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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-01-2010 | Original Article

Diagnostic value of [¹⁸F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation

Authors: Niklas Jasper, Jan Däbritz, Michael Frosch, Markus Loeffler, Matthias Weckesser, Dirk Foell

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2010

Abstract

Purpose

Fever of unknown origin (FUO) and unexplained signs of inflammation are challenging medical problems especially in children and predominantly caused by infections, malignancies or noninfectious inflammatory diseases. The aim of this study was to assess the diagnostic value of ¹⁸F-FDG PET and PET/CT in the diagnostic work-up in paediatric patients.

Methods

In this retrospective study, 47 FDG PET and 30 PET/CT scans from 69 children (median age 8.1 years, range 0.2–18.1 years, 36 male, 33 female) were analysed. The diagnostic value of PET investigations in paediatric patients presenting with FUO (44 scans) or unexplained signs of inflammation without fever (33 scans) was analysed.

Results

A diagnosis in paediatric patients with FUO or unexplained signs of inflammation could be established in 32 patients (54%). Of all scans, 63 (82%) were abnormal, and of the total number of 77 PET and PET/CT scans 35 (45%) were clinically helpful. In patients with a final diagnosis, scans were found to have contributed to the diagnosis in 73%. Laboratory, demographic or clinical parameters of the children did not predict the usefulness of FDG PET scans.

Conclusion

This is the first larger study demonstrating that FDG PET and PET/CT may be valuable diagnostic tools for the evaluation of children with FUO and unexplained signs of inflammation. Depicting inflammation in the whole body, while not being traumatic, it is attractive for use especially in children. The combination of PET with CT seems to be superior, since the site of inflammation can be localized more accurately.

Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 2007;48:35–45.PubMed

Hirschmann JV. Fever of unknown origin in adults. Clin Infect Dis 1997;24:291–300; quiz 301-2.PubMed

Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997;350:575–80. doi:10.1016/S0140-6736(97)07061-X.CrossRefPubMed

Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961;40:1–30. doi:10.1097/00005792-196102000-00001.CrossRef

Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med 1992;152:21–2. doi:10.1001/archinte.152.1.21.CrossRefPubMed

Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003;163:545–51. doi:10.1001/archinte.163.5.545.CrossRefPubMed

Steele RW, Jones SM, Lowe BA, Glasier CM. Usefulness of scanning procedures for diagnosis of fever of unknown origin in children. J Pediatr 1991;119:526–30. doi:10.1016/S0022-3476(05)82399-6.CrossRefPubMed

Hayani A, Mahoney DH, Fernbach DJ. Role of bone marrow examination in the child with prolonged fever. J Pediatr 1990;116:919–20. doi:10.1016/S0022-3476(05)80651-1.CrossRefPubMed

Pizzo PA, Lovejoy FH Jr, Smith DH. Prolonged fever in children: review of 100 cases. Pediatrics 1975;55:468–73.PubMed

10.

Lohr JA, Hendley JO. Prolonged fever of unknown origin: a record of experiences with 54 childhood patients. Clin Pediatr (Phila) 1977;16:768–73. doi:10.1177/000992287701600905.CrossRef

11.

Pasic S, Minic A, Djuric P, Micic D, Kuzmanovic M, Sarjanovic L, et al. Fever of unknown origin in 185 paediatric patients: a single-centre experience. Acta Paediatr 2006;95:463–6. doi:10.1080/08035250500437549.CrossRefPubMed

12.

Bleeker-Rovers CP, Vos FJ, Mudde AH, Dofferhoff AS, de Geus-Oei LF, Rijnders AJ, et al. A prospective multi-centre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin. Eur J Nucl Med Mol Imaging 2007;34:694–703. doi:10.1007/s00259-006-0295-z.CrossRefPubMed

13.

de Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). I A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:392–400. doi:10.1097/00005792-199711000-00002.CrossRef

14.

de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:401–14. doi:10.1097/00005792-199711000-00003. CrossRef

15.

Kjaer A, Lebech AM, Eigtved A, Hojgaard L. Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 2004;31:622–6. doi:10.1007/s00259-003-1425-5.CrossRefPubMed

16.

Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, et al. Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET. Eur J Nucl Med 2000;27:1617–25. doi:10.1007/s002590000341.CrossRefPubMed

17.

Bleeker-Rovers CP, Vos FJ, Corstens FH, Oyen WJ. Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging 2008;52:17–29.PubMed

18.

