MRI findings in autoimmune encephalitis

IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Revue neurologique Pub Date : 2024-11-01 DOI:10.1016/j.neurol.2024.08.006
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Abstract

Autoimmune encephalitis encompasses a spectrum of conditions characterized by distinct clinical features and magnetic resonance imaging (MRI) findings. Here, we review the literature on acute MRI changes in the most common autoimmune encephalitis variants. In N-methyl-D-aspartate (NMDA) receptor encephalitis, most patients have a normal MRI in the acute stage. When lesions are present in the acute stage, they are typically subtle and non-specific white matter lesions that do not correspond with the clinical syndrome. In some NMDA receptor encephalitis cases, these T2-hyperintense lesions may be indicative of an NMDA receptor encephalitis overlap syndrome with simultaneous co-existence of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Encephalitis with leucine-rich glioma-inactivated 1 (LGI1)-, contactin-associated protein-like 2 (CASPR2)- or glutamic acid decarboxylase (GAD)- antibodies typically presents as limbic encephalitis (LE) with unilateral or bilateral T2/fluid attenuated inversion recovery (FLAIR) hyperintensities in the medial temporal lobe that can progress to hippocampal atrophy. Gamma aminobutyric acid-B (GABA-B) receptor encephalitis also often shows such medial temporal hyperintensities but may additionally involve cerebellar lesions and atrophy. Gamma aminobutyric acid-A (GABA-A) receptor encephalitis features multifocal, confluent lesions in cortical and subcortical areas, sometimes leading to generalized atrophy. MRI is unremarkable in most patients with immunoglobulin-like cell adhesion molecule 5 (IgLON5)-disease, while individual case reports identified T2/FLAIR hyperintense lesions, diffusion restriction and atrophy in the brainstem, hippocampus and cerebellum. These findings highlight the need for MRI studies in patients with suspected autoimmune encephalitis to capture disease-specific changes and to exclude alternative diagnoses. Ideally, MRI investigations should be performed using dedicated autoimmune encephalitis imaging protocols. Longitudinal MRI studies play an important role to evaluate potential relapses and to manage long-term complications. Advanced MRI techniques and current research into imaging biomarkers will help to enhance the diagnostic accuracy of MRI investigations and individual patient outcome prediction. This will eventually enable better treatment decisions with improved clinical outcomes.
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自身免疫性脑炎的磁共振成像发现。
自身免疫性脑炎包括一系列以不同临床特征和磁共振成像(MRI)结果为特征的疾病。在此,我们回顾了有关最常见自身免疫性脑炎变异型的急性磁共振成像变化的文献。在N-甲基-D-天冬氨酸(NMDA)受体脑炎中,大多数患者在急性期的磁共振成像正常。如果在急性期出现病变,通常是细微的非特异性白质病变,与临床综合征不符。在某些 NMDA 受体脑炎病例中,这些 T2-高密度病变可能是 NMDA 受体脑炎重叠综合征的指征,同时并存多发性硬化症(MS)、神经脊髓炎视网膜频谱障碍(NMOSD)或髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)。富亮氨酸胶质瘤灭活1(LGI1)、接触素相关蛋白样2(CASPR2)或谷氨酸脱羧酶(GAD)抗体脑炎通常表现为边缘脑炎(LE),单侧或双侧颞叶内侧T2/流体减弱反转恢复(FLAIR)高密度,可发展为海马萎缩。γ-氨基丁酸-B(GABA-B)受体脑炎也经常出现这种颞叶内侧高密度,但也可能伴有小脑病变和萎缩。γ-氨基丁酸-A(GABA-A)受体脑炎的特点是皮质和皮质下区域出现多灶性、融合性病变,有时会导致全身萎缩。大多数免疫球蛋白样细胞粘附分子5(IgLON5)病患者的核磁共振成像无明显异常,但个别病例报告发现脑干、海马和小脑存在T2/FLAIR高强度病变、弥散受限和萎缩。这些发现凸显了对疑似自身免疫性脑炎患者进行磁共振成像研究的必要性,以捕捉疾病特异性变化并排除其他诊断。理想情况下,磁共振成像检查应采用专门的自身免疫性脑炎成像方案。纵向核磁共振成像研究在评估潜在复发和控制长期并发症方面发挥着重要作用。先进的磁共振成像技术和目前对成像生物标志物的研究将有助于提高磁共振成像检查的诊断准确性和对患者个体结果的预测。这最终将有助于做出更好的治疗决定,改善临床疗效。
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来源期刊
Revue neurologique
Revue neurologique 医学-临床神经学
CiteScore
4.80
自引率
0.00%
发文量
598
审稿时长
55 days
期刊介绍: The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
期刊最新文献
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