The clinical utility of fluorodeoxyglucose‐positron emission tomography for investigation of fever in immunocompromised children. (13th December 2017)

• Record Type: Journal Article
• Authors: Wang, Shiqi Stacie; Mechinaud, Francoise; Thursky, Karin; Cain, Timothy; Lau, Eddie; Haeusler, Gabrielle M
• Is Part Of: Journal of paediatrics and child health. Volume 54:Number 5(2018:May)
• Page Start: 487
• Page End: 492
• Publication Date: 2017-12-13
• Subjects: fluorodeoxyglucose‐positron emission tomography -- febrile neutropenia -- fever -- immunocompromised -- infection; Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.13809
• Languages: English
• ISSNs: 1034-4810

Abstract

Abstract : Aim: Fever in immunocompromised children presents significant challenges. We aimed to determine the clinical impact of fluorodeoxyglucose‐positron emission tomography (FDG‐PET) in combination with computed tomography (CT) in children with malignancy or following haematopoietic stem cell transplantation with prolonged or recurrent fever. Methods: Immunocompromised children who underwent FDG‐PET/CT for investigation of prolonged or recurrent fever were identified from hospital databases. The clinical impact of the FDG‐PET/CT was considered 'high' if it contributed to any of the following: diagnosis of a new site infection/inflammation, change to antimicrobials or chemotherapy, or additional investigations or specialist consult contributing to final diagnosis. Results: Fourteen patients underwent an FDG‐PET/CT for prolonged or recurrent fever. Median age was 11 years and 46% had diagnosis of acute lymphoblastic leukaemia. The median absolute neutrophil count on the day of FDG‐PET/CT was 0.47 cells/μL. The clinical impact of FDG‐PET/CT was 'high' in 11 (79%) patients, contributing to rationalisation of antimicrobials in three, and cessation of antimicrobials in five. Compared to conventional imaging, FDG PET/CT identified seven additional sites of clinically significant infection/inflammation in seven patients. Of the 10 patients who had a cause of fever identified, FDG‐PET/CT contributed to the final diagnosis in six (60%). Conclusion: This study has identified potential utility for FDG‐PET/CT in immunocompromised children with prolonged or recurrent fever. Further prospective studies are needed to compare FDG‐PET/CT versus conventional imaging, to identify the optimal timing of FDG‐PET/CT and to study the role of subsequent scans to monitor response to therapy.