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自身免疫性脑炎患者18F-FDG PET/CT影像学特征

Imaging features of 18F-FDG PET/CT in patients with autoimmune encephalitis

摘要:

目的 研究自身免疫性脑炎(AE)患者脑部18F-脱氧葡萄糖(FDG) PET/CT影像学特征,探讨PET/CT在AE早期诊断中的应用价值.方法 收集2012年3月至2017年12月16例(男11例,女5例,年龄11~68岁)未经免疫治疗的脑脊液或(和)血清自身免疫抗体阳性的AE患者资料,分析患者18F-FDG PET/CT、MRI的影像及临床特征.结果 16例AE患者中有9例抗Ⅳ-甲基-D-天冬氨酸受体(NMDAR)抗体脑炎、7例边缘性脑炎(LE),LE组中抗γ-氨基丁酸B型受体(GABABR)抗体脑炎3例、抗富亮氨酸胶质瘤失活蛋白1(LGI1)抗体脑炎2例、抗Hu抗体脑炎1例、抗Yo抗体脑炎1例.15例显示脑内散在的18F-FDG代谢增高或减低灶,阳性率为15/16;其中抗NMDAR抗体脑炎表现为散在的额叶、颞叶、顶叶等高代谢灶及枕叶低代谢灶,LE表现为颞叶、海马等边缘系统的高代谢灶,同期CT密度均未见异常.MRI示部分患者T2、T2液体衰减反转恢复序列(FLAIR)、弥散加权成像(DWI)呈稍高信号,阳性率为7/16.结论 不同类型的AE患者脑PET/CT影像特征不同.18F-FDG PET/CT对AE患者的早期诊断阳性率高.

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abstracts:

Objective To study the imaging features of 18F-fluorodeoxyglucose(FDG) PET/CT in patients with autoimmune encephalitis (AE) and evaluate the value of PET/CT on early diagnosis of AE.Methods Sixteen patients with AE (11 males,5 females,age:11-68 years) between March 2012 and December 2017 were included.Patients had positive antibodies in cerebrospinal fluid or (and) serum without immunity therapy.The imaging (18F-FDG PET/CT,MRI) and clinical data were analyzed.Results Nine patients suffered from anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and other 7 patients had limbic encephalitis (LE),which including 2 cases of anti-leucine-rich glioma inactivated 1 (LGI1) encephalitis,3 cases of anti-γ-aminobutyric acid-B receptor(GABAsR) encephalitis,1 case of anti-Hu encephalitis and 1 case of anti-Yo encephalitis.Fifteen patients showed scattered hypermetabolism or hypometabolism in the brain on PET/CT imaging,and the positive rate was 15/16.Among those patients with anti-NMDAR encephalitis,hypermetabolism in frontotemporal parietal lobes and hypometabolism in occipital lobe were shown;hypermetabolism in limbic systems including temporal lobe and hippocampus were shown in LE.No abnormal CT density was found at the same phase.Slightly higher signals on T2,fluid-attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) were detected in some patients,and the positive rate was 7/16.Conclusions Patients with AE of different types have different characteristics on 18F-FDG PET/CT.18F-FDG PET/CT has high positive rate for early diagnosis of AE.

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