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The value of 18F-FDG PET/CT in Langerhans cell histiocytosis

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Abstract

Objective

To investigate the value of 18F-FDG PET/CT in diagnosis and disease evaluation of Langerhans cell histiocytosis (LCH).

Methods

A retrospective analysis of 31 patients with LCH confirmed by histopathology was performed. A systematic analysis of the PET/CT imaging manifestations of LCH was performed, recording patients who were treated and receiving PET/CT for efficacy evaluation. In addition, clinical and laboratory data of LCH patients were collected, and the correlation between these data and PET/CT metabolic parameters was initially investigated.

Results

Of the 31 patients, thirty had at least 1 PET/CT positive lesions (96.7%), and one had only skin damage without abnormalities on PET/CT. Of 31 patients, fifteen (48.4%) had single system (SS) disease (9 cases with a single site and 6 cases with multiple sites) and 16 (51.6%) had multisystem (MS) disease (6 low risk and 10 high risk cases). The incidence of LCH lesions in the bone, lymphatic system, pituitary gland, liver, soft tissue, thyroid gland, thymus, and lungs was 20 cases (64.5%), 12 cases (38.7%), 3 cases (9.7%), 2 cases (6.5%), 2 cases (6.5%), 1 case (3.2%), 1 case (3.2%), and 8 cases (25.8%), respectively. A total of 21 PET/CT follow-up scanning were performed in 13 patients receiving chemotherapy, with 13 (61.9%) partial metabolic remission (PMR), 6 (28.6%) progressive metabolic disease (PMD), and 2 (9.5%) stable metabolic disease (SMD), according to PET Response Evaluation Criteria in Solid Tumors (PRECIST) 1.0. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Lactic Dehydrogenase (LDH) were positively correlated with TTLG (total TLG) (R2 = 0.3256, 0.2409, 0.4205, P < 0.05). The Re-examine SUVmax is positively correlated with re-examine LDH (R2 = 0.7285, P < 0.05).

Conclusions

18F-FDG PET/CT is an effective way to diagnose and evaluate LCH. PET metabolic parameters were associated with laboratory inflammatory markers, suggesting that 18F-FDG PET/CT may be helpful in evaluating disease activity of LCH.

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References

  1. Allen CE, Merad M, McClain KL. Langerhans-cell histiocytosis. N Engl J Med. 2018;379(9):856–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Binkovitz LA, Olshefski RS, Adler BH. Coincidence FDG-PET in the evaluation of Langerhans’ cell histiocytosis: preliminary findings. Pediatr Radiol. 2003;33(9):598–602.

    Article  PubMed  Google Scholar 

  3. Kaste SC, Rodriguez-Galindo C, McCarville ME, Shulkin BL. PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Radiol. 2007;37(7):615–22.

    Article  PubMed  Google Scholar 

  4. Phillips M, Allen C, Gerson P, McClain K. Comparison of FDG-PET scans to conventional radiography and bone scans in management of Langerhans cell histiocytosis. Pediatr Blood Cancer. 2009;52(1):97–101.

    Article  PubMed  Google Scholar 

  5. Lee HJ, Ahn BC, Lee SW, Lee J. The usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with Langerhans cell histiocytosis. Ann Nucl Med. 2012;26(9):730–7.

    Article  PubMed  Google Scholar 

  6. Zhou W, Wu H, Han Y, Wang S, Dong Y, Wang Q. Preliminary study on the evaluation of Langerhans cell histiocytosis using F-18-fluoro-deoxy-glucose PET/CT. Chin Med J (Engl). 2014;127(13):2458–62.

    Article  PubMed  Google Scholar 

  7. Garcia JR, Riera E, Bassa P, Mourelo S, Soler M. (18)F-FDG PET/CT in follow-up evaluation in pediatric patients with Langerhans histiocytosis. Rev Esp Med Nucl Imagen Mol. 2017;36(5):325–8.

    CAS  PubMed  Google Scholar 

  8. Zhao Y, Zhou Y, Tian R, Su M. Solitary bone Langerhans cell histiocytosis demonstrated on multimodality imaging in an adult. Clin Nucl Med. 2020;45(1):78–80.

    Article  PubMed  Google Scholar 

  9. Xu T, Cen B, Li H, Wang Y, Chen Y. 99m Tc-MDP bone scan findings of recurrent Langerhans cell histiocytosis in an adult involving femur after joint replacement. Clin Nucl Med. 2023;48(9):804–5.

    Article  PubMed  Google Scholar 

  10. Rodriguez-Galindo C, Allen CE. Langerhans cell histiocytosis. Blood. 2020;135(16):1319–31.

    Article  PubMed  Google Scholar 

  11. Pinker K, Riedl C, Weber WA. Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments. Eur J Nucl Med Mol Imaging. 2017;44(Suppl 1):55–66.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Berres ML, Lim KP, Peters T, Price J, Takizawa H, Salmon H, et al. BRAF-V600E expression in precursor versus differentiated dendritic cells defines clinically distinct LCH risk groups. J Exp Med. 2014;211(4):669–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Laman JD, Leenen PJ, Annels NE, Hogendoorn PC, Egeler RM. Langerhans-cell histiocytosis “insight into DC biology.” Trends Immunol. 2003;24(4):190–6.

