Objective To evaluate the clinical value of ¹⁸F-FDG PET/CT in staging for children with neuroblastoma (NB). Methods The data of 45 patients who were diagnosed as NB were retrospectively analyzed. Patients were divided into the pre-treatment group (n=13) and post-treatment group (n=32). All patients underwent ¹⁸F-flourodeoxyglucose (FDG) PET/CT imaging and the maximum standardized uptake value (SUV) was used as the basis for PET quantitative analysis. Results All

patients of the pre-treatment group showed increased FDG uptake at the primary site (13/13, 100%). Seven patients of the post-treatment group showed increased FDG uptake (7/32, 21.9%). Among 23 patients who were detected with lymph nodes metastasis (23/45, 51.1%), 17 with local lymph nodes metastasis, 13 with distant lymph node metastasis, 18 with bone (or bone marrow) metastasis (18/45, 40.0%), 2 with pleura metastasis, 1 with liver metastasis, 3 with meninges metastasis, 1 with brain metastasis (some patients with multi-organ metastasis). After PET/CT imaging, stages of 4 patients of the pre-treatment group changed (4/13, 30.8%). Among them, the stage of 1 patient upgraded from II to IV (1/2), stages of 3 patients upgraded from III to IV (3/5). Stages of 17 patients of the post-treatment group changed (17/32, 53.1%). Stages of 4 stage 0 patients were upgraded due to bone (or bone marrow) metastasis (4/14, 28.6%). Among suspected stage I patients, stages of 6 patients were degraded because abnormal tissues at primary sites had no FDG uptake (6/7, 85.7%). The stage of 1 stage II patient was upgraded because nodules with FDG uptake were found in abdomen (1/3). Stages of 2 stage III patients were upgraded due to bone metastasis and intraspinal metastasis (2/2). Conclusion ¹⁸F-FDG PET/CT can provide objective evidences for staging and improve the accuracy of initial staging and re-staging for NB. Re-staging can benefit more from the PET/CT. Stages of stage III patients change more significantly. Stages of stage I patients are degraded significantly after treatments. The main reason that PET/CT can change the stage is the high sensitivity for whole body lesion detection. PET/CT can also evaluate the activity of abnormal tissues in primary sites after operations.