FDG-PET/CT显示枕叶代谢降低：一种抗NMDA受体脑炎生物标志物。
Decreased occipital lobe metabolism by FDG-PET/CT: An anti-NMDA receptor encephalitis biomarker.
作者信息
Probasco John C, Solnes Lilja, Nalluri Abhinav, Cohen Jesse, Jones Krystyna M, Zan Elcin, Javadi Mehrbod S, Venkatesan Arun
机构信息
Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2017 Nov 15;5(1):e413. doi: 10.1212/NXI.0000000000000413. eCollection 2018 Jan.
OBJECTIVE
To compare brain metabolism patterns on fluorodeoxyglucose (FDG)-PET/CT in anti-NMDA receptor and other definite autoimmune encephalitis (AE) and to assess how these patterns differ between anti-NMDA receptor neurologic disability groups.
METHODS
Retrospective review of clinical data and initial dedicated brain FDG-PET/CT studies for neurology inpatients with definite AE, per published consensus criteria, treated at a single academic medical center over a 10-year period. Z-score maps of FDG-PET/CT were made using 3-dimensional stereotactic surface projections in comparison to age group-matched controls. Brain region mean Z scores with magnitudes ≥2.00 were interpreted as significant. Comparisons were made between anti-NMDA receptor and other definite AE patients as well as among patients with anti-NMDA receptor based on modified Rankin Scale (mRS) scores at the time of FDG-PET/CT.
RESULTS
The medial occipital lobes were markedly hypometabolic in 6 of 8 patients with anti-NMDA receptor encephalitis and as a group (Z = -4.02, interquartile range [IQR] 2.14) relative to those with definite AE (Z = -2.32, 1.46; = 0.004). Among patients with anti-NMDA receptor encephalitis, the lateral and medial occipital lobes were markedly hypometabolic for patients with mRS 4-5 (lateral occipital lobe Z = -3.69, IQR 1; medial occipital lobe Z = -4.08, 1) compared with those with mRS 0-3 (lateral occipital lobe Z = -0.83, 2; < 0.0005; medial occipital lobe Z = -1.07, 2; = 0.001).
CONCLUSIONS
Marked medial occipital lobe hypometabolism by dedicated brain FDG-PET/CT may serve as an early biomarker for discriminating anti-NMDA receptor encephalitis from other AE. Resolution of lateral and medial occipital hypometabolism may correlate with improved neurologic status in anti-NMDA receptor encephalitis.
目的
比较氟脱氧葡萄糖（FDG）-PET/CT在抗N-甲基-D-天冬氨酸受体（anti-NMDA receptor）脑炎及其他明确的自身免疫性脑炎（AE）中的脑代谢模式，并评估这些模式在不同抗NMDA受体神经功能障碍组之间的差异。
方法
回顾性分析在一家学术医疗中心接受治疗的、符合已发表的共识标准的明确AE神经内科住院患者的临床资料及最初的专用脑FDG-PET/CT研究，研究为期10年。使用三维立体定向表面投影制作FDG-PET/CT的Z评分图，并与年龄匹配的对照组进行比较。FDG-PET/CT脑区平均Z评分≥2.00被视为有意义。比较抗NMDA受体脑炎患者与其他明确AE患者，以及基于FDG-PET/CT检查时改良Rankin量表（mRS）评分的抗NMDA受体脑炎患者。
结果
8例抗NMDA受体脑炎患者中有6例枕叶内侧代谢明显减低，作为一个整体（Z=-4.02，四分位数间距[IQR] 2.14），与明确AE患者相比（Z=-2.32，1.46；P=0.004）。在抗NMDA受体脑炎患者中，mRS评分为4-5分的患者枕叶外侧和内侧代谢明显减低（枕叶外侧Z=-3.69，IQR 1；枕叶内侧Z=-4.08，1），而mRS评分为0-3分的患者（枕叶外侧Z=-0.83，2；P<0.0005；枕叶内侧Z=-1.07，2；P=0.001）。
结论
专用脑FDG-PET/CT显示的枕叶内侧明显代谢减低可能是区分抗NMDA受体脑炎与其他AE的早期生物标志物。枕叶外侧和内侧代谢减低的改善可能与抗NMDA受体脑炎患者神经功能状态的改善相关。
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