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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (12) : 1009 -1012. doi: 10.3877/cma.j.issn.1674-0785.2020.12.011

所属专题: 文献

综述

自身免疫性脑炎影像学特征的研究进展
徐秦岚1, 孟雪1, 刘献增1,()   
  1. 1. 102206 北京,北京大学国际医院神经内科
  • 收稿日期:2020-06-18 出版日期:2020-12-15
  • 通信作者: 刘献增

Research progress of imaging features of autoimmune encephalitis

Qinlan Xu1, Xue Meng1, Xianzeng. Liu1,()   

  1. 1. Department of Neurology, Peking University International Hospital, Beijing 102206, China
  • Received:2020-06-18 Published:2020-12-15
  • Corresponding author: Xianzeng. Liu
引用本文:

徐秦岚, 孟雪, 刘献增. 自身免疫性脑炎影像学特征的研究进展[J/OL]. 中华临床医师杂志(电子版), 2020, 14(12): 1009-1012.

Qinlan Xu, Xue Meng, Xianzeng. Liu. Research progress of imaging features of autoimmune encephalitis[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(12): 1009-1012.

自身免疫性脑炎(AE)的诊断取决于临床症状、影像学和抗体,确诊依赖抗体及免疫治疗反应,但抗体检测普及性差、抗体阴性及早期免疫治疗反应不明显不能除外该病。细胞内抗原相关的AE其头颅MRI常表现为颞叶内侧异常,而细胞表面抗原相关AE头颅MRI常为正常或颞叶内侧以外的区域异常,不同类型AE急性期FDG-PET表现不同,但晚期所有AE患者均可出现不同程度的脑萎缩,其中以海马萎缩多见。因此,影像学如头颅MRI检查在AE早期确诊中具有十分重要的作用。此外,FDG-PET具有高敏感性,在AE诊断中受到了越来越多的重视。本文总结分析不同类型AE的结构影像和代谢影像学表现,提高其在AE早期诊断和治疗中的应用。

The diagnosis of autoimmune encephalitis depends on symptoms, imaging, and autoantibodies. However, the detection of autoantibodies has poor popularity, and the negative result of autoantibodies or no significant immunotherapy response in the early stage cannot rule out the disease. Cerebral MRI of intracellular antigen-related limbic encephalitis often shows abnormalities in the medial temporal lobe, while cell-surface antigen-associated encephalitis is usually normal or abnormal in areas other than the medial temporal lobe. Different autoantibody-associated encephalitis has different FDG-PET manifestations in the acute phase, but all patients with encephalitis in the later stage can have different degrees of brain atrophy, with hippocampal atrophy being more common. Therefore, imaging modalities such as head MRI play a very important role in early diagnosis. And because of it high sensitivity, FDG-PET has attracted wide attention in detecting autoimmune encephalitis. Here we review the MRI and FDG-PET findings in different types of AE, with an aim to improve its application in early screening and diagnosis of AE.

