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Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types

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Abstract

In parallel to the detection of new neuronal autoantibodies, the diagnosis of non-infectious limbic encephalitis has risen. Given that cerebral imaging studies show highly variable results, the present retrospective study investigates imaging findings in association with autoantibody type. An institutional database search identified 18 patients with non-infectious limbic encephalitis who had undergone [18F] fluorodeoxyglucose positron emission tomography (FDG-PET). Sixteen of these patients also underwent magnetic resonance imaging (MRI). MRI and FDG-PET images were categorized as follows: normal (0); mesiotemporal abnormality (1); normal mesiotemporal finding but otherwise abnormal (2). Neuronal autoantibodies were determined in serum and/or CSF. Autoantibodies were grouped according to the cellular localization of their target antigen: antibodies against surface antibodies (i.e., VGKC, NMDAR): 9; antibodies against intracellular antigens (i.e., Hu, Ri, GAD): 4; no autoantibodies: 5. The fraction of abnormal scans was lower for MRI (10/16) than for FDG-PET (14/18). There was a significant association between PET findings and autoantibody type: All patients with autoantibodies against intracellular antigens showed mesiotemporal findings on FDG-PET. In turn, only 2/9 patients with autoantibodies against surface antigens displayed mesiotemporal hypermetabolism. In the remaining seven patients, four scans were rated as normal and three only showed findings outside the mesiotemporal region. A similar association was found using MRI, although this did not reach statistical significance. Autoantibody type was found to be associated with FDG-PET and, to a lesser extent, with MRI imaging results. Our observations may explain the heterogeneity of imaging data in LE and based on in vivo findings support the assumption of different patho mechanisms underlying LE due to antibodies against surface and intracellular antigens, respectively.

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Acknowledgments

The authors thank Dr. Sandra Dieni for helpful comments on the text.

Conflicts of interest

A.B and S.R. report receiving consulting and lecture fees, grant and research support from Bayer Vital GmbH, Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis and Teva. S.R. is a founding member of ravo Diagnostika GmbH, Freiburg. I.M. is supported by the German Research Council (DFG MA-2343/41) and by the Bernstein Focus of Neuro technology (B3). P.T.M. received research grants from GE Healthcare and payments for lectures by Siemens AG and consultancy by Bayer-Schering AG. None of the authors has any financial or personal relationships with individuals or organizations that could inappropriately influence this submission.

Ethical standard

This study was approved by the local ethic committee and patients gave written informed consent.

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Authors and Affiliations

  1. Department of Neurology, Albert Ludwigs University Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    Annette Baumgartner & Sebastian Rauer

  2. Department of Neuroradiology, University of Freiburg, Freiburg, Germany

    Irina Mader

  3. Department of Nuclear Medicine, University of Freiburg, Freiburg, Germany

    Philipp T. Meyer

Authors
  1. Annette Baumgartner
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  2. Sebastian Rauer
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  4. Philipp T. Meyer
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Correspondence to Annette Baumgartner.

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Baumgartner, A., Rauer, S., Mader, I. et al. Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types. J Neurol 260, 2744–2753 (2013). https://doi.org/10.1007/s00415-013-7048-2

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  • DOI: https://doi.org/10.1007/s00415-013-7048-2

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