Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma

Zoccarato, Marco; Valeggia, Silvia; Zuliani, Luigi; Gastaldi, Matteo; Mariotto, Sara; Franciotta, Diego; Ferrari, Sergio; Lombardi, Giuseppe; Zagonel, Vittorina; Gaspari, Piera De; Ermani, Mario; Signori, Alessio; Pichiecchio, Anna; Giometto, Bruno; Manara, Renzo

doi:10.1007/s00234-019-02212-1

Cited by 32 publications

(20 citation statements)

References 31 publications

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“…Brain MRI often shows unilateral or bilateral T2-hyperintensity of the mesial temporal lobes ( Figures 1A,B ), with or without associated enhancement. The main differential diagnosis is with herpes simplex virus encephalitis ( 41 ), neoplasms ( 42 ), and seizures ( 43 ). Autoimmune limbic encephalitis is more commonly bilateral and infrequently extends outside the mesial temporal lobes, although acute distinction can be challenging based on MRI alone.…”

Section: Diagnosis Of Antibody-mediated Cns Disordersmentioning

confidence: 99%

Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management

Sechi

Flanagan

2021

Front. Neurol.

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Antibody-mediated disorders of the central nervous system (CNS) are increasingly recognized as neurologic disorders that can be severe and even life-threatening but with the potential for reversibility with appropriate treatment. The expanding spectrum of newly identified autoantibodies targeting glial or neuronal (neural) antigens and associated clinical syndromes (ranging from autoimmune encephalitis to CNS demyelination) has increased diagnostic precision, and allowed critical reinterpretation of non-specific neurological syndromes historically associated with systemic disorders (e.g., Hashimoto encephalopathy). The intracellular vs. cell-surface or synaptic location of the different neural autoantibody targets often helps to predict the clinical characteristics, potential cancer association, and treatment response of the associated syndromes. In particular, autoantibodies targeting intracellular antigens (traditionally termed onconeural autoantibodies) are often associated with cancers, rarely respond well to immunosuppression and have a poor outcome, although exceptions exist. Detection of neural autoantibodies with accurate laboratory assays in patients with compatible clinical-MRI phenotypes allows a definite diagnosis of antibody-mediated CNS disorders, with important therapeutic and prognostic implications. Antibody-mediated CNS disorders are rare, and reliable autoantibody identification is highly dependent on the technique used for detection and pre-test probability. As a consequence, indiscriminate neural autoantibody testing among patients with more common neurologic disorders (e.g., epilepsy, dementia) will necessarily increase the risk of false positivity, so that recognition of high-risk clinical-MRI phenotypes is crucial. A number of emerging clinical settings have recently been recognized to favor development of CNS autoimmunity. These include antibody-mediated CNS disorders following herpes simplex virus encephalitis or occurring in a post-transplant setting, and neurological autoimmunity triggered by TNFα inhibitors or immune checkpoint inhibitors for cancer treatment. Awareness of the range of clinical and radiological manifestations associated with different neural autoantibodies, and the specific settings where autoimmune CNS disorders may occur is crucial to allow rapid diagnosis and early initiation of treatment.

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Section: Diagnosis Of Antibody-mediated Cns Disordersmentioning

confidence: 99%

Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management

Sechi

Flanagan

2021

Front. Neurol.

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“…Currently, multiple imaging methods are used to improve the diagnosis of encephalitis. Conventional magnetic resonance image (MRI), with the advantages of high soft tissue resolution and the non-invasive nature of the procedure, has been widely used to diagnose encephalitis in the clinic; however, it can only provide anatomical information and the physiological or biochemical information that can be acquired is limited (Zoccarato et al, 2019). Moreover, the perfusion information of lesions can be obtained by injecting gadolinium (Gd)-based contrast agents and, in turn, can increase the risk of Gd deposition and potential side effects (Rogosnitzky and Branch, 2016).…”

