Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Guang Zhou Road 264, Nanjing, 210029, Jiangsu, China.
Department of Video-Electroencephalogram, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.
J Neurol. 2020 Jun;267(6):1760-1773. doi: 10.1007/s00415-020-09747-x. Epub 2020 Mar 4.
This study aimed to identify to resting-state cerebral blood flow (CBF) connectivity alterations in patients with anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis.
Three-dimensional pseudo-continuous arterial spin labeling (pcASL) imaging was performed to measure the resting-state CBF in 23 patients with anti-NMDAR encephalitis at the peak stage of the disease and 32 healthy subjects. CBF was normalized to reduce variations among subjects. CBF was compared between the groups, and the correlations between the CBF alterations and clinical parameters were assessed. Differences in CBF connectivity in specific brain regions were also compared between groups.
Compared with the healthy subjects, the patients with anti-NMDAR encephalitis exhibited increased CBF in the left insula (L_insula), left superior temporal lobe (L_STL), L_hippocampus, L_pallidum, bilateral putamen (Bi_putamen), and Bi_caudate, and decreased CBF in the bilateral precuneus (Bi_Pc) and bilateral occipital lobe (Bi_OL) (P < 0.05, FEW corrected). Compared with healthy subjects, the patients with anti-NMDAR encephalitis exhibited increased negative CBF connectivity between the Bi_Pc, Bi_OL and L_TL, L_insula (P < 0.05, FEW corrected). Anti-NMDAR encephalitis patients with behavioral changes exhibited higher CBF in the L_insula and lower CBF in the R_Pc, Bi_calcarine, Bi_cuneus, and Bi_lingual than patients without behavioral changes and health controls. The ROC curve shows changed CBF in the L_insula, and R_Pc, Bi_calcarine, Bi_cuneus, and Bi_lingual served as a predictor of behavioral changes in patients with anti-NMDAR encephalitis.
Our results suggest that patients with anti-NMDAR encephalitis may exhibit both regional CBF abnormalities and deficits in CBF connectivity, which may underlie the clinical symptoms of anti-NMDAR encephalitis.
本研究旨在探讨抗 N-甲基-D-天冬氨酸受体（anti-NMDAR）脑炎患者静息态脑血流（CBF）连接改变。
对 23 例处于疾病高峰期的抗 NMDAR 脑炎患者和 32 名健康对照者进行三维伪连续动脉自旋标记（pcASL）成像，以测量静息状态 CBF。对 CBF 进行归一化以减少个体间的变异。比较两组之间的 CBF，评估 CBF 改变与临床参数的相关性。还比较了两组之间特定脑区 CBF 连接的差异。
与健康对照组相比，抗 NMDAR 脑炎患者的左侧岛叶（L_insula）、左侧颞上回（L_STL）、左侧海马、左侧苍白球、双侧壳核（Bi_putamen）和双侧尾状核（Bi_caudate）的 CBF 增加，双侧楔前叶（Bi_Pc）和双侧枕叶（Bi_OL）的 CBF 减少（P<0.05，FEW 校正）。与健康对照组相比，抗 NMDAR 脑炎患者的 Bi_Pc、Bi_OL 与 L_TL、L_insula 之间的负 CBF 连接增加（P<0.05，FEW 校正）。有行为改变的抗 NMDAR 脑炎患者的 L_insula 区 CBF 升高，R_Pc、Bi_calcarine、Bi_cuneus 和 Bi_lingual 区 CBF 降低，与无行为改变的患者和健康对照组相比。ROC 曲线显示 L_insula 和 R_Pc、Bi_calcarine、Bi_cuneus 和 Bi_lingual 的 CBF 改变可作为抗 NMDAR 脑炎患者行为改变的预测因子。
我们的研究结果表明，抗 NMDAR 脑炎患者可能存在局部 CBF 异常和 CBF 连接缺陷，这可能是抗 NMDAR 脑炎临床症状的基础。