Loffler M, Weckesser M, Franzius C, Schober O, Zimmer KP. High diagnostic value of 18F-FDG-PET in pediatric patients with chronic inflammatory bowel disease. Ann N Y Acad Sci 2006;1072:379–85. doi:10.1196/annals.1326.014.CrossRefPubMed

19.

Xiu Y, Yu JQ, Cheng E, Kumar R, Alavi A, Zhuang H. Sarcoidosis demonstrated by FDG PET imaging with negative findings on gallium scintigraphy. Clin Nucl Med 2005;30:193–5. doi:10.1097/00003072-200503000-00013.CrossRefPubMed

20.

Sturm E, Rings EH, Scholvinck EH, Gouw AS, Porte RJ, Pruim J. Fluordeoxyglucose positron emission tomography contributes to management of pediatric liver transplantation candidates with fever of unknown origin. Liver Transpl 2006;12:1698–704. doi:10.1002/lt.20922.CrossRefPubMed

21.

Lemberg DA, Issenman RM, Cawdron R, Green T, Mernagh J, Skehan SJ, et al. Positron emission tomography in the investigation of pediatric inflammatory bowel disease. Inflamm Bowel Dis 2005;11:733–8. doi:10.1097/01.MIB.0000172810.49619.cb.CrossRefPubMed

22.

Lassmann M, Biassoni L, Monsieurs M, Franzius C, Jacobs F; EANM Dosimetry and Paediatrics Committees. The new EANM paediatric dosage card. Eur J Nucl Med Mol Imaging 2007;34:796–8. doi:10.1007/s00259-007-0370-0.CrossRefPubMed

23.

Jacobs F, Thierens H, Piepsz A, Bacher K, Van de Wiele C, Ham H, et al. Optimised tracer-dependent dosage cards to obtain weight-independent effective doses. Eur J Nucl Med Mol Imaging 2005;32:581–8. doi:10.1007/s00259-004-1708-5.CrossRefPubMed

24.

Fahey FH, Palmer MR, Strauss KJ, Zimmerman RE, Badawi RD, Treves ST. Dosimetry and adequacy of CT-based attenuation correction for pediatric PET: phantom study. Radiology 2007;243:96–104. doi:10.1148/radiol.2431060696.CrossRefPubMed

25.

Honnef D, Wildberger JE, Stargardt A, Hohl C, Barker M, Gunther RW, et al. Multislice spiral CT (MSCT) in pediatric radiology: dose reduction for chest and abdomen examinations. Rofo 2004;176:1021–30.PubMed

26.

Rogalla P, Stover B, Scheer I, Juran R, Gaedicke G, Hamm B. Low-dose spiral CT: applicability to paediatric chest imaging. Pediatr Radiol 1999;29:565–9. doi:10.1007/s002470050648.CrossRefPubMed

27.

Franzius C, Juergens KU, Schober O. Is PET/CT necessary in paediatric oncology? For. Eur J Nucl Med Mol Imaging 2006;33:960–5. doi:10.1007/s00259-006-0114-6.CrossRefPubMed

28.

Stauss J, Franzius C, Pfluger T, Juergens KU, Biassoni L, Begent J, et al. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging 2008;35:1581–8. doi:10.1007/s00259-008-0826-x.CrossRefPubMed

29.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Fam Pract 2004;21:4–10. doi:10.1093/fampra/cmh103.CrossRefPubMed

30.

Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics 2005;25:1357–68. doi:10.1148/rg.255045122.CrossRefPubMed

31.

Blockmans D, Knockaert D, Maes A, De Caestecker J, Stroobants S, Bobbaers H, et al. Clinical value of [(18)F]fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin. Clin Infect Dis 2001;32:191–6. doi:10.1086/318480.CrossRefPubMed

32.

Bleeker-Rovers CP, de Kleijn EM, Corstens FH, van der Meer JW, Oyen WJ. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 2004;31:29–37. doi:10.1007/s00259-003-1338-3.CrossRefPubMed

33.

Buysschaert I, Vanderschueren S, Blockmans D, Mortelmans L, Knockaert D. Contribution of (18)fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin. Eur J Intern Med 2004;15:151–6. doi:10.1016/j.ejim.2004.01.018.CrossRefPubMed

34.

Federici L, Blondet C, Imperiale A, Sibilia J, Pasquali JL, Pflumio F, et al. Value of (18)F-FDG-PET/CT in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome: a single centre analysis experience. Int J Clin Pract. doi:10.1111/j.1742-1241.2008.01774.x.

35.

