed in 22 patients (92%) and 16 patients (67%), respectively, with six (25%) showing splenic lesions. Splenic uptake > liver was observed in 62.5% of patients and BM uptake > liver uptake in 50% of patients. There was no significant difference in median BM uptake (SUV\n max<\/jats:sub>\n 4.0 vs. 3.5,\n P<\/jats:italic>\n = 0.6) and BLR (1.475 vs. 1.514,\n P<\/jats:italic>\n = 0.4) in patients with and without HLH on marrow sampling, but a significant difference was observed in hypercellular vs. normocellular\/hypocellular marrow (SUV\n max<\/jats:sub>\n 5.1 vs. 3.2,\n P<\/jats:italic>\n = 0.019 and BLR 1.58 vs. 0.82,\n P<\/jats:italic>\n = 0.043). A significant positive correlation was observed between splenic and BM uptake (\n r<\/jats:italic>\n = 0.501,\n P<\/jats:italic>\n = 0.013), BLR and SLR (\n r<\/jats:italic>\n = 0.623,\n P<\/jats:italic>\n = 0.001), C-reactive protein levels with BLR (\n r<\/jats:italic>\n = 0.731,\n P<\/jats:italic>\n = 0.001), and SLR (\n r<\/jats:italic>\n = 0.594,\n P<\/jats:italic>\n = 0.015), respectively. In 11 patients who underwent targeted sampling from most hypermetabolic sites, it helped reach the final diagnosis or eliminate malignant causes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n 18<\/jats:sup>\n F FDG PET\/CT has a high diagnostic yield in HLH with the potential to detect its underlying causes and may be considered in the diagnostic algorithm of HLH.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijnm.ijnm_5_25","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T14:00:36Z","timestamp":1758290436000},"page":"189-196","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Utility of 18F FDG PET\/CT in Hemophagocytic Lymphohistiocytosis"],"prefix":"10.25259","volume":"40","author":[{"given":"Piyush","family":"Aggarwal","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshay","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harmandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajender","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur Kumar","family":"Jindal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Allergy Immunology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manupdesh Singh","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepti","family":"Suri","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Allergy Immunology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhagwant Rai","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"R1-20250922","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/0885066613517076","article-title":"Hemophagocytic syndrome and critical illness: New insights into diagnosis and management","volume":"30","author":"Tothova","year":"2015","journal-title":"J Intensive Care Med"},{"key":"R2-20250922","doi-asserted-by":"crossref","first-page":"612583","DOI":"10.3389\/fimmu.2021.612583","article-title":"The spectrum of clinical, immunological, and molecular findings in familial hemophagocytic lymphohistiocytosis: Experience from India","volume":"12","author":"Shabrish","year":"2021","journal-title":"Front Immunol"},{"key":"R3-20250922","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1002\/pbc.22359","article-title":"Hemophagocytic lymphohistiocytosis in Texas: Observations on ethnicity and race","volume":"54","author":"Niece","year":"2010","journal-title":"Pediatr Blood Cancer"},{"key":"R4-20250922","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/j.1651-2227.1991.tb11878.x","article-title":"Incidence in Sweden and clinical features of familial hemophagocytic lymphohistiocytosis","volume":"80","author":"Henter","year":"1991","journal-title":"Acta Paediatr Scand"},{"key":"R5-20250922","doi-asserted-by":"crossref","first-page":"e797","DOI":"10.1097\/HS9.0000000000000797","article-title":"Temporal trends in the incidence of hemophagocytic lymphohistiocytosis: A nationwide cohort study from England 2003-2018","volume":"6","author":"West","year":"2022","journal-title":"Hemasphere"},{"key":"R6-20250922","doi-asserted-by":"crossref","first-page":"564","DOI":"10.5005\/jp-journals-10071-24136","article-title":"Clinical profile, treatment, and outcome of patients with secondary hemophagocytic lymphohistiocytosis in critically ill patients: A prospective observational study","volume":"26","author":"Fazal","year":"2022","journal-title":"Indian J Crit Care Med"},{"key":"R7-20250922","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4103\/0022-3859.150904","article-title":"Hemophagocytic lymphohistiocytosis secondary to infections: A tropical experience!","volume":"61","author":"Kodan","year":"2015","journal-title":"J