Ge J, Deng B, Guan Y, Bao W, Wu P, Chen X, Zuo C. Distinct cerebral
18F-FDG PET metabolic patterns in anti-N-methyl-D-aspartate receptor encephalitis patients with different trigger factors.
Ther Adv Neurol Disord 2021;
14:1756286421995635. [PMID:
33717212 PMCID:
PMC7919218 DOI:
10.1177/1756286421995635]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022] Open
Abstract
Aim:
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a subgroup of
treatable autoimmune encephalitis, characterized by rapid development of
psychosis, cognitive impairments and seizures. Etiologically, anti-NMDAR
encephalitis could be divided into three subgroups, which are paraneoplastic
(especially associated with ovarian teratoma), viral encephalitis-related
and cryptogenic. Each type is different in clinical course, treatment
strategies and prognosis. In this study, we aim to investigate whether
anti-NMDAR encephalitis patients with different trigger factors exhibit
distinct cerebral metabolic patterns detected by
18F-fluorodeoxyglucose positron emission tomography imaging.
Methods:
24 patients with anti-NMDAR encephalitis in acute phase from Huashan
Hospital, Fudan University (Shanghai, China) were recruited in this study.
Each patient was classified into one of etiological subgroups. Positron
emission tomography images of individual patients were analyzed with both
routine visual reading and computer-supported reading by comparison with
those of the same 10 healthy controls using a voxel-wise statistical
parametric mapping analysis.
Results:
Patients in both the cryptogenic (13 patients) and paraneoplastic (five
patients) subgroups showed hypermetabolism in the frontal-temporal lobes and
basal ganglia, covarying with hypometabolism in the occipital regions.
Notably, the abnormal metabolism was usually asymmetric in the cryptogenic
subgroup, but relatively symmetric in the paraneoplastic subgroup. Moreover,
the other six patients secondary to viral encephalitis presented with
significant hypometabolism in the bilateral occipital regions, as well as in
the unilateral temporal lobes and part of basal ganglia (also is virus
infection side), but hypermetabolism in the contralateral temporal
areas.
Conclusion:
This study revealed that patients with anti-NMDAR encephalitis triggered by
different factors presented distinct cerebral metabolic patterns. Awareness
of these patterns may help to better understand the varying occurrence and
development of anti-NMDAR encephalitis in each subgroup, and could offer
valuable information to the early diagnosis, treatment and prognosis of this
disorder.
Trial registration number
ChiCTR2000029115 (Chinese clinical trial registry site, http://www.chictr.org)
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