{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:01:40Z","timestamp":1789970500844,"version":"4.0.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>\n                    Pyrexia of unknown origin (PUO) in children presents a significant diagnostic challenge owing to its broad and heterogeneous aetiology. Among autoimmune causes, childhood-onset Takayasu arteritis (cTAK) is rare but clinically critical, typically characterised by non-specific constitutional symptoms and diagnosed late. Conventional angiographic imaging depicts structural vascular changes and may fail to identify the disease in its early, pre-stenotic inflammatory phase. We evaluated the role of 18F-fluorodeoxyglucose positron emission tomography\/magnetic resonance imaging (\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR) in the early detection of pre-stenotic cTAK in children presenting with PUO and its impact on management and short-term outcomes. In this single-centre, retrospective descriptive case series conducted over 2\u2005years, children (\u226418\u2005years) presenting with PUO who underwent\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR and were subsequently diagnosed with pre-stenotic Takayasu arteritis (paediatric European League Against Rheumatism\/Paediatric Rheumatology International Trials Organisation\/Paediatric Rheumatology European Society 2008 criteria) were analysed. During the study period, 28 children with PUO underwent\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR; 7 (25%) were diagnosed with pre-stenotic cTAK (mean age 13.9\u2005years; 5 girls), and of the remaining 21, 20 received alternative diagnoses. All had constitutional symptoms and markedly elevated inflammatory markers (mean ESR of 104\u2005mm\/h; mean C-reactive protein of 128.4\u2005mg\/L), with infrequent overt vascular signs.\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR demonstrated FDG-avid wall thickening of the aorta and its major branches in every patient (maximum standardised uptake value 2.7\u20137.4; median 4.8), without haemodynamically significant stenosis at baseline. All children received pulsed methylprednisolone, oral prednisolone, and mycophenolate mofetil; three required tocilizumab and one adalimumab. Over a median follow-up of 20\u2005months (range 9\u201336), one child developed a short-segment left subclavian stenosis, while the remainder showed no new structural progression, occlusion, or pulseless features.\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR detected metabolically active large-vessel inflammation in the pre-stenotic phase, enabling early diagnosis and treatment. These preliminary, hypothesis-generating findings support further investigation of\n                    <jats:sup>18<\/jats:sup>\n                    F-FDG-PET\/MR in selected children with PUO and persistent inflammation; prospective, multicentre validation with standardised paediatric protocols and longer follow-up is required before routine integration into diagnostic pathways.\n                  <\/jats:p>","DOI":"10.3389\/fped.2026.1842712","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:36:32Z","timestamp":1789968992000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["FDG-PET\/MR in paediatric pyrexia of unknown origin: early detection of Takayasu arteritis\u2014a single-centre experience"],"prefix":"10.3389","volume":"14","author":[{"given":"Ashwani","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham","place":["Kochi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suma","family":"Balan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham","place":["Kochi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopika P.","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham","place":["Kochi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00005792-196102000-00001","article-title":"Fever of unknown origin: report on 100 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