Postgrad Med"},{"key":"R8-20250922","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/pbc.21039","article-title":"HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis","volume":"48","author":"Henter","year":"2007","journal-title":"Pediatr Blood Cancer"},{"key":"R9-20250922","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/art.38690","article-title":"Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome","volume":"66","author":"Fardet","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"R10-20250922","first-page":"103430","article-title":"Performances of the H-score and the HLH-2004 score in the positive diagnosis of secondary hemophagocytic lymphohistiocytosis","volume":"72","author":"Fatma","year":"2024","journal-title":"Curr Res Transl Med"},{"key":"R11-20250922","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1186\/s13054-020-02941-3","article-title":"Hemophagocytic lymphohistiocytosis in critically ill patients: Diagnostic reliability of HLH-2004 criteria and HScore","volume":"24","author":"Knaak","year":"2020","journal-title":"Crit Care"},{"key":"R12-20250922","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1016\/S0140-6736(13)61048-X","article-title":"Adult haemophagocytic syndrome","volume":"383","author":"Ramos-Casals","year":"2014","journal-title":"Lancet"},{"key":"R13-20250922","doi-asserted-by":"crossref","first-page":"198","DOI":"10.4103\/0972-5229.106501","article-title":"Severe hemophagocytic lymphohistiocytosis in adults-experience from an intensive care unit from North India","volume":"16","author":"Rajagopala","year":"2012","journal-title":"Indian J Crit Care Med"},{"key":"R14-20250922","doi-asserted-by":"crossref","first-page":"W11","DOI":"10.2214\/AJR.19.21788","article-title":"Hemophagocytic lymphohistiocytosis: A primer for radiologists","volume":"214","author":"Shieh","year":"2020","journal-title":"Am J Roentgenol"},{"key":"R15-20250922","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1007\/s00247-003-0894-9","article-title":"Imaging characteristics of hemophagocytic lymphohistiocytosis","volume":"33","author":"Fitzgerald","year":"2003","journal-title":"Pediatr Radiol"},{"key":"R16-20250922","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.critrevonc.2017.03.023","article-title":"Similar but not the same: Differential diagnosis of HLH and sepsis","volume":"114","author":"Machowicz","year":"2017","journal-title":"Crit Rev Oncol Hematol"},{"key":"R17-20250922","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1136\/annrheumdis-2017-212660","article-title":"Utility of PET\/CT in the diagnosis of inflammatory rheumatic diseases: A systematic review and meta-analysis","volume":"77","author":"Descamps","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"R18-20250922","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1177\/0284185118799512","article-title":"Contribution of 18F-FDG PET\/CT in a case-mix of fever of unknown origin and inflammation of unknown origin: A meta-analysis","volume":"60","author":"Kan","year":"2019","journal-title":"Acta Radiol"},{"key":"R19-20250922","doi-asserted-by":"crossref","first-page":"3018349","DOI":"10.1155\/2019\/3018349","article-title":"Diagnostic performance of (18)F-FDG PET\/CT in infectious and inflammatory diseases according to published meta-analyses","volume":"2019","author":"Treglia","year":"2019","journal-title":"Contrast Media Mol Imaging"},{"key":"R20-20250922","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2147\/JBM.S46255","article-title":"Hemophagocytic lymphohistiocytosis: Review of etiologies and management","volume":"5","author":"George","year":"2014","journal-title":"J Blood Med"},{"key":"R21-20250922","doi-asserted-by":"crossref","first-page":"471","DOI":"10.5152\/dir.2016.15226","article-title":"18F-FDG PET\/CT for identifying the potential causes and extent of secondary hemophagocytic lymphohistiocytosis","volume":"22","author":"Yuan","year":"2016","journal-title":"Diagn Interv Radiol"},{"key":"R22-20250922","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/RLU.0b013e3181ef0905","article-title":"The clinical implication and prediction of diffuse splenic FDG uptake during cancer surveillance","volume":"35","author":"Nam","year":"2010","journal-title":"Clin Nucl Med"},{"key":"R23-20250922","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s00259-020-05071-8","article-title":"Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia","volume":"48","author":"Pijl","year":"2021","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"R24-20250922","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00277-013-1906-y","article-title":"Clinical