Role of 18F-FDG-PET imaging in the diagnosis of autoimmune encephalitis

Morbelli, Silvia; Djekidel, Mehdi; Hesse, Swen; Pagani, Marco; Barthel, Henryk

doi:10.1016/s1474-4422(16)30140-5

Cited by 62 publications

(62 citation statements)

References 8 publications

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“…Our results in a small group of antibody-positive AE patients show a much greater sensitivity for detection of an underlying abnormality with 18 F-FDG PET/CT than with MRI. Because early intervention is paramount to optimal clinical outcome, our results suggest that 18 F-FDG PET/CT of the brain be added to the clinical workup of patients with suspected AE, particularly in those with normal or nonspecific MRI findings (29).…”

Section: Resultsmentioning

confidence: 94%

“…The panel did not include 18 F-FDG PET/CT in their recommendations in the diagnosis of possible AE or seronegative probable AE. This is despite reports that have described characteristic findings that support the value of 18 F-FDG PET/CT in the diagnostic workup of AE (29)(30)(31)(32)(33). PET imaging was likely not included because more work is needed to delineate the exact role of this molecular imaging technique in the setting of suspected AE as well as patterns characteristic of the various AE syndromes.…”

Section: Discussionmentioning

confidence: 99%

“…In our subset of patients, none of the anti-NMDARpositive patients demonstrated findings on MRI suggestive of encephalitis. Hence, brain 18 F-FDG PET/CT rather than MRI may be indicated in the workup of young women thought to have anti-NMDAR encephalitis (29,36).…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

et al. 2017

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Diagnosis of autoimmune encephalitis presents some challenges in the clinical setting because of varied clinical presentations and delay in obtaining antibody panel results. We examined the role of neuroimaging in the setting of autoimmune encephalitides, comparing the utility of 18 F-FDG PET/CT versus conventional brain imaging with MRI. Methods: A retrospective study was performed assessing the positivity rate of MRI versus 18 F-FDG PET/CT during the initial workup of 23 patients proven to have antibody-positive autoimmune encephalitis. 18 F-FDG PET/CT studies were analyzed both qualitatively and semiquantitatively. Areas of cortical lobar hypo (hyper)-metabolism in the cerebrum that were 2 SDx from the mean were recorded as abnormal. Results: On visual inspection, all patients were identified as having an abnormal pattern of 18 F-FDG uptake. In semiquantitative analysis, at least 1 region of interest with metabolic change was identified in 22 of 23 (95.6%) patients using a discriminating z score of 2. Overall, 18 F-FDG PET/ CT was more often abnormal during the diagnostic period than MRI (10/23, 43% of patients). The predominant finding on brain 18 F-FDG PET/CT imaging was lobar hypometabolism, being observed in 21 of 23 (91.3%) patients. Hypometabolism was most commonly observed in the parietal lobe followed by the occipital lobe. An entire subset of antibody-positive patients, anti-N-methyl-D-aspartate receptor (5 patients), had normal MRI results and abnormal 18 F-FDG PET/CT findings whereas the other subsets demonstrated a greater heterogeneity. Conclusion: Brain 18 F-FDG PET/CT may play a significant role in the initial evaluation of patients with clinically suspected antibody-mediated autoimmune encephalitis. Given that it is more often abnormal when compared with MRI in the acute setting, this molecular imaging technique may be better positioned as an early biomarker of disease so that treatment may be initiated earlier, resulting in improved patient outcomes.

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Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

et al. 2017

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“…1 However, FDG-PET has been recognized as a potentially useful biomarker in suspected AE. 2–7 In autoimmune limbic encephalitis, hypermetabolism on FDG-PET in otherwise normal mesial temporal lobe structures by MRI suggests that FDG-PET may be more sensitive than MRI. 2–4 Also, particular patterns of metabolism noted by FDG-PET have been identified in certain AE syndromes.…”

mentioning

confidence: 99%

Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis

Probasco

Solnes

Nalluri

et al. 2017

Neurol Neuroimmunol Neuroinflamm

158

114

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Objective:To compare the rate of abnormal brain metabolism by FDG-PET/CT to other paraclinical findings and to describe brain metabolism patterns in autoimmune encephalitis (AE).Methods:A retrospective review of clinical data and initial dedicated brain FDG-PET/CT studies for neurology inpatients with AE, per consensus criteria, treated at a single tertiary center over 123 months. Z-score maps of FDG-PET/CT were made using 3-dimensional stereotactic surface projections with comparison to age group–matched controls. Brain region mean Z-scores with magnitudes ≥2.00 were interpreted as significant. Comparisons were made to rates of abnormal initial brain MRI, abnormal initial EEG, and presence of intrathecal inflammation.Results:Sixty-one patients with AE (32 seropositive) underwent brain FDG-PET/CT at median 4 weeks of symptoms (interquartile range [IQR] 9 weeks) and median 4 days from MRI (IQR 8.5 days). FDG-PET/CT was abnormal in 52 (85%) patients, with 42 (69%) demonstrating only hypometabolism. Isolated hypermetabolism was demonstrated in 2 (3%) patients. Both hypermetabolic and hypometabolic brain regions were noted in 8 (13%) patients. Nine (15%) patients had normal FDG-PET/CT studies. CSF inflammation was evident in 34/55 (62%) patients, whereas initial EEG (17/56, 30%) and MRI (23/57, 40%) were abnormal in fewer. Detection of 2 or more of these paraclinical findings was in weak agreement with abnormal brain FDG-PET/CT (κ = 0.16, p = 0.02).Conclusions:FDG-PET/CT was more often abnormal than initial EEG, MRI, and CSF studies in neurology inpatients with AE, with brain region hypometabolism the most frequently observed.

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“…Further, analysis of paired serum-CSF samples suggests intrathecal synthesis is rare in encephalitis associated with antibodies to the VGKC complex. 18 Given mounting evidence for the use of positron emission tomography (PET) in the assessment of autoimmune encephalitis, [19][20][21] it is possible that PET may have a future role in the assessment of cases such as this, where demonstration of continued hypermetabolic activity, even in the absence of positive MRI and EEG findings, could indicate ongoing inflammation. Postencephalitic psychosis has been described before 22 but not in association with autoimmune encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis

Pollak

Moran

2017

BMJ Case Reports

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Neuronal autoantibodies targeting cell surface antigens have been described in association with autoimmune encephalitides which frequently feature psychosis and other psychiatric disturbances alongside neurological signs and symptoms. Little has been written however about the long-term psychiatric status of individuals following recovery from the acute phase of autoimmune encephalitis, despite case series and anecdotal evidence suggesting this may be a cause of considerable disability. Here, we describe a man aged 58 years with no psychiatric history who developed a severe and acute psychotic disorder following resolution of a protracted course of limbic encephalitis associated with antibodies to leucine-rich glioma inactivated 1 protein. No indications of a gross ongoing inflammatory or encephalopathic process were present at presentation of his psychosis. Possible aetiologies of his acute psychosis are discussed. This case highlights the importance of ongoing psychiatric follow-up of patients following an episode of autoimmune encephalitis.

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Role of 18F-FDG-PET imaging in the diagnosis of autoimmune encephalitis

Cited by 62 publications

References 8 publications

Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis

Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis

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Role of 18F-FDG-PET imaging in the diagnosis of autoimmune encephalitis

Cited by 62 publications

References 8 publications

Diagnostic Value of18F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

Diagnostic Value of18F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis

Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis

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Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis

Diagnostic Value of¹⁸F-FDG PET/CT Versus MRI in the Setting of Antibody-Specific Autoimmune Encephalitis