2
|
Li Q, Tian R, Wang H, Li L, Wu T, Ren Y, Su M, Zou K, Sun X. Quantifying the contribution of 18F-FDG PET to the diagnostic assessment of pediatric patients with fever of unknown origin: a systematic review and meta-analysis. Pediatr Radiol 2022; 52:1500-1511. [PMID: 35348809 DOI: 10.1007/s00247-022-05333-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/18/2021] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in the diagnostic assessment of pediatric fever of unknown origin is not known, and evidence from adults is not applicable. OBJECTIVE To quantify the contribution of 18F-FDG PET to pediatric fever of unknown origin, considering its diagnostic limitations. MATERIALS AND METHODS We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials up to Feb. 18, 2021. We included studies on patients with pediatric fever of unknown origin presenting sufficient data to calculate the likelihood of achieving definite diagnosis (based on pathology or clinical follow-up) between those with abnormal PET findings versus those with normal PET findings. We assessed the risk of bias using a modified Newcastle-Ottawa quality assessment scale and quantified the value of PET by pooling the likelihood of achieving definite diagnosis using a random-effects model. RESULTS We included 6 studies and found that pediatric patients with abnormal PET findings were about 17 times more likely to achieve definite diagnoses than those with normal PET findings (odds ratio [OR]: 16.75, 95% confidence interval [CI] 8.0-35, P < 0.00001). Sensitivity analyses using a fixed-effect model (OR 16.91, 95% CI 8.1-35, P < 0.0001) or removing one study at a time (OR 12-20, 95% CI lower bound 3.8-8.6, 95% CI upper bound 33-45, P < 0.0001) did not significantly alter the results. Sample size (interaction P = 0.75), imaging modality (interaction P = 0.29), length of follow-up (interaction P = 0.37), fever of unknown origin subclasses (interaction P = 0.89) and geographical areas (interaction P = 0.74) of studies showed no statistically significant influence on the results. CONCLUSION 18F-FDG PET is a promising approach in the diagnostic work-up of pediatric fever of unknown origin. Further studies are warranted to support routine use in clinical care.
Collapse
Affiliation(s)
- Qianrui Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hongxi Wang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Tian Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China. .,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Liu M, Wu H, Shan L, Dong A, Han Y. Focal FDG Uptake in the Cerebral Parenchyma Beneath the Subdural Hematoma. Clin Nucl Med 2022; 47:553-554. [PMID: 35044957 DOI: 10.1097/rlu.0000000000004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Changes in cerebral glucose metabolism after subdural hematoma have been rarely reported. We present a case with acute subdural hematoma detected unexpectedly on FDG PET/CT. Focal intense FDG uptake in the cerebral parenchyma beneath the subdural hematoma was seen on PET. The density of the cerebral parenchyma was normal on CT. The patient received conservative management. He recovered without any complication. This case indicates that familiarity with the changes in cerebral glucose metabolism on PET after subdural hematoma may be helpful for optimal patient care.
Collapse
Affiliation(s)
- Mingyuan Liu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Haibo Wu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Lili Shan
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yan Han
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| |
Collapse
|
4
|
PET/Computed Tomography in the Evaluation of Fever of Unknown Origin and Infectious/Inflammatory Disease in Pediatric Patients. PET Clin 2021; 15:361-369. [PMID: 32498991 DOI: 10.1016/j.cpet.2020.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fever in children is common. If it persists and its cause cannot be identified in a reasonable time, along with laboratory and conventional imaging investigations, it is defined as fever of unknown origin (FUO). 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) is well established in the evaluation of malignancy, which is a possible cause of FUO. FDG often locates inflammatory and infectious lesions considered nonspecific or false-positive for oncology; however, these findings are beneficial in FUO evaluation because infectious and inflammatory diseases are important FUO causes. FDG-PET/CT is being increasingly used for investigation of FUO as well as infectious/inflammatory disease.
Collapse
|
6
|
Is There Any Potential of FDG PET/CT in Monitoring Disease Activity in Familial Hemophagocytic Lymphohistiocytosis? Clin Nucl Med 2018; 43:296-298. [PMID: 29465491 DOI: 10.1097/rlu.0000000000002008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
FDG PET/CT was performed in a 30-year-old woman to detect the source of fever of unknown origin. The images showed widespread abnormal activity, consistent with lymphoma. However, lymph node biopsy revealed only inflammation, and a diagnosis of familial hemophagocytic lymphohistiocytosis was eventually made after familial hemophagocytic lymphohistiocytosis-specific gene was detected. After proper therapy, a follow-up FDG PET/CT examination 2 months later showed resolution of most of the previously seen lesions.
Collapse
|