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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

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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.

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Acknowledgements

This study was supported by the Fundamental Research Funds for the Central Universities (grant 2021SCU12008), China Postdoctoral Science Foundation (grant 2020M683342), Post-Doctor Research Project, West China Hospital, Sichuan University (grant 2020HXBH147), Department of Science and Technology of Sichuan Province (grant 2019YFS0373) and the 1·3·5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant ZYYC08003). The funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to submit results.

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Authors and Affiliations

  1. Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Qianrui Li, Rong Tian, Hongxi Wang & Minggang Su

  2. Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China

    Qianrui Li, Ling Li, Yan Ren, Kang Zou & Xin Sun

  3. National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China

    Qianrui Li, Ling Li, Yan Ren, Kang Zou & Xin Sun

  4. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Tian Wu

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  1. Qianrui Li
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  4. Ling Li
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Correspondence to Xin Sun.

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Li, Q., Tian, R., Wang, H. et al. 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 52, 1500–1511 (2022). https://doi.org/10.1007/s00247-022-05333-7

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  • DOI: https://doi.org/10.1007/s00247-022-05333-7

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