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18F-Flurodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) findings in children with encephalitis and comparison to conventional imaging

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Abstract

Purpose

FDG PET/CT is emerging as a new tool for the evaluation of acute encephalitis (AE). However, to date, there are no exclusively pediatric studies on the use of FDG PET for suspected AE. The objective of this study was to compare qualitative and quantitative brain PET to conventional brain imaging in a cohort of children, and to identify patterns of metabolic abnormalities characteristic of AE.

Methods

This retrospective study included 34 children imaged with PET/CT, CT and magnetic resonance imaging (MRI). The positivity rate of all three imaging modalities was measured. Besides visual assessment, quantification of relative regional brain metabolism (RRBM) was performed and compared to a database of normal pediatric brains.

Results

Fourteen subjects had a clinical diagnosis of autoimmune encephalitis (AIE) or encephalitis of unknown origin (EX), six of anti-N-methyl-D-aspartate receptor (anti-NMDAr) encephalitis, three of Hashimoto’s encephalopathy, three of neurolupus and eight had other subtypes of encephalitis.

Quantitative PET was abnormal in 100% of cases, visually assessed PET in 94.1% of subjects, MRI in 41.2% and CT in 6.9%. RRBM quantification demonstrated multiple hyper and hypo metabolic cortical regions in 82.3% of subjects, exclusively hypermetabolic abnormalities in 3%, and exclusively hypometabolic abnormalities in 14.7%. The basal ganglia were hypermetabolic in 26.5% of cases on visual assessment and in 58.8% of subjects using quantification.

Conclusion

In our pediatric population FDG PET was more sensitive than conventional imaging for the detection of AE, and basal ganglia hypermetabolism was frequently encountered.

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Acknowledgements

Dr. Daniel H Silverman, UCLA Medical Center.

Funding

This study was funded from a financial support from the Radiology, Radio-oncology and Nuclear Medicine Department, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada, “10th Faculty Competition”, 2016.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Medical Imaging, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada

    Sophie Turpin & Raymond Lambert

  2. Department of Nuclear Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    Patrick Martineau

  3. Department of Nuclear Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada

    Marc-André Levasseur

  4. Division of Neurology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada

    Inge Meijer

  5. Department of Medical Imaging, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada

    Jean-Claude Décarie

  6. Division of Immunology, Allergy, Rhumatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada

    Julie Barsalou, Hélène Decaluwe & Elie Haddad

  7. Division of Microbiology, Infectious Disease, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada

    Christian Renaud

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  1. Sophie Turpin
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Corresponding author

Correspondence to Sophie Turpin.

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Ethical approval

The study was approved by the ethical committee of our institution.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Turpin, S., Martineau, P., Levasseur, MA. et al. 18F-Flurodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) findings in children with encephalitis and comparison to conventional imaging. Eur J Nucl Med Mol Imaging 46, 1309–1324 (2019). https://doi.org/10.1007/s00259-019-04302-x

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