Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Bordonné, Manon; Chawki, Mohammad B.; Doyen, Matthieu; Kas, Aurélie; Guedj, Éric; Tyvaert, Louise; Verger, Antoine

doi:10.1007/s00259-021-05299-y

Cited by 78 publications

(82 citation statements)

References 63 publications

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“…However, the regions with abnormal MRI signals did not match perfectly with those with abnormal 18 FDG-PET metabolism, mainly because those 2 imaging modalities had a different emphasis on metabolism and structure. The inconsistency might be also due to the different time points when MRI and PET examinations were conducted along the disease course (38). Previous 18 FDG-PET/MRI studies of AE patients (mainly anti-NMDAR encephalitis) indicated a higher sensitivity of PET than MRI in AE (39,40).…”

Section: F-fluorodeoxyglucose Positron Emission Tomographymentioning

confidence: 99%

Anti-Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor Encephalitis: A Review

et al. 2021

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Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis, a rare subtype of autoimmune encephalitis, was first reported by Lai et al. The AMPAR antibodies target against extracellular epitopes of the GluA1 or GluA2 subunits of the receptor. AMPARs are expressed throughout the central nervous system, especially in the hippocampus and other limbic regions. Anti-AMPAR encephalitis was more common in middle-aged women and most patients had an acute or subacute onset. Limbic encephalitis, a classic syndrome of anti-AMPAR encephalitis, was clinically characterized by a subacute disturbance of short-term memory loss, confusion, abnormal behavior and seizure. Magnetic resonance imaging often showed T2/fluid-attenuated inversion-recovery hyperintensities in the bilateral medial temporal lobe. For suspected patients, paired serum and cerebrospinal fluid (CSF) testing with cell-based assay were recommended. CSF specimen was preferred given its higher sensitivity. Most patients with anti-AMPAR encephalitis were complicated with tumors, such as thymoma, small cell lung cancer, breast cancer, and ovarian cancer. First-line treatments included high-dose steroids, intravenous immunoglobulin and plasma exchange. Second-line treatments, including rituximab and cyclophosphamide, can be initiated in patients who were non-reactive to first-line treatment. Most patients with anti-AMPAR encephalitis showed a partial neurologic response to immunotherapy.

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Section: F-fluorodeoxyglucose Positron Emission Tomographymentioning

confidence: 99%

Anti-Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor Encephalitis: A Review

et al. 2021

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“…We analyzed the medical records of all patients with CNS tuberculosis examined at Aster Medcity, Kochi, Kerala, India, from 2014 to 2021. Of the total of 37 patients, all had undergone brain MRI with contrast at least once, and nine patients had undergone 18 F-FDG PET-CT. Of these nine patients, three patients demonstrated focal cortical involvement on 18 F-FDG PET-CT in addition to other findings of neurotuberculosis. Ethics committee approval was obtained from our institution; informed patient consent was also obtained.…”

Section: Methodsmentioning

confidence: 99%

“…With the increasing use of 18F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography-computed tomography (PET-CT), infective or inflammatory foci that are undetectable on magnetic resonance imaging (MRI) can be detected in CNS tuberculosis. 4 Tuberculosis encephalitis (TbE) is such an entity that can be detected by 18 F-FDG PET-CT. We have previously reported TbE in a young girl who required more than 2.5 years of antituberculous therapy (ATT) and continues to be mute and disabled even after being "cured." During the past 7 years, we have encountered two more cases of TbE.…”

Section: Introductionmentioning

confidence: 99%

Tuberculous Encephalitis May Be Undetectable on Magnetic Resonance Imaging but Detectable on 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography

Maramattom

Santhamma

2021

The American Journal of Tropical Medicine and Hygiene

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Neurotuberculosis (NT) continues to be a global health problem with severe morbidity and mortality. The manifestations of NT are well-known and encompass forms such as meningitis, tuberculomas, military tuberculosis, ventriculitis, and brain abscess. Data of all patients with central nervous system tuberculosis who underwent magnetic resonance imaging (MRI) and/or 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) were analyzed. Over a 7-year period (2014–2021), we encountered three patients who had dense neurological deficits and 18F-FDG PET-CT results suggesting focal cortical encephalitis. 18F-FDG PET-CT demonstrated focal hypermetabolism involving focal–regional areas of the left hemisphere that corresponded to clinical deficits in two of the three patients. Follow-up 18F-FDG PET-CT showed improvement in cortical hypermetabolism in all three patients that corresponded with clinical improvement. MRI of the brain with contrast showed subtle leptomeningeal enhancement in these areas, along with other features of NT, but it could not detect cortical involvement. A literature review also revealed some previous descriptions that seemed to be consistent with tuberculous encephalitis (TbE). TbE seems to be a distinct subset of NT and may coexist with other features of NT or disseminated tuberculosis. It may be detected by 18F-FDG PET-CT even when brain MRI does not show any evident abnormality to explain a focal neurological deficit. 18F-FDG PET-CT can be considered during the evaluation and monitoring of NT to detect TbE. The presence of TbE may affect the prognosis and treatment duration of NT.

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“…Several studies have nevertheless addressed the role of 18 F-FDG PET/CT in the early diagnosis process of suspected DE, with also a recent meta-analysis [15], suggesting that 18 F-FDG PET/CT is more sensitive for this purpose than brain MRI [16]. Indeed, hypometabolism or hypermetabolism was observed in patients with normal MRI [17][18][19], as were extra-limbic abnormalities [16].…”

Section: Introductionmentioning

confidence: 99%

Decrease in the Cortex/striatum Metabolic Ratio on 18F-FDG PET: a Biomarker of Dysimmune Encephalitis

Leiris

Ruel

Vervandier

et al. 2021

Preprint

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Purpose: The aim was to determine the diagnostic value of the cortex/striatum metabolic ratio in 18F-FDG PET in a large cohort of patients suffering from dysimmune encephalitis (DE) and to search for clinical correlations with the course of the disease.Methods: We retrospectively collected complete clinical and paraclinical data of DE patients, including brain 18F-FDG PET/CT. Whole-brain statistical analysis was performed using SPM8 software after activity parametrization to the striatum and in comparison to healthy subjects. Conventional discriminant analysis between the DE group and controls was performed using cluster metabolic ratios. A correlation analysis between cluster metabolic ratios and clinical/paraclinical data was assessed.Results: Seventy-three patients with DE were included. In comparison to 44 controls, voxel-based statistical analysis identified one large cluster (p-voxel < 0.001 uncorrected; p-cluster<0.05, FWE corrected) of widespread decreased cortical metabolism relative to the striatum in DE patients. The mean parametrized cluster metabolic value was significantly lower for DE patients (1.06 ± 0.13) than for the control group (1.46 ± 0.08; p < 0.001). This cluster metabolic ratio correctly classified 97.4% of the individuals between patients with DE and healthy controls. Correlation analyses showed that a low cluster metabolic ratio was associated with higher risk of death (p = 0.04), the absence of autoantibodies (p = 0.05), and an increased delay between onset of symptoms and diagnostic (p = 0.01).Conclusion: The decrease in the cortex/striatal metabolic ratio has a good diagnostic performance for the differentiation of DE patients from controls and seems to provide prognostic information on the clinical course.

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Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Cited by 78 publications

References 63 publications

Anti-Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor Encephalitis: A Review

Anti-Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor Encephalitis: A Review

Tuberculous Encephalitis May Be Undetectable on Magnetic Resonance Imaging but Detectable on 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography

Decrease in the Cortex/striatum Metabolic Ratio on 18F-FDG PET: a Biomarker of Dysimmune Encephalitis

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