%0 Journal Article %A Qianrui Li %A Hongxi Wang %A Ling Li %A Yan Ren %A Minggang Su %A Kang Zou %A Xin Sun %A Rong Tian %T The value of 18F-FDG PET in the diagnostic workup of pediatric fever of unknown origin: a systematic review and meta-analysis %D 2021 %J Journal of Nuclear Medicine %P 90-90 %V 62 %N supplement 1 %X 90Background: 18F-FDG PET is a potentially valuable approach to identify disease foci in pediatric fever of unknown origin (FUO), but its contribution to diagnosis remains quantitatively undetermined. The aim of this study was to quantify the contribution of 18F-FDG PET in the diagnostic assessment of pediatric FUO. Methods: We conducted a systematic review and meta-analysis of diagnostic accuracy studies that (1) involved pediatric FUO patients undergoing PET or PET/CT imaging, (2) based definite diagnosis on pathology or clinical follow up, and (3) reported sufficient data to calculate the likelihood of achieving definite diagnosis between those with abnormal PET findings versus those with normal PET findings. We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials until 3 June 2020. We quantified the value of 18F-FDG PET through the likelihood of achieving definite diagnosis and pooled data using a Mantel-Haenszel random-effects model. We assessed the risk of bias using a modified Newcastle-Ottawa quality assessment scale (NOS). Results: Our search returned 421 results and eventually 6 studies (reporting 191 children) were included in the final analysis. 85% children with abnormal PET findings and 21% with normal PET findings achieved definite diagnoses, corresponding to that children with abnormal PET findings were 16.75 times more likely to achieve definite diagnoses than those with normal PET findings (odds ratio [OR]: 16.75, 95% confidence interval [CI] 7.95-35.16, P<0.00001). Sensitivity analyses using a fixed-effect model (OR 16.91, 95% CI 8.14-35.13, P<0.0001) or removing one study at a time (OR 11.60-19.72, 95% CI lower bound 3.80-8.59, 95% CI upper bound 33.09-45.25, P<0.0001) did not significantly alter the results. Subgroup analysis found that sample size (≤10 v >10 patients, interaction P=0.75), imaging modality (non-hybrid PET v PET/CT, interaction P=0.29), length of follow up (≤3 months v >3 months, interaction P=0.37), underlying medical conditions (otherwise healthy v predisposed with major medical conditions, interaction P=0.89), and geographic areas (Europe v Asia, interaction P=0.74) of studies did not significantly influence the results. Conclusions: Our results supported the promising value of 18F-FDG PET in the diagnostic work-up of pediatric FUO, since abnormal PET findings substantially increase the rate of achieving definite diagnoses. Rigorously designed prospective studies with larger sample size are warrant to support routine use in clinical care. %U