Spectrum of Autoimmune Limbic Encephalitis on FDG PET/CT
To evaluate the role of FDG PET CT in the diagnosis, treatment response evaluation and follow up of patients with suspected autoimmune limbic encephalitis and correlation with specific antibody sub-type.
METHOD AND MATERIALS
A retrospective analysis of 27 patients of clinically suspected and serologically proven cases of autoimmune encephalitis, who underwent FDG PET CT, was done. Whole body FDG PET CT scans were done in all the patients with separate special brain sequence. The patterns of FDG uptake in different antibody subtypes were recorded and comparison with normalized data was attempted. The areas of hypo/hypermetabolism that were two standard deviations from the mean were considered as abnormal. The patients were also analyzed based on the Z score surface maps of the 3D stereotactic surface projections (SSP) image and regional Z scores were evaluated. Post treatment follow-up scans were also acquired and analyzed.
Focal areas of hypermetabolism involving medial temporal regions, basal ganglia and thalami with relative global hypometabolism in rest of the cortical and subcortical structures was seen, both on visual inspection and on semiquantitative analysis. Serologically, 17 patients had antibodies against Voltage gated potassium channel (VGKC) complex /LGI1 receptors, 2 had antibodies against CRMP-5 (Anti-CV-2) and 1 had had antibodies against PCA-1/Anti-Yo receptor. We could not isolate the antibody in 7 patients. Suspicious mitotic lesions were identified in 10 patients on the whole body scan, which later were biopsied and characterized. No scan evidence of mitotic pathology was identified in 17 patients, thus were labeled as non-paraneoplastic.Depending on the temporal phase of the disease, focal hypermetabolism was found to be a feature of acute phase, whereas hypometabolic areas were seen in sub-acute and chronic phases of the disease. On follow-up, the post-treatment FDG PET CT scans obtained in some of these patients showed reversal to normal metabolism in the corresponding areas.
FDG PET/CT may have an important role both in the identification of Autoimmune encephalitis and in the detection of the unknown malignancy that might have caused it.
FDG PET CT scan is a non-invasive diagnostic modality in the early diagnosis and management of patients with clinical suspicion of autoimmune encephalitis