Suenaga Yuta, Kubota Kazuo, Matsui Motohiro, Makimoto Atsushi, Yamanaka Junko, Mochizuki Shinji, Hotta Masatoshi, Chikanishi Miyako Morooka, Shichino Hiroyuki
Department of Pediatrics, Japan Institute for Health Security National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku 162-8655, Japan.
Division of Critical Care Medicine, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama 330-8777, Japan.
Children (Basel). 2025 Sep 11;12(9):1218. doi: 10.3390/children12091218.
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a valuable imaging modality for detecting malignancies and diagnosing fever of unknown origin (FUO). However, data regarding FDG accumulation in bone marrow among pediatric acute leukemia (AL) cases are limited. In this study, we aimed to compare FDG-PET/CT findings between children with AL and those with inflammatory diseases (IDs), including FUO, and develop a scoring system for differential diagnoses. We retrospectively analyzed FDG-PET/CT findings in six children with AL and 22 with IDs. The maximum standardized uptake value (SUV max), visual score (VS), and spread score (SS) were evaluated across various bone marrow sites, including vertebrae, pelvic bone, humerus, forearm, and femur. Statistical analysis consisted of Mann-Whitney U test for group comparisons and receiver operating characteristic curve (ROC)/area under the curve (AUC) analyses to assess diagnostic performance. SUV max, VS, and SS were significantly higher in children with AL across all evaluated sites. The combined VS + SS scoring system yielded the highest diagnostic accuracy. A simplified version using only the VS of the middle humerus and femur plus the SS showed comparable effectiveness. FDG-PET/CT in children with AL showed high FDG accumulation in bone marrow areas in the whole body. The simple scoring system, which comprises FDG accumulation in the middle portion of the extremities and the whole body, appears to be helpful in distinguishing AL from IDs in children. FDG-PET/CT-based visual scoring may provide supportive information alongside conventional diagnostics in pediatric acute leukemia.
氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）是检测恶性肿瘤和诊断不明原因发热（FUO）的一种有价值的成像方式。然而，关于小儿急性白血病（AL）病例骨髓中FDG聚集的数据有限。在本研究中，我们旨在比较AL患儿与包括FUO在内的炎症性疾病（IDs）患儿的FDG-PET/CT表现，并开发一种用于鉴别诊断的评分系统。我们回顾性分析了6例AL患儿和22例IDs患儿的FDG-PET/CT表现。在包括椎骨、骨盆、肱骨、前臂和股骨在内的各个骨髓部位评估最大标准化摄取值（SUV max）、视觉评分（VS）和扩散评分（SS）。统计分析包括用于组间比较的Mann-Whitney U检验以及用于评估诊断性能的受试者操作特征曲线（ROC）/曲线下面积（AUC）分析。在所有评估部位，AL患儿的SUV max、VS和SS均显著更高。VS + SS联合评分系统具有最高的诊断准确性。仅使用肱骨中部和股骨的VS加上SS的简化版本显示出 comparable effectiveness（此处原文可能有误，推测为“相当的有效性”）。AL患儿的FDG-PET/CT显示全身骨髓区域FDG聚集较高。由四肢中部和全身的FDG聚集组成的简单评分系统似乎有助于区分儿童AL与IDs。基于FDG-PET/CT的视觉评分可能在小儿急性白血病的传统诊断中提供辅助信息。