implication of F-18 FDG PET\/CT in patients with secondary hemophagocytic lymphohistiocytosis","volume":"93","author":"Kim","year":"2014","journal-title":"Ann Hematol"},{"key":"R25-20250922","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1007\/s00259-024-06732-8","article-title":"EANM consensus document on the use of [(18)F] FDG PET\/CT in fever and inflammation of unknown origin","volume":"51","author":"Hess","year":"2024","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"R26-20250922","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1756-8722-5-40","article-title":"The significance of 18F-FDG PET\/CT in secondary hemophagocytic lymphohistiocytosis","volume":"5","author":"Zhang","year":"2012","journal-title":"J Hematol Oncol"},{"key":"R27-20250922","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3390\/diagnostics6020018","article-title":"(18)F-FDG PET\/CT findings in acute Epstein-Barr virus infection mimicking malignant lymphoma","volume":"6","author":"\u00d8rb\u00e6k","year":"2016","journal-title":"Diagnostics (Basel)"},{"key":"R28-20250922","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1097\/RLU.0b013e3181bed135","article-title":"Epstein-Barr virus mimicking lymphoma on FDG-PET\/CT","volume":"34","author":"Thomas","year":"2009","journal-title":"Clin Nucl Med"},{"key":"R29-20250922","doi-asserted-by":"crossref","first-page":"836438","DOI":"10.3389\/fmed.2021.836438","article-title":"The role of pre-therapeutic (18)F-FDG PET\/CT in pediatric hemophagocytic lymphohistiocytosis with Epstein-Barr virus infection","volume":"8","author":"Lu","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"R30-20250922","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13550-020-0591-9","article-title":"Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response","volume":"10","author":"Malherbe","year":"2020","journal-title":"EJNMMI Res"},{"key":"R31-20250922","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1038\/sj.npp.1301362","article-title":"Basal ganglia hypermetabolism and symptoms of fatigue during interferon-alpha therapy","volume":"32","author":"Capuron","year":"2007","journal-title":"Neuropsychopharmacology"},{"key":"R32-20250922","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s12149-009-0286-9","article-title":"A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity","volume":"23","author":"Inoue","year":"2009","journal-title":"Ann Nucl Med"},{"key":"R33-20250922","first-page":"e6723","article-title":"Adult-onset primary hemophagocytic lymphohistiocytosis: Reporting a rare case with review of literature","volume":"12","author":"Memon","year":"2020","journal-title":"Cureus"},{"key":"R34-20250922","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1080\/1744666X.2024.2386427","article-title":"Epstein-Barr virus-driven lymphoproliferation in inborn errors of immunity: A diagnostic and therapeutic challenge","volume":"20","author":"Barman","year":"2024","journal-title":"Expert Rev Clin Immunol"},{"key":"R35-20250922","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1159\/000531296","article-title":"X-linked lymphoproliferative syndrome: A spectrum of clinical and immunological profile and novel pathogenic variants from Chandigarh, India","volume":"185","author":"Jindal","year":"2024","journal-title":"Int Arch Allergy Immunol"},{"key":"R36-20250922","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/bjh.17638","article-title":"Haemophagocytic lymphohistiocytosis and Epstein-Barr virus: A complex relationship with diverse origins, expression and outcomes","volume":"196","author":"El-Mallawany","year":"2022","journal-title":"Br J Haematol"},{"key":"R37-20250922","doi-asserted-by":"crossref","first-page":"76","DOI":"10.5582\/irdr.2016.01084","article-title":"Griscelli syndrome subtype 2 with hemophagocytic lympho-histiocytosis: A case report and review of literature","volume":"6","author":"Minocha","year":"2017","journal-title":"Intractable Rare Dis Res"}],"container-title":["Indian Journal of Nuclear Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/ijnm.ijnm_5_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:38:29Z","timestamp":1779694709000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijnm.co.in\/utility-of-18f-fdg-pet-ct-in-hemophagocytic-lymphohistiocytosis\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijnm.ijnm_5_25","relation":{},"ISSN":["0972-3919","0974-0244"],"issn-type":[{"value":"0972-3919","type":"print"},{"value":"0974-0244","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2025-01-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}