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Sanvito F, Pichiecchio A, Paoletti M, Rebella G, Resaz M, Benedetti L, Massa F, Morbelli S, Caverzasi E, Asteggiano C, Businaro P, Masciocchi S, Castellan L, Franciotta D, Gastaldi M, Roccatagliata L. Autoimmune encephalitis: what the radiologist needs to know. Neuroradiology 2024; 66:653-675. [PMID: 38507081 PMCID: PMC11031487 DOI: 10.1007/s00234-024-03318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Autoimmune encephalitis is a relatively novel nosological entity characterized by an immune-mediated damage of the central nervous system. While originally described as a paraneoplastic inflammatory phenomenon affecting limbic structures, numerous instances of non-paraneoplastic pathogenesis, as well as extra-limbic involvement, have been characterized. Given the wide spectrum of insidious clinical presentations ranging from cognitive impairment to psychiatric symptoms or seizures, it is crucial to raise awareness about this disease category. In fact, an early diagnosis can be dramatically beneficial for the prognosis both to achieve an early therapeutic intervention and to detect a potential underlying malignancy. In this scenario, the radiologist can be the first to pose the hypothesis of autoimmune encephalitis and refer the patient to a comprehensive diagnostic work-up - including clinical, serological, and neurophysiological assessments.In this article, we illustrate the main radiological characteristics of autoimmune encephalitis and its subtypes, including the typical limbic presentation, the features of extra-limbic involvement, and also peculiar imaging findings. In addition, we review the most relevant alternative diagnoses that should be considered, ranging from other encephalitides to neoplasms, vascular conditions, and post-seizure alterations. Finally, we discuss the most appropriate imaging diagnostic work-up, also proposing a suggested MRI protocol.
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Affiliation(s)
- Francesco Sanvito
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Giacomo Rebella
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Martina Resaz
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luana Benedetti
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Federico Massa
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Largo Daneo 3, 16132, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Eduardo Caverzasi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Carlo Asteggiano
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Pietro Businaro
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Stefano Masciocchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Lucio Castellan
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
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Harms A, Bauer T, Witt JA, Baumgartner T, von Wrede R, Racz A, Ernst L, Becker AJ, Helmstaedter C, Surges R, Rüber T. Mesiotemporal Volumetry, Cortical Thickness, and Neuropsychological Deficits in the Long-term Course of Limbic Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200125. [PMID: 37230543 DOI: 10.1212/nxi.0000000000200125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/30/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Limbic encephalitis (LE) is an autoimmune disease often associated with temporal lobe epilepsy and subacute memory deficits. It is categorized into serologic subgroups, which differ in clinical progress, therapy response, and prognosis. Using longitudinal MRI analysis, we hypothesized that mesiotemporal and cortical atrophy rates would reveal serotype-specific patterns and reflect disease severity. METHODS In this longitudinal case-control study, all individuals with antibody-positive (glutamic acid decarboxylase 65 [GAD], leucine-rich glioma-inactivated protein 1 [LGI1], contactin-associated protein 2 [CASPR2], and N-methyl-d-aspartate receptor [NMDAR]) nonparaneoplastic LE according to Graus' diagnostic criteria treated between 2005 and 2019 at the University Hospital Bonn were enrolled. A longitudinal healthy cohort was included as the control group. Subcortical segmentation and cortical reconstruction of T1-weighted MRI were performed using the longitudinal framework in FreeSurfer. We applied linear mixed models to examine mesiotemporal volumes and cortical thickness longitudinally. RESULTS Two hundred fifty-seven MRI scans from 59 individuals with LE (34 female, age at disease onset [mean ± SD] 42.5 ± 20.4 years; GAD: n = 30, 135 scans; LGI1: n = 15, 55 scans; CASPR2: n = 9, 37 scans; and NMDAR: n = 5, 30 scans) were included. The healthy control group consisted of 128 scans from 41 individuals (22 female, age at first scan [mean ± SD] 37.7 ± 14.6 years). The amygdalar volume at disease onset was significantly higher in individuals with LE (p ≤ 0.048 for all antibody subgroups) compared with that in healthy controls and decreased over time in all antibody subgroups, except in the GAD subgroup. We observed a significantly higher hippocampal atrophy rate in all antibody subgroups compared with that in healthy controls (all p ≤ 0.002), except in the GAD subgroup. Cortical atrophy rates exceeded normal aging in individuals with impaired verbal memory, while those who were not impaired did not differ significantly from healthy controls. DISCUSSION Our data depict higher mesiotemporal volumes in the early disease stage, most likely due to edematous swelling, followed by volume regression and atrophy/hippocampal sclerosis in the late disease stage. Our study reveals a continuous and pathophysiologically meaningful trajectory of mesiotemporal volumetry across all serogroups and provides evidence that LE should be considered a network disorder in which extratemporal involvement is an important determinant of disease severity.
