抗LGI1抗体自身免疫性脑炎^(18)F-FDG PET/CT影像学特征  

^(18)F-FDG PET/CT imaging features of autoimmune encephalitis with anti-LGI1 antibody

作　　者：李晓桐 赵晓斌[1] 吕瑞娟[2] 袁磊磊 陈谦[1] 王群[2] 艾林[1] Li Xiaotong;Zhao Xiaobin;Lyu Ruijuan;Yuan Leilei;Chen Qian;Wang Qun;Ai Lin(Department of Nuclear Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院核医学科,北京100070 [2]首都医科大学附属北京天坛医院神经内科,北京100070

出　　处：《首都医科大学学报》2024年第1期8-12,共5页Journal of Capital Medical University

基　　金：国家自然科学基金项目(82371449,81771143);北京市自然科学基金项目(7192054)。

摘　　要：目的研究抗富亮氨酸胶质瘤失活1蛋白(leucine-rich glioma-inactivated 1,LGI1)抗体自身免疫性脑炎(autoimmune encephalitis,AE)患者头部^(18)F-脱氧葡萄糖(^(18)F-deoxyglucose,FDG)正电子发射计算机断层显像(positron emission tomography,PET)/电子计算机断层显像(computed tomography,CT)影像学特点,探讨PET/CT在抗LGI1-AE早期诊断中的应用价值。方法回顾性分析2014年10月至2020年11月在首都医科大学附属北京天坛医院神经内科诊断为LGI1-AE的43例患者[其中急性期24例(56%),慢性期19例(44%)]的资料,分析患者^(18)F-FDG PET/CT的影像及临床特征。结果^(18)F-FDG PET显像结果显示,40例(93%)LGI1-AE患者出现明显的代谢异常,而只有26例(60%)患者出现异常磁共振(magnetic resonance imaging,MRI)信号(P<0.05)。^(18)F-FDG PET代谢异常在治疗后是可逆的,大多数患者出院后^(18)F-FDG PET的代谢几乎均正常。LGI1-AE患者的高代谢区位于基底节区(basal ganglia,BG)和内侧颞叶(medial temporal lobe,MTL)。在33例(77%)患者中观察到BG区高代谢,72%的患者表现出MTL高代谢。共有22例患者(51%)表现出面臂肌张力障碍性癫痫发作(faciobrachial dystonic seizures,FBDS),其余患者表现出非FBDS症状(49%)。FBDS患者中有7例(7/21)检测到仅BG区高代谢,而非FBDS患者中只有2例患者(2/19)检测到BG区高代谢(33%vs 10%,P<0.05)。结论^(18)F-FDG PET/CT对抗LGI1-AE患者的早期诊断阳性率高。FBDS患者多表现为仅BG区高代谢,这表明BG区可能参与FBDS发作。Objective To study the imaging features of ^(18)F-deoxyglucose(FDG)positron emission tomography(PET)/computed tomography(CT)in the head of patients with anti-leucine-rich glioma-inactivated 1(LGI1)antibody autoimmune encephalitis(AE),and to evaluate the value of PET/CT in the early diagnosis of anti-LGI1 antibody AE.Methods The data of 43 patients with LGI1-AE diagnosed in the Department of Neurology,Beijing Tiantan Hospital,Capital Medical University from October 2014 to November 2020 were retrospectively analyzed,including 24 patients in acute phase(56%),19 patients in chronic phase(44%),and AE patients whose anti-LGI1 autoimmune antibodies were positive in cerebrospinal fluid or/and serum.The imaging and clinical features of^(18)F-FDG PET/CT were analyzed.Results^(18)F-FDG PET imaging showed that 40 LGI1-AE patients(93%)had obvious metabolic abnormalities,while only 26 patients(60%)had abnormal magnetic resonance imaging(MRI)signals(P<0.05).The abnormal metabolism of ^(18)F-FDG PET is reversible after treatment,and the metabolism of^(18)F-FDG PET in most patients is almost normal after discharge.The hypermetabolic regions of patients with LGI1-AE are located in the basal ganglia(BG)and medial temporal lobe(MTL).Hypermetabolism in the BG was observed in 33 patients(77%),and hypermetabolism in the MTL was observed in 72%of the patients.A total of 22 patients(51%)showed facial arm dystonia seizures(FBDS),whereas rest showed non-FBDS symptoms(49%).Hypermetabolism in the BG was detected only in 7 patients with FBDS(7/21),while that detected in only 2 patients without FBDS(2/19)(33%vs 10%).Conclusion^(18)F-FDG PET imaging was more sensitive in the early diagnosis of LGI1-AE.Most of the patients with FBDS showed hypermetabolism isolated in the BG,suggesting the potential involvement of the BG.

关 键 词：抗LGI1抗体 脑炎 自身免疫性疾病 脱氧葡萄糖 正电子发射断层显像术 

分 类 号：R730.44[医药卫生—肿瘤]