18F-FDG PET/CT in Anti-NMDA Receptor Encephalitis

Moubtakir, A.; Dejust, S.; Guilhot, François; Messaoud, L.; Morland, David

doi:10.1097/rlu.0000000000002098

Cited by 16 publications

(11 citation statements)

References 7 publications

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“…The results of PET analysis between patients with scans < 12 weeks from symptom onset and those ≥ 12 weeks from symptom onset showed no significant difference in the present study. Although some cases have reported that the duration of symptom onset is related to the metabolic pattern of autoimmune encephalitis ( 11 , 24 , 38 , 39 ), whether and how the duration of symptom onset influences the metabolic pattern has not been concluded in a large sample prospective study. Compared with the duration of symptom onset, daily activities score of patients can reflect objectively the stage of autoimmune encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

Zhao

Chen

et al. 2021

Front. Immunol.

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PurposeBrain 18F-fluorodeoxyglucose positron emission tomography (FDG PET) is a sensitive technique for assisting in the diagnosis of patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. However, the common pattern of this disorder assessed by FDG PET remains unknown. The present study aimed to explore the glucose metabolic patterns of this disorder based on PET voxel analysis.MethodsThis retrospective study enrolled 25 patients with anti-LGI1 encephalitis, who were admitted in Beijing Tiantan Hospital between September 2014 and July 2019. The glucose metabolic pattern was compared between the included patients and 44 age- and gender-matched healthy controls using Statistical Parametric Mapping. Then, the correlation between the metabolic pattern and scaled activities of daily living (ADLs) of the patients was assessed.ResultsThe median time from symptom onset to PET scans was 9 w (range:2-53w). The groupwise analysis revealed that patients with anti-LGI1 encephalitis had left hippocampal hypermetabolism and hypometabolism in almost all neocortical regions. The individual-level results showed most patients presented a decreased metabolism in neocortical regions, as well as an increase in metabolism in the hippocampus and basal ganglia. Furthermore, the metabolic gradient between hippocampus and neocortical regions was positively associated with the ADLs (frontal lobe, r=0.529, P=0.008; parietal lobe, r=0.474, P=0.019; occipital lobe, r=0.413, P=0.045; temporal lobe, r=0.490, P=0.015), respectively. In addition, the patients with facio-brachial dystonic seizures (FBDS) presented bilateral putamen hypermetabolism, when compared to patients without FBDS and healthy controls.ConclusionSubcortical hypermetabolism associated with cortical hypometabolism presented with a common metabolic pattern in patients with anti-LGI1 encephalitis in the present study. The resolution of the metabolic gradient of the hippocampal hypermetabolism and neocortical hypometabolism may bring about improved clinical neurologic disability.

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Section: Discussionmentioning

confidence: 99%

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

Zhao

Chen

et al. 2021

Front. Immunol.

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“…Literature Review on 18 F-FDG-PET Findings in Subtypes of AE A total of 124 subjects with AE and PET scans were reviewed as shown in Table 4. For anti-NMDAR encephalitis, 18 F-FDG-PET mainly presented with hypometabolism in the occipital (63%) and parietal (42%) areas, in the BG (33%) and the temporal lobe (29%) (14,(19)(20)(21)(22)(23)(24)(25)(26)(27). Patients with CASPR2 and GABAB showed no specific metabolic pattern due to the limitations regarding the number of cases (19,(30)(31)(32).…”

Section: F-fdg-pet Pattern Among Subtypes Of Lgi1 Ae Patientsmentioning

confidence: 99%

The Clinical Value of 18F-FDG-PET in Autoimmune Encephalitis Associated With LGI1 Antibody

et al. 2020

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Purpose: The metabolic patterns of 18 F-fluoro-2-deoxy-d-glucose positron emission tomography ( 18 F-FDG-PET) in autoimmune encephalitis associated with leucine-rich glioma-inactivated 1 antibody (LGI1 AE) are still unclear. We performed a cohort study to investigate the clinical metabolic characteristics and diagnostic value based on 18 F-FDG-PET in patients with LGI1 AE.Materials and Methods: A total of 34 patients including 18 patients (53%) in the acute phase and 16 patients (47%) in the chronic phase who were diagnosed with LGI1 AE were retrospectively analyzed from October 2014 to June 2018 at the Department of Neurology in Beijing Tiantan Hospital, the Capital Medical University. The clinical data were collected by searching through electronic medical records.Results: The initial 18 F-FDG-PET scan indicated a significant abnormal metabolic pattern in 31 LGI1 AE patients (91%), whereas only 20 patients (59%) showed an abnormal MRI signal (P < 0.05). The 18 F-FDG-PET metabolic pattern was reversible after treatment; most of the patients showed an almost normal uptake of 18 F-FDG-PET after discharge. Regarding the spatial distribution, the abnormal metabolic pattern in LGI1 AE subjects exhibiting hypermetabolism was specifically located in the basal ganglia (BG) and medial temporal lobe (MTL). BG hypermetabolism was observed in 28 subjects (82%), and 68% of patients showed MTL hypermetabolism. A total of 17 patients (50%) exhibited faciobrachial dystonic seizures (FBDS), and the remaining subjects showed non-FBDS symptoms (50 and 50%). BG-only hypermetabolism was detected in seven subjects in the FBDS subgroup (7/16) but in only one subject in the non-FBDS subgroup (1/15) (44 vs. 7%, P < 0.05). Conclusion:18 F-FDG-PET imaging was more sensitive than MRI in the diagnosis of LGI1 AE. Isolated BG hypermetabolism was more frequently observed in subjects with FBDS, suggesting the potential involvement of the BG.

