Unexplained fever in children-Benefits and challenges of FDG-PET/CT

Ulrikka Nygaard*, Laerke Vinge Larsen, Nadja Hawwa Vissing, Marie-Louise von Linstow, Charlotte Myrup, Anne Kiil Berthelsen, Anja Poulsen, Lise Borgwardt

*Corresponding author for this work
5 Citations (Scopus)

Abstract

AIM: To explore [fluorine-18]-fluoro-2-deoxy-d-glucose positron-emission-tomography/computed tomography (18 FDG-PET/CT) in patients where standard investigations were non-diagnostic.

METHODS: We reviewed medical records of previously healthy children who had 18 FDG-PET/CT performed at Copenhagen University Hospital in 2015-2020 due to unexplained fever.

RESULTS: Thirty-five of 819 paediatric 18 FDG-PET/CT were performed due to unexplained fever. The final diagnoses were malignancy (11%), infections (23%), inflammatory diseases (43%) and miscellaneous (26%). 18 FDG-PET/CT was diagnostic in six cases with Takayasu's arteritis, tuberculosis, Langerhans cell histiocytosis and Ewing sarcoma. Sixteen cases had focal 18 FDG-uptake, but 18 FDG-PET/CT could only differentiate malignancy, infection and inflammation in three cases. In six cases with inflammatory diseases and no focal signs, PET/CT was normal except increased non-specific 18 FDG-uptake in bone marrow and spleen in five cases. One case was false positive (suspicion of appendicitis) and two false negative (leukaemia and inflammatory disease).

CONCLUSION: 18 FDG-PET/CT was diagnostic, or contributed to the diagnosis, in several children with unexplained fever referred to a tertiary centre. Challenges comprised (i) only increased non-specific 18 FDG-uptake in bone marrow and spleen in half of cases with inflammatory diseases, (ii) no differentiation between complicated infections, malignancy and inflammation in most cases with focal processes and (iii) a small risk of false positive and false negative results.

Original languageEnglish
JournalActa paediatrica
Volume111
Issue number11
Pages (from-to)2203-2209
Number of pages7
ISSN1651-2227
DOIs
Publication statusPublished - Nov 2022

Keywords

  • Child
  • Fever of Unknown Origin/diagnostic imaging
  • Fluorodeoxyglucose F18
  • Humans
  • Inflammation
  • Positron Emission Tomography Computed Tomography/methods
  • Radiopharmaceuticals
  • Retrospective Studies
  • Sarcoma, Ewing
  • FUO
  • persistent fever
  • PET-CT
  • paediatric infectious diseases

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