    Article  CAS  PubMed  Google Scholar 

  14. Senechal B, Elain G, Jeziorski E, Grondin V, Patey-Mariaud de Serre N, Jaubert F, et al. Expansion of regulatory T cells in patients with Langerhans cell histiocytosis. PLoS Med. 2007;4(8):e253.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Allen CE, Li L, Peters TL, Leung HC, Yu A, Man TK, et al. Cell-specific gene expression in Langerhans cell histiocytosis lesions reveals a distinct profile compared with epidermal Langerhans cells. J Immunol. 2010;184(8):4557–67.

    Article  CAS  PubMed  Google Scholar 

  16. Wang J, Song T, Wang J, Ma L, Jiang Y, Kong D, et al. Aggressive Langerhans cell histiocytosis transformation of T cell acute lymphoblastic leukemia detected on (18)F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2021;48(2):642–3.

    Article  CAS  PubMed  Google Scholar 

  17. Luo ZH, Lu PX, Qi WL, Liao FX, Jin AF, Zen QY. Role of (18)F-FDG PET/CT in the diagnosis and management of patients with Langerhans cell histiocytosis. Quant Imaging Med Surg. 2022;12(6):3351–63.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Albano D, Bosio G, Giubbini R, Bertagna F. Role of (18)F-FDG PET/CT in patients affected by Langerhans cell histiocytosis. Jpn J Radiol. 2017;35(10):574–83.

    Article  CAS  PubMed  Google Scholar 

  19. Kobayashi M, Ando S, Kawamata T, Makiyama J, Yokoyama K, Imai Y, et al. Clinical features and outcomes of adult Langerhans cell histiocytosis: a single-center experience. Int J Hematol. 2020;112(2):185–92.

    Article  CAS  PubMed  Google Scholar 

  20. Agarwal KK, Seth R, Behra A, Jana M, Kumar R. 18F-Fluorodeoxyglucose PET/CT in Langerhans cell histiocytosis: spectrum of manifestations. Jpn J Radiol. 2016;34(4):267–76.

    Article  CAS  PubMed  Google Scholar 

  21. Ohshima K, Fujiya K, Nagashima T, Ohnami S, Hatakeyama K, Urakami K, et al. Driver gene alterations and activated signaling pathways toward malignant progression of gastrointestinal stromal tumors. Cancer Sci. 2019;110(12):3821–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gatenby RA, Gillies RJ. Why do cancers have high aerobic glycolysis? Nat Rev Cancer. 2004;4(11):891–9.

    Article  CAS  PubMed  Google Scholar 

  23. McCleland ML, Adler AS, Deming L, Cosino E, Lee L, Blackwood EM, et al. Lactate dehydrogenase B is required for the growth of KRAS-dependent lung adenocarcinomas. Clin Cancer Res. 2013;19(4):773–84.

    Article  CAS  PubMed  Google Scholar 

  24. de la Cruz-Lopez KG, Castro-Munoz LJ, Reyes-Hernandez DO, Garcia-Carranca A, Manzo-Merino J. Lactate in the regulation of tumor microenvironment and therapeutic approaches. Front Oncol. 2019;9:1143.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Zer A, Domachevsky L, Rapson Y, Nidam M, Flex D, Allen AM, et al. The Role of 18F-FDG PET/CT on staging and prognosis in patients with small cell lung cancer. Eur Radiol. 2016;26(9):3155–61.

    Article  CAS  PubMed  Google Scholar 

  27. Kwon HR, Cho J, Park S, Lee SH, Ahn MJ, Choi JY, et al. Metabolic parameters on baseline (18)F-FDG PET/CT are potential predictive biomarkers for immunotherapy in patients with head and neck squamous cell carcinoma. Front Med (Lausanne). 2022;9: 896494.

    Article  PubMed  Google Scholar 

  28. Lee JW, Kang CM, Choi HJ, Lee WJ, Song SY, Lee JH, et al. Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative (1)(8)F-FDG PET/CT in patients with pancreatic cancer. J Nucl Med. 2014;55(6):898–904.

    Article  PubMed  Google Scholar 

  29. Burger IA, Casanova R, Steiger S, Husmann L, Stolzmann P, Huellner MW, et al. 18F-FDG PET/CT of non-small cell lung carcinoma under neoadjuvant chemotherapy: background-based adaptive-volume metrics outperform TLG and MTV in predicting histopathologic response. J Nucl Med. 2016;57(6):849–54.

    Article  CAS  PubMed  Google Scholar 

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The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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  1. Department of Nuclear Medicine, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road Changsha, Changsha, 410011, Hunan, China

    Rongchen An, Xiaowei Ma & Yunhua Wang

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  1. Rongchen An
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  2. Xiaowei Ma
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Correspondence to Yunhua Wang.

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An, R., Ma, X. & Wang, Y. The value of 18F-FDG PET/CT in Langerhans cell histiocytosis. Ann Nucl Med 38, 238–245 (2024). https://doi.org/10.1007/s12149-023-01892-3

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