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Published on: January 20, 2023
Usefulness of brain FDG PET/CT imaging in pediatric patients with suspected autoimmune encephalitis from a
Yafu Yin1, Jing Wu2, Shuqi Wu3
1Department of Nuclear Medicine, Yangpu District, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Kongjiang Road 1665, Shanghai City, 200092, China. yinyafu@xinhuamed.com.cn.
Insights
Fluorodeoxyglucose (FDG) PET/CT imaging demonstrates high accuracy in diagnosing autoimmune encephalitis (AE) in children. This diagnostic tool shows significant sensitivity and specificity, aiding early detection and treatment of AE in pediatric patients.
Area of Science:
- Neurology
- Nuclear Medicine
- Pediatrics
Background:
- Autoimmune encephalitis (AE) requires early diagnosis and treatment in pediatric patients.
- FDG PET/CT is a potential imaging modality for evaluating suspected AE.
Purpose of the Study:
- To evaluate the diagnostic utility of FDG PET/CT in children with suspected autoimmune encephalitis.
- To determine the sensitivity, specificity, and accuracy of FDG PET/CT for AE diagnosis in a pediatric cohort.
Main Methods:
- A prospective study included 104 pediatric inpatients with clinically suspected AE.
- Patients underwent comprehensive testing, including blood, CSF, EEG, MRI, and 18F-FDG PET/CT.
- AE diagnosis was confirmed based on seropositive/seronegative criteria, with FDG PET/CT findings analyzed for hypometabolism patterns.
Main Results:
- Of 104 patients, 58 were diagnosed with AE (16 seropositive, 42 seronegative).
- FDG PET/CT detected large lobar hypometabolism in 61 children, with 88.5% ultimately diagnosed with AE.
- The imaging modality achieved 93.1% sensitivity, 84.4% specificity, and 89.3% accuracy for AE diagnosis.
Conclusions:
- Brain FDG PET/CT imaging demonstrates high diagnostic performance for autoimmune encephalitis in children.
- The study confirms the usefulness of FDG PET/CT as a valuable tool for diagnosing AE in pediatric neurology.
- FDG PET/CT findings, particularly parietal lobe hypometabolism, are key indicators in AE diagnosis.
Purpose:
Early diagnosis and treatment are of paramount importance for pediatric patients with autoimmune encephalitis (AE). The aim is to evaluate the usefulness of FDG PET/CT in pediatric patients with suspected AE from a prospective study.
Methods:
The prospective study was conducted over a period of 23.5 months from May 14, 2019, to April 30, 2021. All patients (< 18-year-old) were hospitalized at the department of pediatric neurology and met the criteria of clinical suspected AE. The children underwent the tests of blood samplings, CSF, EEG, MRI, and 18F-FDG PET/CT. The criteria for FDG PET/CT diagnosis of AE were large lobar hypometabolism with or without focal hypermetabolism found on PET/CT. The clinical final diagnosis of AE includes seropositive and seronegative AE based on the diagnostic criteria.
Results:
One hundred four pediatric inpatients (57 boys, 47 girls) were included, of which 58 children were diagnosed with AE (seropositive, 16; seronegative, 42), 45 children were diagnosed with non-AE, and one boy remained indeterminate diagnosis. Large lobar hypometabolism was found in 61 children, of which 54 (88.5%) children were finally diagnosed with AE. The sensitivity, specificity, and accuracy of FDG PET/CT for diagnosis of AE were 93.1%, 84.4%, and 89.3%, respectively, with a positive predictive value of 88.5% and a negative predictive value of 90.5%. The most common involved with hypometabolism was the parietal lobe, followed by occipital and frontal lobes, finally the temporal lobe on PET/CT in children with AE.
Conclusion:
Brain FDG PET/CT imaging has high specificity, sensitivity, and accuracy for diagnosis of AE in clinical suspected AE children.
Clinical Trials:
gov. NCT02969213. Registered 17 October 2016.
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