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

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.

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.

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).

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.