Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity

Abstract

Kikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent F-18-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUVmean) was higher in patients with severe KFD than those with mild KFD (2.38 +/- 1.18 vs. 1.79 +/- 0.99, p=0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 +/- 504.4 vs. 201.6 +/- 363.5, p=0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001-0.792; p=0.035), total lymph node SUVmax (cutoff 9.27; OR 24.734; 95% CI 1.323-462.407; p=0.032), and spleen SUVmean (cutoff 1.79; OR 37.770; 95% CI 1.769-806.583; p=0.020) were significantly associated with severe KFD. F-18-FDG PET/CT could be useful in assessing KFD severity.