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Diagnostic value of FDG-PET/(CT) in children with fever of unknown origin and unexplained fever during immune suppression

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Abstract

Purpose

Fever of unknown origin (FUO) and unexplained fever during immune suppression in children are challenging medical problems. The aim of this study is to investigate the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET combined with computed tomography (FDG-PET/CT) in children with FUO and in children with unexplained fever during immune suppression.

Methods

All FDG-PET/(CT) scans performed in the Radboud university medical center for the evaluation of FUO or unexplained fever during immune suppression in the last 10 years were reviewed. Results were compared with the final clinical diagnosis.

Results

FDG-PET/(CT) scans were performed in 31 children with FUO. A final diagnosis was established in 16 cases (52 %). Of the total number of scans, 32 % were clinically helpful. The sensitivity and specificity of FDG-PET/CT in these patients was 80 % and 78 %, respectively. FDG-PET/(CT) scans were performed in 12 children with unexplained fever during immune suppression. A final diagnosis was established in nine patients (75 %). Of the total number of these scans, 58 % were clinically helpful. The sensitivity and specificity of FDG-PET/CT in children with unexplained fever during immune suppression was 78 % and 67 %, respectively.

Conclusions

FDG-PET/CT appears a valuable imaging technique in the evaluation of children with FUO and in the diagnostic process of children with unexplained fever during immune suppression. Prospective studies of FDG-PET/CT as part of a structured diagnostic protocol are warranted to assess the additional diagnostic value.

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References

  1. Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Med (Baltimore). 1961;40:1–30.

    Article  CAS  Google Scholar 

  2. Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med. 1992;152(1):21–2.

    Article  CAS  PubMed  Google Scholar 

  3. 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. Med (Baltimore). 1997;76(6):392–400.

    Article  Google Scholar 

  4. Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Intern Med. 2003;253(3):263–75.

    Article  CAS  PubMed  Google Scholar 

  5. Durack DT, Street AC. Fever of unknown origin–reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35–51.

    CAS  PubMed  Google Scholar 

  6. Brewis EG. Child care in general practice. Undiagnosed Fever. Br Med J. 1965;1(5427):107–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Dechovitz AB, Moffet HL. Classification of acute febrile illnesses in childhood. Clin Pediatr (Phila). 1968;7(11):649–53.

    Article  CAS  Google Scholar 

  8. Chow A, Robinson JL. Fever of unknown origin in children: a systematic review. World J Pediatr. 2011;7(1):5–10. doi:10.1007/s12519-011-0240-5.

    Article  PubMed  Google Scholar 

  9. Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Med (Baltimore). 2007;86(1):26–38. doi:10.1097/MD.0b013e31802fe858.

    Article  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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(11):1698–704. doi:10.1002/lt.20922.

    Article  PubMed  Google Scholar 

  12. Dong MJ, Zhao K, Liu ZF, Wang GL, Yang SY, Zhou GJ. A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol. 2011;80(3):834–44. doi:10.1016/j.ejrad.2010.11.018.

    Article  PubMed  Google Scholar 

  13. Jasper N, Dabritz J, Frosch M, Loeffler M, Weckesser M, Foell D. Diagnostic value of [(18)F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation. Eur J Nucl Med Mol Imaging. 2010;37(1):136–45. doi:10.1007/s00259-009-1185-y.

    Article  PubMed  Google Scholar 

  14. 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(8):1581–8. doi:10.1007/s00259-008-0826-x.

    Article  CAS  PubMed  Google Scholar 

  15. 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(10):1389–97. doi:10.1007/s00259-003-1263-5.

    Article  PubMed  Google Scholar 

  16. Shammas A, Lim R, Charron M. Pediatric FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29(5):1467–86. doi:10.1148/rg.295085247.

    Article  PubMed  Google Scholar 

  17. Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med. 2007;48(1):35–45.

    CAS  PubMed  Google Scholar 

  18. 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(1):29–37. doi:10.1007/s00259-003-1338-3.

    Article  PubMed  Google Scholar 

  19. 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(11):1617–25.

    Article  CAS  PubMed  Google Scholar 

  20. 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(2):191–6. doi:10.1086/318480.

    Article  CAS  PubMed  Google Scholar 

  21. Lorenzen J, Buchert R, Bohuslavizki KH. Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun. 2001;22(7):779–83.

    Article  CAS  PubMed  Google Scholar 

  22. 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(5):622–6. doi:10.1007/s00259-003-1425-5.

    Article  PubMed  Google Scholar 

  23. 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(3):151–6. doi:10.1016/j.ejim.2004.01.018.

    Article  PubMed  Google Scholar 

  24. 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(5):694–703. doi:10.1007/s00259-006-0295-z.

    Article  PubMed  Google Scholar 

  25. Kubota K, Nakamoto Y, Tamaki N, Kanegae K, Fukuda H, Kaneda T, et al. FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study. Ann Nucl Med. 2011;25(5):355–64. doi:10.1007/s12149-011-0470-6.

    Article  PubMed  Google Scholar 

  26. Seshadri N, Sonoda LI, Lever AM, Balan K. Superiority of 18F-FDG PET compared to 111In-labelled leucocyte scintigraphy in the evaluation of fever of unknown origin. J Infect. 2012;65(1):71–9. doi:10.1016/j.jinf.2012.02.008.

    Article  CAS  PubMed  Google Scholar 

  27. Keidar Z, Gurman-Balbir A, Gaitini D, Israel O. Fever of unknown origin: the role of 18F-FDG PET/CT. J Nucl Med. 2008;49(12):1980–5. doi:10.2967/jnumed.108.054692.