Lorenzen J, Buchert R, Bohuslavizki KH. Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun 2001;22:779–83. doi:10.1097/00006231-200107000-00009.CrossRefPubMed

36.

Jaruskova M, Belohlavek O. Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states. Eur J Nucl Med Mol Imaging 2006;33:913–8. doi:10.1007/s00259-006-0064-z.CrossRefPubMed

37.

Depas G, Decortis T, Francotte N, Bricteux G, Hustinx R. F-18 FDG PET in infectious diseases in children. Clin Nucl Med 2007;32:593–8. doi:10.1097/RLU.0b013e3180a1abe8.CrossRefPubMed

38.

Chacko TK, Zhuang H, Nakhoda KZ, Moussavian B, Alavi A. Applications of fluorodeoxyglucose positron emission tomography in the diagnosis of infection. Nucl Med Commun 2003;24:615–24. doi:10.1097/00006231-200306000-00002.CrossRefPubMed

39.

Sugawara Y, Braun DK, Kison PV, Russo JE, Zasadny KR, Wahl RL. Rapid detection of human infections with fluorine-18 fluorodeoxyglucose and positron emission tomography: preliminary results. Eur J Nucl Med 1998;25:1238–43. doi:10.1007/s002590050290.CrossRefPubMed

40.

Vos FJ, Bleeker-Rovers CP, Corstens FH, Kullberg BJ, Oyen WJ. FDG-PET for imaging of non-osseous infection and inflammation. Q J Nucl Med Mol Imaging 2006;50:121–30.PubMed

41.

Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. Neth J Med 2003;61:323–9.PubMed

42.

Czernin J, Auerbach MA. Clinical PET/CT imaging: promises and misconceptions. Nucl Med (Stuttg) 2005;44(Suppl 1):S18–23.

43.

Wechalekar K, Sharma B, Cook G. PET/CT in oncology – a major advance. Clin Radiol 2005;60:1143–55. doi:10.1016/j.crad.2005.05.018.CrossRefPubMed

44.

Goerres GW, Forster A, Uebelhart D, Seifert B, Treyer V, Michel B, et al. F-18 FDG whole-body PET for the assessment of disease activity in patients with rheumatoid arthritis. Clin Nucl Med 2006;31:386–90. doi:10.1097/01.rlu.0000222678.95218.42.CrossRefPubMed

45.

Gungor T, Engel-Bicik I, Eich G, Willi UV, Nadal D, Hossle JP, et al. Diagnostic and therapeutic impact of whole body positron emission tomography using fluorine-18-fluoro-2-deoxy-D-glucose in children with chronic granulomatous disease. Arch Dis Child 2001;85:341–5. doi:10.1136/adc.85.4.341.CrossRefPubMed

46.

Davies SG, Garvie NW. The role of indium-labelled leukocyte imaging in pyrexia of unknown origin. Br J Radiol 1990;63:850–4.CrossRefPubMed

47.

Schmidt KG, Rasmussen JW, Sorensen PG, Wedebye IM. Indium-111-granulocyte scintigraphy in the evaluation of patients with fever of undetermined origin. Scand J Infect Dis 1987;19:339–45. doi:10.3109/00365548709018480.CrossRefPubMed

48.

Syrjala MT, Valtonen V, Liewendahl K, Myllyla G. Diagnostic significance of indium-111 granulocyte scintigraphy in febrile patients. J Nucl Med 1987;28:155–60.PubMed

49.

Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake – the role of PET/CT. Eur Radiol 2006;16:1054–65. doi:10.1007/s00330-005-0088-y.CrossRefPubMed

50.

Pierce DA, Shimizu Y, Preston DL, Vaeth M, Mabuchi K. Studies of the mortality of atomic bomb survivors. Report 12, Part I. Cancer: 1950–1990. Radiat Res 1996;146:1–27. doi:10.2307/3579391.CrossRefPubMed

51.

Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289–96.PubMed

52.

Frush DP, Donnelly LF, Rosen NS. Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 003;112:951–7. doi:10.1542/peds.112.4.951.CrossRefPubMed

53.

Borgwardt L, Larsen HJ, Pedersen K, Hojgaard L. Practical use and implementation of PET in children in a hospital PET centre. Eur J Nucl Med Mol Imaging 2003;30:1389–97. doi:10.1007/s00259-003-1263-5.CrossRefPubMed

Title: Diagnostic value of [18F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation
Authors: Niklas Jasper
Jan Däbritz
Michael Frosch
Markus Loeffler
Matthias Weckesser
Dirk Foell
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1185-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic value of [¹⁸F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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