目的:探讨18F-FDGPET/CT对整体自身免疫性脑炎(AE)患者的诊断和预测作用。
方法:共招募了5名AE患者(20名女性和15名男性)。与健康对照相比,使用基于SPM12的体素到体素半定量分析来分析18F-FDGPET/CT成像数据。通过改良Rankin量表(mRS)分类,对不同预后组进行了进一步比较。
结果:总计,24例患者(68.6%)血清和/或CSF中神经元抗体检测呈阳性。精神症状和癫痫发作是主要的临床症状。在急性期,13例(37.1%)患者脑MRI结果异常,33(94.3%)呈现异常代谢模式。18F-FDGPET/CT比MRI敏感(p<0.05)。与匹配的对照组相比,AE患者主要表现为混合代谢模式,表现出主要在小脑的代谢亢进,BG,MTL,脑干,脑岛,额中回,和额叶皮层的相对低代谢,枕骨皮质,颞回,右顶叶回,左扣带回(p<0.05,FWE校正)。经过26个月的中位随访,多变量分析确定意识水平下降是AE不良结局相关的独立危险因素(HR=3.591,p=0.016).同时,在预后较差的患者中,右额上回的代谢下降以及中上脑干的代谢增加更为明显(p<0.001,未经校正)。
结论:18F-FDGPET/CT比MRI更敏感地检测AE的神经影像学异常。混合代谢模式,以大面积的皮质低代谢和局灶性高代谢为特征的一般代谢模式。右额上回代谢减少,中上脑干代谢增加可能预示AE的长期预后不良。
OBJECTIVE: To investigate the diagnostic and predictive role of 18F-FDG PET/CT in patients with autoimmune encephalitis (AE) as a whole group.
METHODS: Thrty-five patients (20 females and 15 males) with AE were recruited. A voxel-to-voxel semi-quantitative analysis based on SPM12 was used to analyze 18F-FDG PET/CT imaging data compared to healthy controls. Further comparison was made in different prognostic groups categorized by modified Rankin Scale (mRS).
RESULTS: In total, 24 patients (68.6%) were tested positive neuronal antibodies in serum and/or CSF. Psychiatric symptoms and seizure attacks were major clinical symptoms. In the acute stage, 13 patients (37.1%) demonstrated abnormal brain MRI results, while 33 (94.3%) presented abnormal metabolism patterns. 18F-FDG PET/CT was more sensitive than MRI (p < 0.05). Patients with AE mainly presented mixed metabolism patterns compared to the matched controls, demonstrating hypermetabolism mainly in the cerebellum, BG, MTL, brainstem, insula, middle frontal gyrus, and relatively hypometabolism in the frontal cortex, occipital cortex, temporal gyrus, right parietal gyrus, left cingulate gyrus (p < 0.05, FWE corrected). After a median follow-up of 26 months, the multivariable analysis identified a decreased level of consciousness as an independent risk factor associated with poor outcome of AE (HR = 3.591, p = 0.016). Meanwhile, decreased metabolism of right superior frontal gyrus along with increased metabolism of the middle and upper brainstem was more evident in patients with poor outcome (p < 0.001, uncorrected).
CONCLUSIONS: 18F-FDG PET/CT was more sensitive than MRI to detect neuroimaging abnormalities of AE. A mixed metabolic pattern, characterized by large areas of cortical hypometabolism with focal hypermetabolism was a general metabolic pattern. Decreased metabolism of right superior frontal gyrus with increased metabolism of the middle and upper brainstem may predict poor long-term prognosis of AE.