Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.
Pediatr Radiol. 2022 Jul;52(8):1500-1511. doi: 10.1007/s00247-022-05333-7. Epub 2022 Mar 29.
The value of F-fluorodeoxyglucose positron emission tomography (F-FDG PET) in the diagnostic assessment of pediatric fever of unknown origin is not known, and evidence from adults is not applicable.
To quantify the contribution of F-FDG PET to pediatric fever of unknown origin, considering its diagnostic limitations.
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.
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.
F-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.
氟代脱氧葡萄糖正电子发射断层扫描（F-FDG PET）在儿童不明原因发热的诊断评估中的价值尚不清楚，且成人的证据并不适用。
量化 F-FDG PET 对儿童不明原因发热的贡献，同时考虑其诊断局限性。
我们检索了 PubMed、EMBASE 和 Cochrane 对照试验中心注册库，检索时间截至 2021 年 2 月 18 日。我们纳入了研究对象为存在儿童不明原因发热且提供了足够数据以计算存在异常 F-FDG PET 表现和正常 F-FDG PET 表现的患者中明确诊断可能性（基于病理或临床随访）的研究。我们使用改良的纽卡斯尔-渥太华质量评估量表评估了偏倚风险，并使用随机效应模型汇总明确诊断的可能性来量化 F-FDG PET 的价值。
我们纳入了 6 项研究，结果显示，存在异常 F-FDG PET 表现的儿科患者明确诊断的可能性约为存在正常 F-FDG PET 表现的患者的 17 倍（比值比[OR]：16.75，95%置信区间[CI] 8.0-35，P<0.00001）。使用固定效应模型（OR 16.91，95% CI 8.1-35，P<0.0001）或每次剔除一项研究（OR 12-20，95% CI 下限 3.8-8.6，95% CI 上限 33-45，P<0.0001）进行敏感性分析，并未显著改变结果。研究样本量（交互 P=0.75）、成像方式（交互 P=0.29）、随访时间（交互 P=0.37）、儿童不明原因发热亚类（交互 P=0.89）和地理区域（交互 P=0.74）并未对结果产生统计学显著影响。
F-FDG PET 是儿童不明原因发热诊断评估的一种很有前途的方法。需要进一步的研究来支持其在临床护理中的常规应用。