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Affiliation(s)
- Antonia Harms
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Tobias Bauer
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Juri-Alexander Witt
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Tobias Baumgartner
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Randi von Wrede
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Attila Racz
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Leon Ernst
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Albert J Becker
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Christoph Helmstaedter
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Rainer Surges
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Theodor Rüber
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany.
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Harms A, Bauer T, Fischbach L, David B, Ernst L, Witt JA, Diers K, Baumgartner T, Weber B, Radbruch A, Becker AJ, Helmstaedter C, Reuter M, Elger CE, Surges R, Rüber T. Shape description and volumetry of hippocampus and amygdala in temporal lobe epilepsy - A beneficial combination with a clinical perspective. Epilepsy Behav 2022; 128:108560. [PMID: 35066389 DOI: 10.1016/j.yebeh.2022.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
Shape-based markers have entered the field of morphometric neuroimaging analysis as a second mainstay alongside conventional volumetric approaches. We aimed to assess the added value of shape description for the analysis of lesional and autoimmune temporal lobe epilepsy (TLE) focusing on hippocampus and amygdala. We retrospectively investigated MRI and clinical data from 65 patients with lesional TLE (hippocampal sclerosis (HS) and astrogliosis) and from 62 patients with limbic encephalitis (LE) with serologically proven autoantibodies. Surface reconstruction and volumetric segmentation were performed with FreeSurfer. For the shape analysis, we used BrainPrint, a tool that utilizes eigenvalues of the Laplace-Beltrami operator on triangular meshes to calculate intra-subject asymmetry. Psychometric tests of memory performance were ascertained, to evaluate clinical relevance of the shape descriptor. The potential benefit of shape in addition to volumetric information for classification was assessed by five-fold repeated cross validation and logistic regression. For the LE group, the best performing classification model consisted of a combination of volume and shape asymmetry (mean AUC = 0.728), the logistic regression model was significantly improved considering both modalities instead of just volume asymmetry. For lesional TLE, the best model only considered volumetric information (mean AUC = 0.867). Shape asymmetry of the hippocampus was largely associated with verbal memory performance only in LE patients (OR = 1.07, p = 0.02). For lesional TLE, shape description is robust, but redundant when compared to volumetric approaches. For LE, in contrast, shape asymmetry as a complementary modality significantly improves the detection of subtle morphometric changes and is further associated with memory performance, which underscores the clinical relevance of shape asymmetry as a novel imaging biomarker.
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Affiliation(s)
- Antonia Harms
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Leon Ernst
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Kersten Diers
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Martin Reuter
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Venusberg-Campus 1, 53127 Bonn, Germany; Martinos Center for Biomedical Imaging, MGH/Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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Sone D, Beheshti I. Clinical Application of Machine Learning Models for Brain Imaging in Epilepsy: A Review. Front Neurosci 2021; 15:684825. [PMID: 34239413 PMCID: PMC8258163 DOI: 10.3389/fnins.2021.684825] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a common neurological disorder characterized by recurrent and disabling seizures. An increasing number of clinical and experimental applications of machine learning (ML) methods for epilepsy and other neurological and psychiatric disorders are available. ML methods have the potential to provide a reliable and optimal performance for clinical diagnoses, prediction, and personalized medicine by using mathematical algorithms and computational approaches. There are now several applications of ML for epilepsy, including neuroimaging analyses. For precise and reliable clinical applications in epilepsy and neuroimaging, the diverse ML methodologies should be examined and validated. We review the clinical applications of ML models for brain imaging in epilepsy obtained from a PubMed database search in February 2021. We first present an overview of typical neuroimaging modalities and ML models used in the epilepsy studies and then focus on the existing applications of ML models for brain imaging in epilepsy based on the following clinical aspects: (i) distinguishing individuals with epilepsy from healthy controls, (ii) lateralization of the temporal lobe epilepsy focus, (iii) the identification of epileptogenic foci, (iv) the prediction of clinical outcomes, and (v) brain-age prediction. We address the practical problems and challenges described in the literature and suggest some future research directions.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.,Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Iman Beheshti