Section: Introductionmentioning

confidence: 99%

Glutamate Chemical Exchange Saturation Transfer (GluCEST) Magnetic Resonance Imaging in Pre-clinical and Clinical Applications for Encephalitis

et al. 2020

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Background: Encephalitis is a common central nervous system inflammatory disease that seriously endangers human health owing to the lack of effective diagnostic methods, which leads to a high rate of misdiagnosis and mortality. Glutamate is implicated closely in microglial activation, and activated microglia are key players in encephalitis. Hence, using glutamate chemical exchange saturation transfer (GluCEST) imaging for the early diagnosis of encephalitis holds promise. Methods: The sensitivity of GluCEST imaging with different concentrations of glutamate and other major metabolites in the brain was validated in phantoms. Twenty-seven Sprague-Dawley (SD) rats with encephalitis induced by Staphylococcus aureus infection were used for preclinical research of GluCEST imaging in a 7.0-Tesla scanner. For the clinical study, six patients with encephalitis, six patients with lacunar infarction, and six healthy volunteers underwent GluCEST imaging in a 3.0-Tesla scanner. Results: The number of amine protons on glutamate that had a chemical shift of 3.0 ppm away from bulk water and the signal intensity of GluCEST were concentrationdependent. Under physiological conditions, glutamate is the main contributor to the GluCEST signal. Compared with normal tissue, in both rats and patients with encephalitis, the encephalitis areas demonstrated a hyper-intense GluCEST signal, while the lacunar infarction had a decreased GluCEST signal intensity. After intravenous immunoglobulin therapy, patients with encephalitis lesions showed a decrease in GluCEST signal, and the results were significantly different from the pre-treatment signal (1.34 ± 0.31 vs 5.0 ± 0.27%, respectively; p = 0.000).

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“…According to previous reports [3,7] and the findings of our study, early-stage glioblastoma is characterized by MR imaging findings of hypointensity of T1WI, hyperintense illdefined lesions on T2WI, little or no brain parenchyma edema, and no contrast enhancement. A subgroup of glioblastoma is found at an earlier stage, before central necrosis and lesion enhancement occur [3], and about 4% of glioblastoma masses display nonenhancement at the first appearance; these lesions can be misdiagnosed as nonneoplastic cerebral lesions such as infarction, encephalitis, or demyelinating disease [2,[4][5][6][7]. Accordingly, two of our patients were considered to have a low-grade glioma based on the initial MR imaging appearance, and the other six patients were considered to have nonneoplastic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…However, a subgroup of glioblastoma is found at an earlier stage before central necrosis and lesion enhancement occur [3], and about 4% of glioblastoma masses display no enhancement at the first appearance. ese lesions can be misdiagnosed as nonneoplastic cerebral lesions such as infarction, encephalitis, or degenerative or demyelinating disease [2,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

Wang

Liu

Zhang

et al. 2020

BioMed Research International

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Purpose. This study was performed to determine whether diffusion-weighted imaging (DWI) plus unenhanced computed tomography (CT) of the brain increases the diagnostic value of routine magnetic resonance (MR) imaging findings of early-stage glioblastoma. Methods. Postcontrast MR images of eight unenhanced lesions that had been pathologically diagnosed as glioblastoma were retrospectively examined. The location, margin, signal intensity, and attenuation on MR imaging and CT were assessed. Results. On MR imaging, all lesions were ill-defined, small, and isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images. Four patients had perilesional edema. In seven patients, DWI showed an inhomogeneous hyperintense lesion (n = 1) or isointense lesion with a hyperintense region (n = 6). On unenhanced CT, all masses presented as a hypoattenuated lesion with a hyperattenuated region (n = 7) or isoattenuated region (n = 1). The hyperattenuated region (n = 6) or isoattenuated region (n = 1) on CT appeared on DWI as an inhomogeneous hyperintense lesion (n = 1), isointense lesion with a hyperintense region (n = 3), or ring-like peritumoral hyperintensity (n = 3). Conclusions. MR imaging was the most sensitive imaging method for depicting early-stage glioblastoma. The CT finding of a hyperattenuated or isoattenuated region combined with the DWI finding of the same region containing an inhomogeneous hyperintense lesion or isointense lesion with a hyperintense region may be a specific diagnostic sign for early-stage glioblastoma. DWI plus unenhanced CT added diagnostic value to the routine MR imaging findings of early-stage glioblastoma.

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Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma

Cited by 32 publications

References 31 publications

Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management

Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management

Glutamate Chemical Exchange Saturation Transfer (GluCEST) Magnetic Resonance Imaging in Pre-clinical and Clinical Applications for Encephalitis

Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

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