Shao Xiali, Fan Siyuan, Luo Huan, Wong Ting Yat, Zhang Weihong, Guan Hongzhi, Qiu Anqi
Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
Front Neurol. 2021 Jan 12;11:618109. doi: 10.3389/fneur.2020.618109. eCollection 2020.
To characterize the magnetic resonance imaging (MRI) features of anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis and explore their clinical relevance. Patients with anti-LGI1 encephalitis who underwent MRI at our center were included in this study. Baseline and follow-up MRI characteristics were evaluated, and relationships between lesion location and clinical symptoms were analyzed. The extent of signal abnormalities within the lesion overlap region was measured and correlated with modified Rankin Scale scores and serum antibody titer. Seventy-six patients were enrolled, of which 57 (75%) were classified as MR positive. Brain lesions were located in medial temporal lobe (MTL) (89%) and basal ganglia (BG) (28%). Hippocampus and amygdala were lesion hubs with more than 50% lesion overlap. BG lesions were found in 30% of patients with faciobrachial dystonic seizure (FBDS) and only 7% of patients without FBDS ( = 0.013). Meanwhile, MTL lesions were more commonly observed in patients with memory impairment (70 vs. 0%, = 0.017). MRI features included hyperintensity and edema at baseline, as well as hypointensity and atrophy at follow-up. Correlations between signal intensity of lesion hubs (including hippocampus and amygdala) and modified Rankin Scale scores were found on T2 ( = 0.414, < 0.001) and diffusion-weighted imaging ( = 0.456, < 0.001). MTL and BG are two important structures affected by anti-LGI1 encephalitis, and they are associated with distinctive symptoms. Our study provided evidence from Chinese patients that BG lesions are more commonly observed in patients with FBDS, potentially suggesting BG localization. Furthermore, in addition to supporting diagnosis, MRI has the potential to quantify disease severity.
旨在描述抗富含亮氨酸胶质瘤失活1（LGI1）脑炎的磁共振成像（MRI）特征，并探讨其临床相关性。本研究纳入了在我院接受MRI检查的抗LGI1脑炎患者。评估了基线和随访时的MRI特征，并分析了病变部位与临床症状之间的关系。测量了病变重叠区域内信号异常的范围，并将其与改良Rankin量表评分和血清抗体滴度相关联。共纳入76例患者，其中57例（75%）MRI呈阳性。脑病变位于内侧颞叶（MTL）（89%）和基底节（BG）（28%）。海马和杏仁核是病变中心，病变重叠率超过50%。30%的面臂肌张力障碍性癫痫（FBDS）患者发现有BG病变，而无FBDS患者中仅7%有BG病变（P = 0.013）。同时，记忆障碍患者中MTL病变更为常见（70%对0%，P = 0.017）。MRI特征在基线时包括高信号和水肿，随访时包括低信号和萎缩。在T2加权像（r = 0.414，P < 0.001）和扩散加权成像（r = 0.456，P < 0.001）上发现病变中心（包括海马和杏仁核）的信号强度与改良Rankin量表评分之间存在相关性。MTL和BG是受抗LGI1脑炎影响的两个重要结构，且它们与不同的症状相关。我们的研究为中国患者提供了证据，表明FBDS患者中更常见BG病变，这可能提示BG定位。此外，MRI除了有助于诊断外，还有量化疾病严重程度的潜力。
