Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2022 Jul-Aug;41(4):247-257. doi: 10.1016/j.remnie.2022.05.003. Epub 2022 Jun 11.
Autoimmune encephalitis are brain inflammatory processes that are classified into two main groups according to the underlying pathogenic mechanism: antibodies to intracellular antigens (paraneoplastic) and antibodies to extracellular or neuronal surface antigens. The clinical manifestations of autoimmune encephalitis are very varied and non-specific. Complementary tests included in its clinical diagnosis include determination of antibodies in serum or cerebrospinal fluid and magnetic resonance imaging (MRI). MRI may show characteristic patterns such as mesial temporal involvement, although in some cases it may be normal or non-specific. 18F-Fluorodeoxyglucose PET/CT (18F-FDG PET/CT) imaging may be helpful in cases of paraneoplastic autoimmune encephalitis to find the primary tumor. In autoimmune encephalitis mediated by antibodies to extracellular antigens, 18F-FDG PET/CT shows distinctive patterns that can aid clinical diagnosis. This continuing education aims to present in a clear and easy-to-understand way, the clinical features of autoimmune encephalitis, the difficulties in clinical diagnosis and the patterns seen on MRI and 18F-FDG PET/CT.
自身免疫性脑炎是一种脑部炎症性疾病,根据潜在的发病机制可分为两类:针对细胞内抗原的抗体(副肿瘤性)和针对细胞外或神经元表面抗原的抗体。自身免疫性脑炎的临床表现非常多样化且无特异性。其临床诊断中包括的辅助检查包括血清或脑脊液中抗体的测定以及磁共振成像(MRI)。MRI 可能显示出特征性的模式,如内侧颞叶受累,尽管在某些情况下可能正常或无特异性。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18F-FDG PET/CT)成像可能有助于发现副肿瘤性自身免疫性脑炎中的原发性肿瘤。在由针对细胞外抗原的抗体介导的自身免疫性脑炎中,18F-FDG PET/CT 显示出独特的模式,可辅助临床诊断。本继续教育旨在以清晰易懂的方式介绍自身免疫性脑炎的临床特征、临床诊断中的难点以及 MRI 和 18F-FDG PET/CT 上的表现。