1
Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis [J]. Lancet Neurol, 2011, 10(1): 63-74.
2
Titulaer MJ, Mccracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study [J]. Lancet Neurol, 2013, 12(2): 157-165.
3
Irani SR, Alexander S, Waters P, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan's syndrome and acquired neuromyotonia [J]. Brain, 2010, 133(9): 2734-2748.
4
Finke C, Kopp UA, Pruss H, et al. Cognitive deficits following anti-NMDA receptor encephalitis [J]. J Neurol Neurosurg Psychiatry, 2012, 83(2): 195-198.
5
Irani SR, Bera K, Waters P, et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes [J]. Brain, 2010, 133(6): 1655-1667.
6
Wegner F, Wilke F, Raab P, et al. Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-D-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography [J]. BMC Neurol, 2014, 14: 136-147.
7
Tobin WO, Strand EA, Clark HM, et al. NMDA receptor encephalitis causing reversible caudate changes on MRI and PET imaging [J]. Neurol Clin Pract, 2014, 4(6): 470-473.
8
Yuan J, Guan H, Zhou X, et al. Changing brain metabolism patterns in patients with ANMDARE: serial 18F-FDG PET/CT findings [J]. Clin Nucl Med, 2016, 41(5): 366-370.
9
Kimura N, Kumamoto T, Takahashi Y. Brain perfusion SPECT in limbic encephalitis associated with autoantibody against the glutamate receptor epsilon 2 [J]. Clin Neurol Neurosurg, 2014, 118: 44-48.
10
Taguchi Y, Takashima S, Nukui T, et al. Reversible "brain atrophy" in anti-NMDA receptor encephalitis [J]. Intern Med, 2011, 50(21): 2697.
11
Iizuka T, Kaneko J, Tominaga N, et al. Association of progressive cerebellar atrophy with long-term outcome in patients with anti-N-methyl-D-aspartate receptor encephalitis [J]. JAMA Neurol, 2016, 73(6): 706-713.
12
Benarroch EE. Potassium channels: brief overview and implications in epilepsy [J]. Neurology, 2009, 72(7): 664-669.
13
Klein CJ, Lennon VA, Aston PA, et al. Insights from LGI1 and CASPR2 potassium channel complex autoantibody subtyping [J]. JAMA Neurol, 2013, 70(2): 229-234.
14
Irani SR, Stagg CJ, Schott JM, et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype [J]. Brain, 2013, 136(10): 3151-3162.
15
Joubert B, Saint-Martin M, Noraz N, et al. Characterization of a subtype of autoimmune encephalitis with anti-contactin-associated protein-like 2 antibodies in the cerebrospinal fluid, prominent limbic symptoms, and seizures [J]. JAMA Neurol, 2016, 73(9): 1115-1124.
16
Sunwoo JS, Lee ST, Byun JI, et al. Clinical manifestations of patients with CASPR2 antibodies [J]. J Neuroimmunol, 2015, 281: 17-22.
17
Bien CG, Mirzadjanova Z, Baumgartner C, et al. Anti-contactin-associated protein-2 encephalitis: relevance of antibody titres, presentation and outcome [J]. Eur J Neurol, 2017, 24(1): 175-186.
18
Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins [J]. Neurology, 2011, 77(2): 179-189.
19
Spinazzi M, Argentiero V, Zuliani L, et al. Immunotherapy-reversed compulsive, monoaminergic, circadian rhythm disorder in Morvan syndrome [J]. Neurology, 2008, 71(24): 2008-2010.
20
Toosy AT, Burbridge SE, Pitkanen M, et al. Functional imaging correlates of fronto-temporal dysfunction in Morvan's syndrome [J]. J Neurol Neurosurg Psychiatry, 2008, 79(6): 734-735.
21
Lancaster E, Huijbers MG, Bar V, et al. Investigations of caspr2, an autoantigen of encephalitis and neuromyotonia [J]. Ann Neurol, 2011, 69(2): 303-311.
22
Lancaster E, Lai M, Peng X, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen [J]. Lancet Neurol, 2010, 9(1): 67-76.
23
徐秦岚, 崔韬, 史伟雄, 等. 以癫痫发作起病的抗GABAB受体脑炎六例 [J]. 脑与神经疾病杂志, 2018, 26(7): 405-410.
24
Hoftberger R, Titulaer MJ, Sabater L, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients [J]. Neurology, 2013, 81(17): 1500-1506.
25
Su M, Xu D, Tian R. (18)F-FDG PET/CT and MRI findings in a patient with anti-GABA(B) receptor encephalitis [J]. Clin Nucl Med, 2015, 40(6): 515-517.
26
Ohta K, Seki M, Dalmau J, et al. Perfusion IMP-SPECT shows reversible abnormalities in GABA(B) receptor antibody associated encephalitis with normal MRI [J]. Brain Behav, 2011, 1(2): 70-72.
27
Lai M, Hughes EG, Peng X, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location [J]. Ann Neurol, 2009, 65(4): 424-434.
28
Hoftberger R, Van Sonderen A, Leypoldt F, et al. Encephalitis and AMPA receptor antibodies: Novel findings in a case series of 22 patients [J]. Neurology, 2015, 84(24): 2403-2412.
29
Wei YC, Liu CH, Lin JJ, et al. Rapid progression and brain atrophy in anti-AMPA receptor encephalitis [J]. J Neuroimmunol, 2013, 261(1-2): 129-133.
30
Spatola M, Stojanova V, Prior JO, et al. Serial brain (1)(8)FDG-PET in anti-AMPA receptor limbic encephalitis [J]. J Neuroimmunol, 2014, 271(1-2): 53-55.
31
Gultekin SH, Rosenfeld MR, Voltz R, et al. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients [J]. Brain, 2000, 123(7): 1481-1494.
32
Helga C, Carlo M, Francesca M, et al. The role of 18F-FDG PET/CT in management of paraneoplastic limbic encephalitis combined with small cell lung cancer [J]. Medicine, 2019, 98: 35-43.
33
Bien CG, Vincent A, Barnett MH, et al. Immunopathology of autoantibody-associated encephalitides: clues for pathogenesis [J]. Brain, 2012, 135(Pt 5): 1622-1638.
34
Ronnyson SG, Wagner CC, Luiz HC, et al. Updates in the diagnosis and treatment of paraneoplastic neurologic syndromes [J]. Curr Oncol Rep, 2018, 20: 92-103.
35
Dalmau J, Graus F, Villarejo A, et al. Clinical analysis of anti-Ma2- associated encephalitis [J]. Brain, 2004, 127(Pt 8): 1831-1844.
36
Da Rocha AJ, Nunes RH, Maia ACJr, et al. Recognizing autoimmune-mediated encephalitis in the differential diagnosis of limbic disorders [J]. AJNR Am J Neuroradiol, 2015, 36(12): 2196-2205.
37
朱莎, 赵春维, 肖丹青, 等. 自身免疫性脑炎相关性癫痫发作的研究进展 [J]. 癫痫杂志, 2015, 1(1): 70-72.
38
Graus F, Saiz A, Dalmau J. Antibodies and neuronal autoimmune disorders of the CNS [J]. J Neurol, 2010, 257(4): 509-517.
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