18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis


Autoři: Cornelius Deuschl aff001;  Theodor Rüber aff002;  Leon Ernst aff002;  Wolfgang P. Fendler aff003;  Julian Kirchner aff004;  Christoph Mönninghoff aff001;  Ken Herrmann aff003;  Carlos M. Quesada aff006;  Michael Forsting aff001;  Christian E. Elger aff002;  Lale Umutlu aff001
Působiště autorů: Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany aff001;  Department of Epileptology, University of Bonn, Bonn, Germany aff002;  Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany aff003;  Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf, Germany aff004;  Clinic for Neuroradiology, Clemenshospital Muenster, Muenster, Germany aff005;  Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227906

Souhrn

Introduction

Limbic encephalitis (LE) is an immune-related, sometimes paraneoplastic process of the central nervous system. Initial diagnosis and treatment are based on the clinical presentation as well as antibody profiles and MRI. This study investigated the diagnostic value of integrated 18F-FDG-PET/MRI in the diagnostic work-up of patients with LE for a cerebral and whole-body imaging concept.

Material and methods

Twenty patients with suspected LE were enrolled in this prospective study. All patients underwent a dedicated PET/MRI protocol of the brain as well as the whole-body. Two neuroradiologists, one body radiologist and one nuclear medicine physician performed blinded consensus readings of each corresponding MRI and PET/MRI dataset of the brain and whole-body. Diagnostic confidence was evaluated on a Likert scale.

Results

Based on integrated PET/MRI 19 / 20 patients were found to show morphologic and / or metabolic changes indicative of LE, whereas sole MRI enabled correct identification in 16 / 20 patients. Three patients with negative MRI showed metabolic changes of the limbic system or extra-limbic regions, shifting the diagnosis from (negative) MRI to positive for LE in PET/MRI. Whole-body staging revealed suspected lesions in 2/20 patients, identified by MRI and PET, one confirmed as malignant and one false positive. Diagnostic confidence for cerebral and whole-body imaging reached higher scores for PET/MRI (cerebral: 2.7 and whole body: 4.8) compared to MRI alone (cerebral: 2.4 and whole body: 4.5).

Conclusion

LE diagnosis remains challenging for imaging as it shows only subtle imaging findings in most patients. Nevertheless, based on the simultaneous and combined analysis of morphologic and metabolic data, integrated PET/MRI may enable a dual platform for improved diagnostic confidence and overall detection of LE as well as whole-body imaging for exclusion of paraneoplastic LE.

Klíčová slova:

Amygdala – Cancer detection and diagnosis – Diagnostic medicine – Hippocampus – Magnetic resonance imaging – Neuroimaging – Positron emission tomography – Limbic system


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