Emerging Trends in Radionuclide Imaging of Infection and Inflammation in Pediatrics: Focus on FDG PET/CT and Immune Reactivity

Khalatbari, Hedieh; Shulkin, Barry L.; Parisi, Marguerite T.

doi:10.1053/j.semnuclmed.2022.10.002

Cited by 11 publications

(4 citation statements)

References 166 publications

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“…The prominent 18 F-FDG PET/CT ndings in HLH may be attributed to the hyperactivation of T cells and macrophages. These ndings include hepatosplenomegaly with diffusely increased FDG uptake; diffusely increased FDG uptake in the axial and appendicular skeleton; hypermetabolic lymphadenopathy; and serous effusions [24,25]. In adult sHLH, a meta-analysis was performed to evaluated the diagnostic performance of 18 F-FDG PET/CT in distinguishing between non-malignancy and malignancy associated HLH.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Diagnostic Precision in EBV-Related HLH: A Multifaceted Approach Using 18F-FDG PET/CT and Nomogram Integration

Yang,

Lu,

Feng

et al. 2024

Preprint

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Background The hyperinflammatory condition and lymphoproliferation due to Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (HLH) affect the detection of lymphomas by 18F-FDG PET/CT. We aimed to improve the diagnostic capabilities of 18F-FDG PET/CT by combining laboratory parameters. Methods This retrospective study involved 46 patients diagnosed with EBV-positive HLH, who underwent 18F-FDG PET/CT before beginning chemotherapy within a 4-year timeframe. These patients were categorized into two groups: EBV-associated HLH (EBV-HLH) (n = 31) and EBV-positive lymphoma-associated HLH (EBV + LA-HLH) (n = 15). We employed multivariable logistic regression and regression tree analysis to develop diagnostic models and assessed their efficacy in diagnosis and prognosis. Results A nomogram combining the SUVmax ratio, copies of plasma EBV-DNA, and IFN-γ reached 100% sensitivity and 81.8% specificity, with an AUC of 0.926 (95%CI, 0.779–0.988). Importantly, this nomogram also demonstrated predictive power for mortality in EBV-HLH patients, with a hazard ratio of 4.2 (95%CI, 1.1–16.5). The high-risk EBV-HLH patients identified by the nomogram had a similarly unfavorable prognosis as patients with lymphoma. Conclusions The study found that while 18F-FDG PET/CT alone has limitations in differentiating between lymphoma and EBV-HLH in patients with active EBV infection, the integration of a nomogram significantly improves the diagnostic accuracy and also exhibits a strong association with prognostic outcomes.

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Section: Discussionmentioning

confidence: 99%

Enhancing Diagnostic Precision in EBV-Related HLH: A Multifaceted Approach Using 18F-FDG PET/CT and Nomogram Integration

Yang,

Lu,

Feng

et al. 2024

Preprint

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“…Bacteriemia of unknown origin is a further condition linked to FUO, in which 18 F-FDG PET may help the identification of the infectious focus, particularly in pediatric [38,39] or immunocompromised patients with acquired immune deficiency syndrome (AIDS) [40].…”

Section: Fever Of Unknown Origin (Fuo)mentioning

confidence: 99%

PET/CT Imaging of Infectious Diseases: Overview of Novel Radiopharmaceuticals

Calabria,

Guadagnino,

Cimini

et al. 2024

Diagnostics

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Infectious diseases represent one of the most common causes of hospital admission worldwide. The diagnostic work-up requires a complex clinical approach, including laboratory data, CT and MRI, other imaging tools, and microbiologic cultures. PET/CT with 18F-FDG can support the clinical diagnosis, allowing visualization of increased glucose metabolism in activated macrophages and monocytes; this tracer presents limits in differentiating between aseptic inflammation and infection. Novel PET radiopharmaceuticals have been developed to overcome these limits; 11C/18F-labeled bacterial agents, several 68Ga-labeled molecules, and white blood cells labeled with 18F-FDG are emerging PET tracers under study, showing interesting preliminary results. The best choice among these tracers can be unclear. This overview aims to discuss the most common diagnostic applications of 18F-FDG PET/CT in infectious diseases and, as a counterpoint, to describe and debate the advantages and peculiarities of the latest PET radiopharmaceuticals in the field of infectious diseases, which will probably improve the diagnosis and prognostic stratification of patients with active infectious diseases.

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“…However, it is worth remembering that, in addition to the non-optimal diagnostic accuracy (possible false positives and negatives), FDG PET/CT exposes the patient to ionizing radiation; therefore, its use must be properly considered. So far, the application of FDG PET/TC is standardized only for entities with significant activation of the immune system, such as HLH [69].…”

Section: Imagingmentioning

confidence: 99%

Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach

Trapani,

Fiordelisi,

Stinco

et al. 2023

Children

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Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient’s history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.

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Emerging Trends in Radionuclide Imaging of Infection and Inflammation in Pediatrics: Focus on FDG PET/CT and Immune Reactivity

Cited by 11 publications

References 166 publications

Enhancing Diagnostic Precision in EBV-Related HLH: A Multifaceted Approach Using 18F-FDG PET/CT and Nomogram Integration

Enhancing Diagnostic Precision in EBV-Related HLH: A Multifaceted Approach Using 18F-FDG PET/CT and Nomogram Integration

PET/CT Imaging of Infectious Diseases: Overview of Novel Radiopharmaceuticals

Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach

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