    Article  PubMed  Google Scholar 

  28. Balink H, Collins J, Bruyn GA, Gemmel F. F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med. 2009;34(12):862–8. doi:10.1097/RLU.0b013e3181becfb1.

    Article  PubMed  Google Scholar 

  29. 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. 2010;64(1):55–60. doi:10.1111/j.1742-1241.2008.01774.x.

    Article  CAS  PubMed  Google Scholar 

  30. Ferda J, Ferdova E, Zahlava J, Matejovic M, Kreuzberg B. Fever of unknown origin: a value of (18)F-FDG-PET/CT with integrated full diagnostic isotropic CT imaging. Eur J Radiol. 2010;73(3):518–25. doi:10.1016/j.ejrad.2008.12.014.

    Article  PubMed  Google Scholar 

  31. Kei PL, Kok TY, Padhy AK, Ng DC, Goh AS. [18F] FDG PET/CT in patients with fever of unknown origin: a local experience. Nucl Med Commun. 2010;31(9):788–92. doi:10.1097/MNM.0b013e32833d0281.

    Article  PubMed  Google Scholar 

  32. Sheng JF, Sheng ZK, Shen XM, Bi S, Li JJ, Sheng GP, et al. Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin. Eur J Intern Med. 2011;22(1):112–6. doi:10.1016/j.ejim.2010.09.015.

    Article  PubMed  Google Scholar 

  33. Pelosi E, Skanjeti A, Penna D, Arena V. Role of integrated PET/CT with [(1)(8)F]-FDG in the management of patients with fever of unknown origin: a single-centre experience. Radiol Med. 2011;116(5):809–20. doi:10.1007/s11547-011-0649-x.

    Article  CAS  PubMed  Google Scholar 

  34. Pedersen TI, Roed C, Knudsen LS, Loft A, Skinhoj P, Nielsen SD. Fever of unknown origin: a retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT. Scand J Infect Dis. 2012;44(1):18–23. doi:10.3109/00365548.2011.603741.

    Article  CAS  PubMed  Google Scholar 

  35. Crouzet J, Boudousq V, Lechiche C, Pouget JP, Kotzki PO, Collombier L, et al. Place of (18)F-FDG-PET with computed tomography in the diagnostic algorithm of patients with fever of unknown origin. Eur J Clin Microbiol Infect Dis. 2012;31(8):1727–33. doi:10.1007/s10096-011-1440-6.

    Article  CAS  PubMed  Google Scholar 

  36. Kim YJ, Kim SI, Hong KW, Kang MW. Diagnostic value of 18F-FDG PET/CT in patients with fever of unknown origin. Intern Med J. 2012;42(7):834–7. doi:10.1111/j.1445-5994.2012.02828.x.

    Article  CAS  PubMed  Google Scholar 

  37. de Groot M, Meeuwis AP, Kok PJ, Corstens FH, Oyen WJ. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging. 2005;32(1):98–101. doi:10.1007/s00259-004-1670-2.

    Article  PubMed  Google Scholar 

  38. 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(10):323–9.

    CAS  PubMed  Google Scholar 

  39. Vos FJ, Bleeker-Rovers CP, Oyen WJ. The use of FDG-PET/CT in patients with febrile neutropenia. Semin Nucl Med. 2013;43(5):340–8. doi:10.1053/j.semnuclmed.2013.04.007.

    Article  PubMed  Google Scholar 

  40. Vos FJ, Donnelly JP, Oyen WJ, Kullberg BJ, Bleeker-Rovers CP, Blijlevens NM. 18F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation. Eur J Nucl Med Mol Imaging. 2012;39(1):120–8. doi:10.1007/s00259-011-1939-1.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Mahfouz T, Miceli MH, Saghafifar F, Stroud S, Jones-Jackson L, Walker R, et al. 18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes. J Clin Oncol. 2005;23(31):7857–63. doi:10.1200/JCO.2004.00.8581.

    Article  CAS  PubMed  Google Scholar 

  42. Guy SD, Tramontana AR, Worth LJ, Lau E, Hicks RJ, Seymour JF, et al. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients. Eur J Nucl Med Mol Imaging. 2012;39(8):1348–55. doi:10.1007/s00259-012-2143-7.

    Article  PubMed  Google Scholar 

  43. Koh KC, Slavin MA, Thursky KA, Lau E, Hicks RJ, Drummond E, et al. Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on diagnosis and antimicrobial utilization in patients with high-risk febrile neutropenia. Leuk Lymphoma. 2012;53(10):1889–95. doi:10.3109/10428194.2012.677533.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

    Gijsbert J. Blokhuis, Marije G. Diender, Wim J. G. Oyen & Lioe-Fee de Geus-Oei

  2. Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

    Chantal P. Bleeker-Rovers

  3. Department of Paediatrics, Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands

    Jos M. Th. Draaisma

  4. MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands

    Lioe-Fee de Geus-Oei

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  1. Gijsbert J. Blokhuis
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  2. Chantal P. Bleeker-Rovers
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Correspondence to Lioe-Fee de Geus-Oei.

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Blokhuis, G.J., Bleeker-Rovers, C.P., Diender, M.G. et al. Diagnostic value of FDG-PET/(CT) in children with fever of unknown origin and unexplained fever during immune suppression. Eur J Nucl Med Mol Imaging 41, 1916–1923 (2014). https://doi.org/10.1007/s00259-014-2801-z

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