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“… 16 , 21 In addition, patients with anti‐NMDAR encephalitis usually show a relative hypermetabolism in the frontal, temporal lobe and basal ganglia, hypometabolism in the parietal and occipital lobe. 22 , 23 , 24 , 25 Hence, compared with anti‐LGI1 and anti‐NMDAR encephalitis, patients with anti‐GABAB receptor encephalitis usually have limited involvement of the basal ganglia, which suggests that, in addition to whole‐body tumor screening, 18 F‐FDG‐PET may also be helpful in differentiating antibodies subtypes of AE. However, the sample size is relatively small and the pathophysiological mechanism of this metabolic signature, which might be related to the distribution of GABAB or other receptors in the brain, is still unclear.…”

Section: Discussionmentioning

confidence: 99%

“…In encephalitis associated with LGI1 antibody, MTL and basal ganglia hypermetabolism have been systematically described 16,21 . In addition, patients with anti‐NMDAR encephalitis usually show a relative hypermetabolism in the frontal, temporal lobe and basal ganglia, hypometabolism in the parietal and occipital lobe 22–25 . Hence, compared with anti‐LGI1 and anti‐NMDAR encephalitis, patients with anti‐GABAB receptor encephalitis usually have limited involvement of the basal ganglia, which suggests that, in addition to whole‐body tumor screening, 18 F‐FDG‐PET may also be helpful in differentiating antibodies subtypes of AE.…”

Section: Discussionmentioning

confidence: 99%

¹⁸F‐fluorodeoxy‐glucose positron emission tomography pattern and prognostic predictors in patients with anti‐GABAB receptor encephalitis

Liu

Zhao

et al. 2021

CNS Neurosci Ther

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Aims To identify the metabolic pattern and prognostic predictors in anti‐gamma‐aminobutyric‐acid B (GABAB) receptor encephalitis using 18F‐fluorodeoxy‐glucose positron emission tomography (18F‐FDG‐PET). Methods Twenty‐one patients diagnosed anti‐GABAB receptor encephalitis who underwent 18F‐FDG‐PET at first hospitalization were retrospectively reviewed. 18F‐FDG‐PET images were analyzed in comparison with controls. Further group comparisons of 18F‐FDG‐PET data were carried out between prognostic subgroups. Results 18F‐FDG‐PET was abnormal in 81% patients with anti‐GABAB receptor encephalitis and was more sensitive than MRI (81% vs. 42.9%, p = 0.025). Alter limbic lobe glucose metabolism (mostly hypermetabolism) was observed in 14 patients (66.7%), of whom 10 (10/14, 71.4%) demonstrated hypermetabolism in the medial temporal lobe (MTL). Group analysis also confirmed MTL hypermetabolism in association with relative frontal and parietal hypometabolism was a general metabolic pattern. After a median follow‐up of 33 months, the group comparisons revealed that patients with poor outcome demonstrated increased metabolism in the MTL compared to those with good outcome. Conclusion 18F‐FDG‐PET may be more sensitive than MRI in the early diagnosis of anti‐GABAB receptor encephalitis. MTL hypermetabolism was associated with relative frontal or parietal hypometabolism and may serve as a prognostic biomarker in anti‐GABAB receptor encephalitis.

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18F-FDG PET/CT in Anti-NMDA Receptor Encephalitis

Cited by 16 publications

References 7 publications

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

The Clinical Value of 18F-FDG-PET in Autoimmune Encephalitis Associated With LGI1 Antibody

¹⁸F‐fluorodeoxy‐glucose positron emission tomography pattern and prognostic predictors in patients with anti‐GABAB receptor encephalitis

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18F-FDG PET/CT in Anti-NMDA Receptor Encephalitis

Cited by 16 publications

References 7 publications

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

The Clinical Value of 18F-FDG-PET in Autoimmune Encephalitis Associated With LGI1 Antibody

18F‐fluorodeoxy‐glucose positron emission tomography pattern and prognostic predictors in patients with anti‐GABAB receptor encephalitis

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¹⁸F‐fluorodeoxy‐glucose positron emission tomography pattern and prognostic predictors in patients with anti‐GABAB receptor encephalitis