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Conde-Blanco E, Pascual-Diaz S, Carreño M, Muñoz-Moreno E, Pariente JC, Boget T, Manzanares I, Donaire A, Centeno M, Graus F, Bargalló N. Volumetric and shape analysis of the hippocampus in temporal lobe epilepsy with GAD65 antibodies compared with non-immune epilepsy. Sci Rep 2021; 11:10199. [PMID: 33986308 PMCID: PMC8119423 DOI: 10.1038/s41598-021-89010-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/15/2021] [Indexed: 11/09/2022] Open
Abstract
Glutamic acid decarboxylase 65 antibodies (anti-GAD65) have been found in patients with late-onset chronic temporal lobe epilepsy (TLE). No prior neuroimaging studies have addressed how they affect hippocampal volume and shape and how they relate to cognitive abnormalities. We aimed to investigate both brain structure and function in patients with isolated TLE and high anti-GAD65 levels (RIA ≥ 2000 U/ml) compared to 8 non-immune mesial TLE (niTLE) and 8 healthy controls (HC). Hippocampal subfield volume properties were correlated with the duration of the disease and cognitive test scores. The affected hippocampus of GAD-TLE patients showed no volume changes to matched HC whereas niTLE volumes were significantly smaller. Epilepsy duration in GAD-TLE patients correlated negatively with volumes in the presubiculum, subiculum, CA1, CA2-3, CA4, molecular layer and granule cell-molecular layer of the dentate nucleus. We found differences by advanced vertex-wise shape analysis in the anterior hippocampus of the left GAD-TLE compared to HC whereas left niTLE showed bilateral posterior hippocampus deformation. Verbal deficits were similar in GAD-TLE and niTLE but did not correlate to volume changes. These data might suggest a distinct expression of hippocampal structural and functional abnormalities based on the immune response.
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Affiliation(s)
- Estefanía Conde-Blanco
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | | | - Mar Carreño
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | | | | | - Teresa Boget
- Epilepsy Program, Neuropsychology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isabel Manzanares
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - María Centeno
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Francesc Graus
- Clinical and Experimental Neuroimmunology Research Team of IDIBAPS, Barcelona, Spain
| | - Nuria Bargalló
- Magnetic Resonance Imaging Core Facility, IDIBAPS, Barcelona, Spain.,Epilepsy Program, Neuroradiology Section, Radiology Department, Center of Image Diagnosis (CDIC), Barcelona, Spain
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Quantitative brain imaging analysis of neurological syndromes associated with anti-GAD antibodies. NEUROIMAGE: CLINICAL 2021; 32:102826. [PMID: 34563986 PMCID: PMC8476448 DOI: 10.1016/j.nicl.2021.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
The pattern of cortical atrophy is present throughout all anti-GAD phenotypes. The radiomic features correctly classify anti-GAD patients versus healthy subjects. The different neurological anti-GAD phenotypes should be considered as a continuum.
Neurological disorders associated with anti-glutamic acid decarboxylase (GAD) autoimmunity are rare and include a variety of neurological syndromes: stiff-person syndrome, cerebellar ataxia or limbic encephalitis. The diagnosis remains challenging due to the variety of symptoms and normal brain imaging. The morphological MRI of 26 patients (T1-weighted and Fluid-attenuated inversion recovery (FLAIR)-weighted images) was analyzed at the initial stage of diagnosis, matched by age and sex to 26 healthy subjects. We performed a vertex-wise analysis using a generalized linear model, adjusting by age, to compare the brain cortical thickness of both populations. In addition, we used a voxel-based morphometry of cerebellum thickness obtained by CEREbellum Segmentation (CERES), as well as the hippocampus volumetry comparison using HIPpocampus subfield Segmentation (HIPS). Finally, we extracted 62 radiomics features using LifeX to assess the classification performance using a random forest model to identify an anti-GAD related MRI. The results suggest a peculiar profile of atrophy in patients with anti-GAD, with a significant atrophy in the temporal and frontal lobes (adjusted p-value < 0.05), and a focal cerebellar atrophy of the V-lobule, independently of the anti-GAD phenotype. Finally, the MRIs from anti-GAD patients were correctly classified when compared to the control group, with an area under the curve (AUC) of 0.98. This study suggests a particular pattern of cortical atrophy throughout all anti-GAD phenotypes. These results reinforce the notion that the different neurological anti-GAD phenotypes should be considered as a continuum due to their similar cortical thickness profiles.
