PURPOSE To determine the role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in children with fever of unknown origin (FUO). METHODS This retrospective single-center study included 110 children (0-18 years) with FUO who underwent FDG-PET/CT between 2010 and 2019. The diagnostic value of FDG-PET/CT for identifying cause of fever was calculated, treatment modifications after FDG-PET/CT were assessed, and logistic regression analyses were performed to identify clinical and biochemical factors associated with FDG-PET/CT outcome. RESULTS In 53 out of 110 patients (48%), FDG-PET/CT identified a (true positive) cause of fever. Endocarditis (11%), systemic juvenile idiopathic arthritis (5%), and inflammatory bowel disorder (5%) were the most common causes of FUO. In 42 patients (38%), no cause of fever was found on FDG-PET/CT. In 58 out of 110 patients (53%), treatment modifications were made after FDG-PET/CT. FDG-PET/CT achieved a sensitivity of 85.5%, specificity of 79.2%, positive predictive value of 84.1%, and negative predictive value of 80.9%. On multivariate logistic regression, C-reactive protein was positively associated with finding a true positive focus of fever on FDG-PET/CT (OR = 1.01 (95% CI 1.00-1.02) per mg/L increase in CRP), while leukocyte count was negatively associated with finding a true positive focus of fever (OR = 0.91 (95% CI 0.85-0.97) per 109 leukocytes/L increase). CONCLUSION FDG-PET/CT is a valuable diagnostic tool in the evaluation of children with FUO, since it may detect a true underlying cause in almost half (48%) of all cases where none was found otherwise. It allows full-body evaluation in patients without disease-specific symptoms on one examination. CRP and leukocyte count were significantly associated with FDG-PET/CT results, which may contribute to a priori assessment on the outcome of FDG-PET/CT. Future research could be aimed at evaluating more patient-specific factors to prospectively estimate the added value of FDG-PET/CT in children with FUO.

中文翻译：

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FDG-PET/CT 在不明原因发热儿童中的作用。

目的 确定 18F-氟-2-脱氧-D-葡萄糖正电子发射断层扫描 (FDG-PET)/计算机断层扫描 (CT) 在不明原因发热 (FUO) 儿童中的作用。方法 这项回顾性单中心研究纳入了 110 名 FUO 儿童（0-18 岁），他们在 2010 年至 2019 年间接受了 FDG-PET/CT。对 FDG-PET/CT 进行了评估，并进行了逻辑回归分析，以确定与 FDG-PET/CT 结果相关的临床和生化因素。结果 110 名患者中有 53 名 (48%)，FDG-PET/CT 确定了发烧的（真阳性）原因。心内膜炎（11%）、全身性幼年特发性关节炎（5%）和炎症性肠病（5%）是 FUO 的最常见原因。FDG-PET/CT 未发现 42 名患者 (38%) 发烧。110 名患者中有 58 名 (53%) 在 FDG-PET/CT 后进行了治疗修改。FDG-PET/CT 的敏感性为 85.5%，特异性为 79.2%，阳性预测值为 84.1%，阴性预测值为 80.9%。在多变量 Logistic 回归中，C 反应蛋白与在 FDG-PET/CT 上发现真正的发热阳性病灶呈正相关（OR = 1.01 (95% CI 1.00-1.02) 每 mg/L CRP 增加），而白细胞计数与发现真正的发热阳性病灶呈负相关（OR = 0.91 (95% CI 0.85-0.97) 每 109 个白细胞/L 增加）。结论 FDG-PET/CT 是评估 FUO 儿童的一种有价值的诊断工具，因为它可以在几乎一半 (48%) 的所有病例中检测到真正的根本原因，而其他情况下则无法发现。它允许在一次检查中对没有疾病特异性症状的患者进行全身评估。CRP和白细胞计数与FDG-PET/CT结果显着相关，这可能有助于对FDG-PET/CT结果的先验评估。未来的研究可能旨在评估更多患者特异性因素，以前瞻性地估计 FDG-PET/CT 对 FUO 儿童的附加值。