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

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.

Automated summary

This study investigated the application of (18)FDG-PET/CT in pediatric patients with non-diagnostic standard investigations, demonstrating its diagnostic value in some cases while highlighting challenges such as false positive and false negative results.