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Bauer T, Ernst L, David B, Becker AJ, Wagner J, Witt JA, Helmstaedter C, Weber B, Hattingen E, Elger CE, Surges R, Rüber T. Fixel-based analysis links white matter characteristics, serostatus and clinical features in limbic encephalitis. NEUROIMAGE-CLINICAL 2020; 27:102289. [PMID: 32623136 PMCID: PMC7334603 DOI: 10.1016/j.nicl.2020.102289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Fixel-based analysis allows for novel view on limbic encephalitis. Bilateral alterations in superior longitudinal fascicle of GAD-limbic-encephalitis. Fiber tract alterations observed relate to verbal memory performance.
Limbic encephalitis (LE) is an autoimmune syndrome often associated with temporal lobe epilepsy. Recent research suggests that particular structural changes in LE depend on the type of the associated antibody and occur in both mesiotemporal gray matter and white matter regions. However, it remains questionable to what degree conventional diffusion tensor imaging (DTI)-methods reflect alterations in white matter microstructure, since these methods do not account for crossing fibers. To address this methodological shortcoming, we applied fixel-based analysis as a novel technique modeling distinct fiber populations. For our study, 19 patients with LE associated with autoantibodies against glutamic acid decarboxylase 65 (GAD-LE, mean age = 35.9 years, 11 females), 4 patients with LE associated with autoantibodies against leucine-rich glioma-inactivated 1 (LGI1-LE, mean age = 63.3 years, 2 females), 5 patients with LE associated with contactin-associated protein-like 2 (CASPR2, mean age = 57.4, 0 females), 20 age- and gender-matched control patients with hippocampal sclerosis (19 GAD-LE control patients: mean age = 35.1 years, 11 females; 4 LGI1-LE control patients: mean age = 52.6 years, 2 females; 5 CASPR2-LE control patients: mean age = 42.7 years, 0 females; 10 patients are included in more than one group) and 33 age- and gender-matched healthy control subjects (19 GAD-LE healthy controls: mean age = 34.6 years, 11 females; 8 LGI1-LE healthy controls: mean age = 57.0 years, 4 females, 10 CASPR2-LE healthy controls: mean age = 57.2 years, 0 females; 4 subjects are included in more than one group) underwent structural imaging and DTI at 3 T and neuropsychological testing. Patient images were oriented according to lateralization in EEG resulting in an affected and unaffected hemisphere. Fixel-based metrics fiber density (FD), fiber cross-section (FC), and fiber density and cross-section (FDC = FD · FC) were calculated to retrieve information about white matter integrity both on the micro- and the macroscale. As compared to healthy controls, patients with GAD-LE showed significantly (family-wise error-corrected, p < 0.05) lower FDC in the superior longitudinal fascicle bilaterally and in the isthmus of the corpus callosum. In CASPR2-LE, lower FDC in the superior longitudinal fascicle was only present in the affected hemisphere. In LGI1-LE, we did not find any white matter alteration of the superior longitudinal fascicle. In an explorative tract-based correlation analysis within the GAD-LE group, only a correlation between the left/right ratio of FC values of the superior longitudinal fascicle and verbal memory performance (R = 0.64, Holm-Bonferroni corrected p < 0.048) remained significant after correcting for multiple comparisons. Our results underscore the concept of LE as a disease comprising a broad and heterogeneous group of entities and contribute novel aspects to the pathomechanistic understanding of this disease that may strengthen the role of MRI in the diagnosis of LE.
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Affiliation(s)
- Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon Ernst
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wagner
- Department of Neurology, University of Ulm and Universitäts- and Rehabilitationskliniken, 89070 Ulm, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Frankfurt, Schleusenweg 2, 60528 Frankfurt, Germany
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Schleusenweg 2, 60528 Frankfurt, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Schleusenweg 2, 60528 Frankfurt, Germany.
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