title: 18F-fluorodeoxyglucose Positron Emission Tomography in Kaposi Sarcoma Herpesvirus-Associated Multicentric Castleman Disease: Correlation With Activity, Severity, Inflammatory and Virologic Parameters.
abstract: BACKGROUND
  Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease (MCD) is a lymphoproliferative inflammatory disorder commonly associated with human immunodeficiency virus (HIV). Its presentation may be difficult to distinguish from HIV and its complications, including lymphoma. Novel imaging strategies could address these problems.
  
  
  METHODS
  We prospectively characterized (18)F-fluorodeoxyglucose positron emission tomography (PET) findings in 27 patients with KSHV-MCD. Patients were imaged with disease activity and at remission with scans evaluated blind to clinical status. Symptoms, C-reactive protein level, and HIV and KSHV loads were assessed in relation to imaging findings.
  
  
  RESULTS
  KSHV-MCD activity was associated with hypermetabolic symmetric lymphadenopathy (median maximal standardized uptake value [SUVmax], 6.0; range, 2.0-8.0) and splenomegaly (3.4; 1.2-11.0), with increased metabolism also noted in the marrow (2.1; range, 1.0-3.5) and salivary glands (3.0; range, 2.0-6.0). The (18)F-fluorodeoxyglucose PET abnormalities improved at remission, with significant SUVmax decreases in the lymph nodes (P = .004), spleen (P = .008), marrow (P = .004), and salivary glands (P = .004). Nodal SUVmax correlated with symptom severity (P = .005), C-reactive protein level (R = 0.62; P = .004), and KSHV load (R = 0.54; P = .02) but not HIV load (P = .52).
  
  
  CONCLUSIONS
  KSHV-MCD activity is associated with (18)F-FDG PET abnormalities of the lymph nodes, spleen, marrow, and salivary glands. These findings have clinical implications for the diagnosis and monitoring of KSHV-MCD and shed light on its pathobiologic mechanism.
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Polizzotto
authors.affiliation: Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda.
authors.forename: Corina
authors.initials: C
authors.lastname: Millo
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Uldrick
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Karen
authors.initials: K
authors.lastname: Aleman
authors.affiliation: Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda.
authors.forename: Millie
authors.initials: M
authors.lastname: Whatley
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Wyvill
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Deirdre
authors.initials: D
authors.lastname: O'Mahony
authors.affiliation: Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Cancer Laboratory for Cancer Research, Maryland.
authors.forename: Vickie
authors.initials: V
authors.lastname: Marshall
authors.affiliation: Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Cancer Laboratory for Cancer Research, Maryland.
authors.forename: Denise
authors.initials: D
authors.lastname: Whitby
authors.affiliation: Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda.
authors.forename: Roberto
authors.initials: R
authors.lastname: Maass-Moreno
authors.affiliation: Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Little
authors.affiliation: HIV and AIDS Malignancy Branch.
authors.forename: Robert
authors.initials: R
authors.lastname: Yarchoan
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D005871:Castleman Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000821:virology; D005260:Female; D005462:Fluorine Radioisotopes / Q000032:analysis; D019788:Fluorodeoxyglucose F18; D015658:HIV Infections / Q000150:complications*; D019288:Herpesvirus 8, Human / Q000502:physiology*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012469:Salivary Glands / Q000000981:diagnostic imaging; D012514:Sarcoma, Kaposi / Q000150:complications* / Q000000981:diagnostic imaging / Q000821:virology; D013154:Spleen / Q000000981:diagnostic imaging
chemical_list: D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein
keywords: 18F-FDG positron emission tomography; Castleman disease; HIV; human herpesvirus 8 (HHV-8)/Kaposi sarcoma herpesvirus (KSHV)
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