Uncommon 18F-FDG-PET/CT findings in patients affected by limbic encephalitis: hyper-hypometabolic pattern with double antibody positivity and migrating foci of hypermetabolism

Cistaro, Angelina; Caobelli, Federico; Quartuccio, Natale; Fania, Piercarlo; Pagani, Marco

doi:10.1016/j.clinimag.2014.09.004

Cited by 28 publications

(17 citation statements)

References 10 publications

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“…In addition, good correlation between FDG-PET patterns and clinical presentation was observed [8]. Most importantly, when autoantibodies were negative and MRI findings were unremarkable, FDG-PET showed typical findings of AE [9].…”

Section: Introductionmentioning

confidence: 76%

18F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results

et al. 2020

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Brain positron emission tomography imaging with 18Fluorine-fluorodeoxyglucose (FDG-PET) has demonstrated utility in suspected autoimmune encephalitis. Visual and/or assisted image reading is not well established to evaluate hypometabolism/hypermetabolism. We retrospectively evaluated patients with autoimmune encephalitis between 2003 and 2018. Patients underwent EEG, brain magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) sampling and autoantibodies testing. Individual FDG-PET images were evaluated by standard visual reading and assisted by voxel-based analyses, compared to a normal database. For the latter, three different methods were performed: two based on statistical surface projections (Siemens syngo.via Database Comparison, and 3D-SSP Neurostat) and one based on statistical parametric mapping (SPM12). Hypometabolic and hypermetabolic findings were grouped to identify specific patterns. We found six cases with definite diagnosis of autoimmune encephalitis. Two cases had anti-LGI1, one had anti-NMDA-R and two anti-CASPR2 antibodies, and one was seronegative. 18F-FDG-PET metabolic abnormalities were present in all cases, regardless of the method of analysis. Medial–temporal and extra-limbic hypermetabolism were more clearly depicted by voxel-based analyses. We found autoantibody-specific patterns in line with the literature. Statistical surface projection (SSP) methods (Neurostat and syngo.via Database Comparison) were more sensitive and localized larger hypermetabolic areas. As it may lead to comparable and accurate results, visual analysis of FDG-PET studies for the diagnosis of autoimmune encephalitis benefits from voxel-based analysis, beyond the approach based on MRI, CSF sample and EEG.

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Section: Introductionmentioning

confidence: 76%

18F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results

et al. 2020

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“…In fact, previous papers on the role of MRI in patients with LE showed controversial results: while some of them report that hyperintensities in the medial temporal lobes on T2 and FLAIR images are often observed (Basu and Alavi, 2008;Hoffmann et al, 2008), many patients have normal or nonspecific MRI scans (Blanc et al, 2009). In addition, in some cases of non-paraneoplasic limbic encephalitis with undetectable antibodies and negative findings at MRI, FDG-PET/CT may be highly suggestive of the disease (Cistaro et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

The role of PET/CT in the evaluation of patients affected by limbic encephalitis: A systematic review of the literature

Quartuccio

Caobelli

Evangelista

et al. 2015

Journal of Neuroimmunology

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“…[ 19 ] An intriguing report showed that in some cases of non-paraneoplastic limbic encephalitis with undetectable antibodies and negative findings on MRI, PET/CT may be highly suggestive of the disease. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Anti-Ma2–associated limbic encephalitis with coexisting chronic inflammatory demyelinating polyneuropathy in a patient with non-Hodgkin lymphoma

Ju¹,

Wang³

et al. 2017

Medicine

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Rationale:We report the rare case of a 74-year-old man with anti-Ma2–associated paraneoplastic neurologic syndrome (PNS), and review and analyze the clinical manifestations, diagnosis, and treatment of the disease.Patient concerns:The patient presented with a 5-month history of muscle weakness, progressive body aches, and weakness and numbness in both lower extremities. Before his hospitalization, he had experienced cognitive function decline; ptosis, inward gaze, and vertical gaze palsy in the right eye; and occasional visual hallucinations. Brain and spinal cord magnetic resonance imaging (MRI) yielded normal results. Anti-Ma2 antibodies were detected in both serum and cerebrospinal fluid. A 4-hour electroencephalogram showed irregular sharp slow waves and δ waves in the temporal region. Electromyography showed peripheral nerve demyelination. Positron-emission tomography/computed tomography (PET-CT) examination revealed hypermetabolism in the lymph nodes of the whole body. Biopsy of the lymph nodes showed non-Hodgkin lymphoma.Diagnosis:A clinical diagnosis of lymphoma and PNS was made.Interventions:The patient was treated with intravenous dexamethasone (15 mg/day) for 3 days.Lessons:We have presented a rare case of a PNS involving both the central and peripheral nervous systems. The clinical features of this case indicated anti-Ma2–associated encephalitis and chronic inflammatory demyelinating polyneuropathy. PET-CT played a critical role in enabling early diagnosis and prompt treatment in this case.

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Uncommon 18F-FDG-PET/CT findings in patients affected by limbic encephalitis: hyper-hypometabolic pattern with double antibody positivity and migrating foci of hypermetabolism

Cited by 28 publications

References 10 publications

18F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results

18F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results

The role of PET/CT in the evaluation of patients affected by limbic encephalitis: A systematic review of the literature

Anti-Ma2–associated limbic encephalitis with coexisting chronic inflammatory demyelinating polyneuropathy in a patient with non-Hodgkin lymphoma

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